Advances in Wearable Sit-to-stand Exoskeleton Designs: A Systematic Review and Meta-analysis of Assistive Performance

Sit-to-stand (STS) transitions are mechanically demanding yet essential for independent function, particularly for older adults and individuals with neuromuscular impairments. Wearable STS devices are body-worn assistive systems, including rigid exoskeletons and soft exosuits, designed to reduce muscular effort during STS transitions. However, existing reviews provide limited quantitative evidence on their assistive efficacy, leaving the design characteristics underlying effective STS assistance underexplored. This systematic review and meta-analysis synthesised 54 system designs published between 2010 and 2025, combining qualitative design synthesis with electromyography (EMG)-based quantitative analysis to examine associations between hardware configurations and muscle unloading. Across 35 effect-size observations, wearable STS systems achieved an overall EMG reduction of 20.79% ( p < 0.01), with powered–rigid systems showing a reduction of 37.27%. Within powered-rigid systems, the stand-up phase demonstrated significantly lower muscle unloading than the overall STS cycle ( p < 0.01), whereas no significant difference was observed between sit-down and the overall cycle ( p = 0.192). Among the evaluated muscles, relatively large EMG reductions were observed in the vastus intermedius (63.70%) and gluteus maximus (47.80%). Contrary to conventional assumptions, no statistically significant association was found between device weight and assistive efficacy, nor were significant differences detected between unilateral and bilateral configurations, different joint strategies, or healthy and clinical populations (all p > 0.05). The findings support powered–rigid assistance for STS tasks and indicate that effective muscle unloading may be achievable without increasing structural complexity, while highlighting the importance of evaluating stand-up and sit-down separately rather than relying solely on overall STS performance.