Ethical Considerations in The Design and Testing of Back-Support Exoskeletons

Project Summary Low-back pain is the primary cause of disability across the world, and over 80% of workplace injuries also occur to the lower back. Wearable robotic technologies, such as back-support exoskeletons (BSE), provide on-body assistance to support and assist the trunk. BSEs are rapidly emerging as a potential intervention to reduce the

risk of occupational musculoskeletal disorders. However, user expectations for intimate body-worn devices such as exoskeletons are likely to vary significantly across diverse user-groups representing different sex, age, and racial characteristics. Current design/testing approaches that do not include diverse user perspectives in these

early stages of design and development of health interventions such as wearable robotics technologies can lead to ethical challenges in equitable accessibility and technology acceptance. The ethical question addressed in this proposal is whether user perceptions, technology acceptance, and health effects of exoskeletons

significantly differ across race, as this is currently undocumented in the literature. Our hypothesis is that important race related differences among men and women in physical characteristics like anthropometry and strength, and psychosocial factors influencing technology adoption, are likely to produce differences in user-acceptance and

health benefits of BSEs. We postulate that limited participant selection/representation in current exoskeleton study designs is thus a critical ethical concern that may lead to health disparities if unaddressed. A repeated-measures mixed-methods study, with a total of 80 participants representing men and women of

different racial groups, is proposed. Participants will trial two different BSEs and complete a standardized battery of tasks. Our first specific aim is to document and analyze user-preferences and health effects of BSEs for different racial groups. We will characterize race-related differences in physical design preferences, device

usability, opinions about BSE usefulness, and physical, psychological, and socio-cultural factors promoting/inhibiting BSE use. We will also quantify racial differences in health effects of BSEs using biomechanical measures of device effectiveness in trunk (primary) and hip/knee (secondary) body regions. Our

second specific aim is to explore race-related differences in factors that predict user acceptance of BSEs, using a decision tree analysis to predict exoskeleton acceptance for each racial group. Outcomes from this study will help document the ethical concerns in current exoskeleton design and evaluation

methods. Detailed data on anthropometric fit and user-preferences, evidence of their correlations with the subjective and objective assessments of exoskeleton effectiveness, and feedback from our diverse stakeholder group (advisory board) will be broadly disseminated, to guide future inclusive design and use of exoskeletons.