Implementation and practical applicability of passive back-support exoskeletons in occupational settings: A mixed-methods systematic review
Year: 2026
Type: review
Study design: Systematic Review
Abstract: Background Passive back-support exoskeletons have demonstrated biomechanical benefits, yet successful workplace implementation depends on more than biomechanical effectiveness. Evidence regarding implementation, user experience, and sustained occupational use remains fragmented. Objective This mixed-methods systematic review synthesizes qualitative and quantitative evidence to identify the user-centered, task-related, psychosocial, and organizational factors shaping successful workplace implementation. Methods Following PRISMA guidelines and prospective PROSPERO registration (CRD420251049513), five databases (Cochrane Library, Embase, PubMed, PubPsych, and Scopus) were systematically searched. Qualitative and quantitative evidence were synthesized separately, and risk of bias was assessed using established appraisal tools. Results Of 1213 identified records, 25 studies met the inclusion criteria. Quantitative evaluations of applicability- and usability-related as well as user-centered and psychosocial factors ranged from favorable to unfavorable, with variability across outcomes, devices, and tasks. No quantitative indicators of implementation- and organization-related factors were identified. Qualitative findings identified contextual challenges, including task-specific discomfort, social stigmatization, emotional ambivalence, perceived performance pressure, and organizational barriers. Acceptance was shaped by modifiable factors and context-dependent conditions. Integrating both evidence types informed the development of an evidence-informed framework for successful occupational implementation. Conclusions Successful implementation of passive back-support exoskeletons depends on the interaction of organizational, usability-related, and psychosocial factors rather than device characteristics alone. The absence of quantitative implementation- and organization-related indicators highlights an important evidence gap. The proposed framework provides a basis for future implementation strategies, research, and the sustainable integration of passive back-support exoskeletons into occupational practice.
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: hybrid
Estimated APC paid: $2,990
OpenAlex ID: W7225756695