Academic Journal
Unequal assistance? A systematic review of demographic representation and outcome differences in exoskeleton studies.
| Title: | Unequal assistance? A systematic review of demographic representation and outcome differences in exoskeleton studies. |
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| Authors: | Kazemi Z; Department of Industrial Engineering, Clemson University, Clemson, SC, USA., Park J; Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA., Srinivasan D; Department of Industrial Engineering, Clemson University, Clemson, SC, USA. Electronic address: sriniv5@clemson.edu. |
| Source: | Applied ergonomics [Appl Ergon] 2026 Nov; Vol. 137, pp. 104808. Date of Electronic Publication: 2026 May 11. |
| Publication Type: | Journal Article; Systematic Review; Review |
| Language: | English |
| Journal Info: | Publisher: Butterworth-Heinemann Country of Publication: England NLM ID: 0261412 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-9126 (Electronic) Linking ISSN: 00036870 NLM ISO Abbreviation: Appl Ergon Subsets: MEDLINE |
| Imprint Name(s): | Publication: Oxford : Butterworth-Heinemann Original Publication: London. |
| MeSH Terms: | Exoskeleton Device* , Demography*, Humans ; Female ; Male ; Biomechanical Phenomena ; Sex Factors |
| Abstract: | Occupational exoskeletons are increasingly adopted to mitigate work-related physical demands, yet demographic variability in effectiveness remains unclear. This systematic review evaluated demographic reporting in arm- and back-support exoskeleton (ASE/BSE) studies and synthesized evidence on demographic-related outcome differences in response to exoskeleton-use. A total of 191 articles (2019-2024) were analyzed for age, sex, race/ethnicity, anthropometry, device type, and setting. Twenty-five studies incorporated demographic variables in statistical analysis; 24 enabled a best-evidence synthesis of sex-specific effects on muscle activity, kinematics, and subjective responses. Quality was appraised using a modified Downs and Black tool. Most studies were laboratory-based with passive devices, and predominantly young male (∼78%) participants; none reported race/ethnicity, and anthropometric diversity was limited. While methodological quality was generally high, sample representativeness and justification were often lacking. Moderate evidence indicated larger reductions in trunk extensor activity for females using BSEs, while evidence for other demographic effects was insufficient. The limited demographic inclusivity of exoskeleton research limits generalizability. Future research should prioritize diverse recruitment and explore how demographic factors influence device efficacy to ensure equitable design and implementation. (Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| Competing Interests: | Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Diversity; Exoskeleton ethics; Inclusion; Occupational intervention; Wearable robotics |
| Entry Date(s): | Date Created: 20260511 Date Completed: 20260609 Latest Revision: 20260611 |
| Update Code: | 20260611 |
| DOI: | 10.1016/j.apergo.2026.104808 |
| PMID: | 42114441 |
| Database: | MEDLINE |
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