Soft Active Back Exosuit to Reduce Workplace Back Pain

Study Overview
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Brief Summary
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The goal of this clinical trial is to determine if a wearable back exosuit can make it safer and easier for workers who bend, lift, and lower objects in an industrial setting. Many studies have shown that wearable back exoskeletons or exosuits can provide helpful forces making a person's back muscles work less. It is believed that exosuits can lower a person's level of workplace effort and fatigue, making it less likely for them to have back pain at work. Back exosuits could be a solution to make a job easier, but how well they work in the real-world over a long period of time is unclear. The investigators want to know if workers who wear a back exosuit during the workday will have lower rates of lower back pain or injury than those who are not wearing a back exosuit. The investigators also want to know how well exosuit technology integrates into the workplace (for example, how this technology improves or hinders job performance). Participants will be randomized into an exosuit group or control group. Participants in the exosuit group will be given a back exosuit that they can use as much as they want at work. All participants will complete surveys monthly. Researchers will compare the exosuit group to the control group to see if using a back exosuit in a workplace can reduce a person's risk and impact of low back injury or pain. The investigators also want to see if a back exosuit impacts job productivity and if participants find the exosuit becomes useful or bothersome over time.

Official Title
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Efficacy of Soft Active Back Exosuit to Reduce the Risk of Occupational Low Back Pain and Injuries

Conditions
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Low Back Pain, Musculoskeletal Pain, Low Back Injury

Intervention / Treatment
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* Device: Back Exosuit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-65 years old Works as a full-time (>35 hours/ week) employee for our Industrial Partner Regularly bends, lifts, or lowers objects below hip height >50% of their working day for multiple periods lasting more than 1 hour without sitting Can read and speak in English Has internet access Has completed an Exosuit Shift Demonstration Thigh circumference is > 19 and < 32 Back length (Neck to Iliac Crest) is >18 Exclusion Criteria: Temporary workers not directly employed by our Industrial Partner Diagnosed or self-reported sensory motor disorders (stroke, Parkinson's disease, ALS, multiple sclerosis, spinal cord injury, etc.) Use of a pacemaker or other powered, implanted medical devices Medical condition that would make the participant likely to break bones (i.e., osteoporosis or osteopenia) Spinal fracture in the past 2 years Spinal surgery at multiple vertebral levels in the participant's lifetime, including vertebroplasty but excluding injections, such as steroids, nerve blockers, etc. Sought medical care for spinal surgery at a single vertebral level in the past 2 years, including vertebroplasty but excluding injections, such as steroids, nerve blockers, etc. Current malignant cancer Currently pregnant Skin issues / sensitivity that an exosuit could exacerbate (e.g., thin skin, sensitive skin, easy rashing, easy bruising or skin conditions, Epidermolysis Bullosa, etc.) A current episode of upper back or neck pain, requiring modified duties at work A recent episode of LBP resulting in pain (sharp, shooting, burning), radiating below one or both legs (past mid-thigh) in the last 3 months (e.g., sciatica) A recent episode of back pain resulting in time off work, modified duties, or seeking medical attention in the last 3 months

