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This review examines the factors that facilitate or hinder the implementation of occupational exoskeletons (OEX) in workplaces.

May 9, 2026Journal of Occupational Rehabilitation1 citationsOpen Access

Occupational Exoskeletons as a Technological Solution for Musculoskeletal Disorders: A Systematic Review of Barriers and Facilitators for Sustainable Workplace Integration

DLD.M. van de LaarUniversity Medical Center Groningen HBH. J. BielemanSaxion CRC. S. I. RijndersUniversity of Groningen

Key Points

This review examines the factors that facilitate or hinder the implementation of occupational exoskeletons (OEX) in workplaces.
Systematic search of PubMed and EMBASE to identify relevant studies on OEX
Analysis of 28 studies focusing on user acceptance and barriers during OEX implementation
Assessment of facilitators and barriers categorized by domains such as Device, Person/User, and Work/Job.
Facilitators were reported 128 times and barriers 110 times across studies
Barriers were most associated with Device (36.4%) and Person/User (24.5%) aspects
Short OEX exposure correlated with fewer reported barriers (25 vs. 50).

Abstract

Abstract Purpose Widespread adoption of occupational exoskeletons (OEX) depends on various human and environmental factors. This systematic review aimed to provide an overview of facilitators and barriers influencing OEX implementation, according to users and interest holders. Methods A systematic search of PubMed and EMBASE identified 28 studies on active or passive OEX and opinions on acceptance or rejection during implementation. Results Facilitators were reported slightly more often than barriers (128 times vs. 110 times), with 70 facilitators and 67 barriers identified. Barriers were most frequently associated with the Device domain (36.4%), followed by the Person/User (24.5%), Work/Job (20.0%), Company/Management (14.5%), and Attitude (4.5%) domains. In contrast, facilitators were primarily linked to the Person/User domain (28.1%), closely followed by the Work/Job domain (26.6%) and then the Device (20.3%), Company/Management (18.8%), and Attitude (6.3%) domains. Studies with short OEX exposure reported fewer barriers than those without actual OEX use or experience (25 vs. 50). Overall risk of bias was moderate across study designs, with common issues including limited reporting, small or convenience samples, and the unavoidable absence of blinding in trials. Conclusion OEX adoption is shaped by multiple factors, some acting as both facilitators and barriers. User-centered strategies (such as training and hands-on familiarization) are critical, as short-term exposure appears to reduce barriers. Registration PROSPERO (CRD420251090106).

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