Exploring Placebo and Nocebo Effects in Occupational Exoskeleton Use: A SCED Study in Physically Demanding Jobs

In the Netherlands, 41% of workers report experiencing physical overexertion, presumed to contribute to occurrence or persistence of musculoskeletal disorders (MSDs) such as non-specific back, neck, and shoulder disorders. These disorders, often associated with occupational overexertion, repetitive motions, and awkward positions, accounted for 30% of private sector injury and illness cases requiring days away from work in 2018. This imposes significant personal, healthcare, financial and social burdens, which are expected to increase as the retirement age rises, placing older workers at greater risk of health issues and highlighting the importance of job retention.

Technical interventions, such as occupational exoskeletons (OEX), have the potential to reduce the physical workload and, consequently, the risk of MSDs. OEX are wearable devices that support workers during work, aiming to reduce biomechanical risk factors. Passive OEX, which use elements like springs and dampers to store and release energy, have been shown to decrease spinal loading and affect metabolic efficiency during tasks.

However, the adoption of OEX depends on consistent and appropriate use by workers, which is hindered by challenges in design, safety, and comfort. Incorporating end-user feedback is essential for successful implementation, however, this is studied scarcely in vivo. The potential placebo and nocebo effects of OEX have not been studied yet, although plausible to exist. By assessing short-term bio-psycho-social aspects among novice users in real work, this study seeks to enhance the understanding of OEX effects and side effects, as well as the influence of placebo and nocebo. These findings will fill existing knowledge gaps, clarify the innovation status of OEX, and support the retention of workers at risk of leaving the labour market prematurely, particularly those with chronic MSDs and those in physically demanding jobs. The primary aim is to investigate the placebo and nocebo effects of using passive OEX during work. The secondary aim is to provide a comprehensive overview of end-user experiences of OEX wear in novice users, as well as explore the differences in sex and age on device acceptance.