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants will be randomized into an exosuit or a control group using a 2:1 stratified ratio. Strata will be developed based on workplace, lifetime back pain history, and job tenure (>90 days). Participants in each group will complete regular workplace tasks while wearing or not wearing a back exosuit respectively.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Exosuit<br>Exosuit refers to a soft active back exosuit. Participants in the exosuit arm will be fitted to a personal back exosuit device. Participants will be trained on how to use the device (retrieval, donning, powering up, mode switching, and doffing). Participants will be instructed to use the device at work, emphasizing they wear it whenever it seems practical (e.g. lifting) for as long as it remains comfortable. Associates from Verve Motion will check in with exosuit participants to address comfort issues and help participants integrate the exosuit into their workday. | Device: Back Exosuit<br>* The back exosuit is a soft wearable robotic suit designed to improve a wearer physiology, kinetics, kinematics to reduce the possibility of injury. The back exosuit is primarily composed of textiles that wrap around an individual's shoulder (backpack) and thighs (thigh wrap) to serve as anchor points. An actuating element attaches to those anchor elements to provide assistive forces while the user performs a physical activity. The soft wearable robot integrates sensing components to be able to detect user biomechanics and device function and actuating elements via algorithms that command the actuation based on users' intent. To encourage usability, the device is easy to don and intuitive to use. This back exosuit has demonstrated significant reductions in back (18%), hip (11%) and knee (22%) extensor muscle activity during a 1-hour workplace simulation task when compared to lifting without a suit.<br>* Other names: Verve SafeLift Suit;|
| No Intervention: Control<br>Control participants will not be assigned a back exosuit. Participants in the control group will perform workplace tasks as normal, completing study surveys at baseline and monthly for 4 months that are identical to exosuit group. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Level of work-interfering low back pain (changes over time and differences between groups) | The Cornell Musculoskeletal Discomfort Questionnaire (MDQ) is a composite score that considers the frequency, severity, and work interference of body aches and pains. The back pain score will be evaluated between the 2 groups at 5 time points. | Baseline, Months (1-4) | 
| Self-reported incidence of low back pain (changes over time and differences between groups) | The definition of low back pain highly influences incidence rates. Low back pain incidence will be identified as a meaningful change (answering in the affirmative with a previous negative response) to the following self-report measures: Reporting a Cornell MDQ low back pain score >13.5 Answering yes to: In the past month, have you felt low back pain that caused you to change your activities for at least 3 days (i.e., have you noticed avoiding certain movements or moving differently than you normally do)? Answering yes to: In the past month, have you seen a health care provider for low back pain (i.e., a doctor, nurse, physical therapist, chiropractor, or another health care provider)? Answering yes to: In the past month, have you taken time off work for low back pain? | Baseline, Months (1-4) | 
| Workplace reported incidence of a low back injury (differences between groups) | Our industrial partner will record if a participant reports a workplace low back injury. The rates of reported events will be measured in each group. | Continuously from randomization to 4 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-reported severity of low back pain (changes over time and differences between groups) | Back pain severity refers to the level of intensity and the occupational or medical consequence of back pain. The following self-report measures will determine these values. Intensity: Numerical rating scale of back pain (average and worse imaginable) Medical consequence: Frequency of using over the counter and prescription medication for LBP Frequency of seeing various types of medical providers for LBP Occupational Consequences: Number of days off following LBP Number of days on modified work duties following LBP | Baseline, Months (1-4) | 
| Workplace reported severity of low back pain (differences between groups) | Our industrial partner will record the severity of a low back injury (LBI) in the following ways: Number of insurance claims for LBI Number of days off work following a LBI Number of days of reduced work productivity (days on modified duties) following a LBI Medical payouts for LBI claims | Continuously from randomization to 4 months | 
| Self-reported intensity of global pain (changes over time and differences between groups) | Beyond low back pain participants will report on total body discomfort and the intensity of discomfort at various joints: Total body discomfort and interference will be evaluated using the Pain, Enjoyment of Lift and General Activity (PEG) 3 Scale. | Baseline, Months (1-4) | 
| Self-reported intensity of localized body discomfort (changes over time and differences between groups) | The Cornell MSD scale (reference in outcome 1) will also be evaluated at every other body part (for example, ankles, knees, hip, upper back, neck, shoulders, elbows, and wrists). | Baseline, Months (1-4) | 
| Self-reported perception of physical fatigue and effort (changes over time and differences between groups) | A modified BORG CR-10 scale has been developed with questions focusing on: Perceived level of back exertion Perceived level of total body exertion Perceived level of workplace fatigue | Baseline, Months (1-4) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Exoskeleton, Ergonomics, Wearable Robotics, Exosuit, Occupational Injury