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

> **NIH NIH R21** · CLEMSON UNIVERSITY · 2024 · $377,809

## Abstract

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.

## Key facts

- **NIH application ID:** 11015530
- **Project number:** 1R21EB036439-01
- **Recipient organization:** CLEMSON UNIVERSITY
- **Principal Investigator:** Divya Srinivasan
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $377,809
- **Award type:** 1
- **Project period:** 2024-09-05 → 2026-09-04

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11015530

## Citation

> US National Institutes of Health, RePORTER application 11015530, Ethical Considerations in The Design and Testing of Back-Support Exoskeletons (1R21EB036439-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/11015530. Licensed CC0.

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