Background: Work-related musculoskeletal disorders at the elbow are a common health problem, which highly impacts workers’ well-being and performance. Besides existing qualitative information, there is a clear lack of quantitative information of physical risk factors associated with specific disorders at the elbow (SDEs). Objective: To provide evidence-based quantitative measures of physical risk factors associated with SDEs. Methods: Studies were searched from 2007 to 2017 in Medline, EMBASE, and Cochrane Work. The identified risk factors were grouped in main- and sub-categories of exposure using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework for rating evidence. Results: 133 different risk-factor specifications were identified in 10/524 articles and were grouped into 5 main- and 16 sub-categories of exposure. The risk factors were significantly associated with lateral epicondylitis, medial epicondylitis, or ulnar neuropathy. Significant risk factors such as wrist angular velocity (5°/s, with increasing prevalence ratio of 0.10%/(°/s), or forearm supination (≥45° and ≥5% of time combined with forceful lifting) were found. Conclusions: This review delivers a categorization of work-related physical risk-factor specifications for SDEs with a special focus on quantitative measures, ranked for evidence. These results may build the base for developing risk assessment methods and prospective preventive measures.

Objective: To evaluate using a back exoskeleton in a simulated sorting task in a static forward bent trunk posture on muscle activity, posture, and heart rate (HR). Background: Potentials of exoskeletons for reducing musculoskeletal demands in work tasks need to be clarified. Methods: Thirty-six healthy males performed the sorting task in 40°-forward bent static trunk posture for 90 seconds, in three trunk orientations, with and without exoskeleton. Muscle activity of the erector spinae (ES), biceps femoris (BF), trapezius descendens (TD), rectus abdominis (RA), vastus laterals (VL), and gastrocnemius medialis was recorded using surface electromyography normalized to a submaximal or maximal reference electrical activity (%RVE (reference voluntary electrical activity)/%MVE). Spine and lower limb postures were assessed by gravimetric position sensors, and HR by electrocardiography. Results: Using the exoskeleton resulted in decreased BF muscle activity [−8.12%RVE], and minor changes in ES [−1.29%MVE], RA [−0.28%RVE], VL [−0.49%RVE], and TD [+1.13%RVE] muscle activity. Hip and knee flexion increased [+8.1°; +6.7°]. Heart rate decreased by 2.1 bpm. Trunk orientation had an influence on BF muscle activity. Conclusion: Using the back exoskeleton in a short sorting task with static trunk posture mainly reduced hip extensor muscle activity and changed lower limb but not spine posture. Implications of using a back exoskeleton for workers’ musculoskeletal health need further clarification. Application: The detected changes by using the Laevo® illustrate the need for further investigation prior to practical recommendations of using exoskeletons in the field. Investigating various work scenarios in different kind of workers and long-term applications would be important elements.

Objective: To investigate postural control related to a lower limb exoskeleton (Chairless Chair) when (a) reaching for a working tool, and (b) an external perturbation occurs. Background: Lower limb exoskeletons aiming to reduce physical load associated with prolonged standing may impair workers’ postural control and increase the risk of falling. Method: Forty-five males were reaching for an object (3-kg dumbbell) at the lateral end of their reaching area without the exoskeleton in upright standing (STAND) and with the exoskeleton at a high (EXO_HIGH.SEAT) and low sitting position (EXO_LOW.SEAT). The task was performed with the object placed in three different angles (120°, 150°, and 180°) in the transversal plane. The minimum absolute static postural stability (SS_ABS.MIN) as the shortest distance (mm) of the center of pressure to the base of support border was measured (zero indicates risk of falling). Additionally, eight subjects were standing without the exoskeleton or sitting on it (EXO_HIGH.SEAT and EXO_LOW.SEAT) while being pulled backward. The tilting moment when subjects lost their balance was assessed. Results: SS_ABS.MIN was lower when using the exoskeleton ( p < .05) but still about 17 mm. The location of the object to be reached had no influence. Tilting moments of less than 30 nm were sufficient to let people fall backward when sitting on the exoskeleton (50 nm for STAND). Conclusion: Impairments in postural control by the exoskeleton may not be relevant when reaching laterally for objects up to 3 kg. When an external perturbation occurs, the risk of falling may be much higher; irrespective of factors like uneven or slippery flooring. Application: The risk of falling using the exoskeleton seems to be low when reaching laterally for an object of up to 3 kg. In situations where, for example, a collision with coworkers is likely, this exoskeleton is not recommended.

Purpose: To evaluate the effect of an exercise therapy concept (the Tübingen exercise therapy approach THüKo) for increasing hip muscle strength (HMS) in patients with hip osteoarthritis (OA), and to investigate whether patients do adhere to the intervention and if there are any adverse events related to the intervention. Methods: A total of 210 hip OA patients (89 females, 121 males) were randomized into a 12-week exercise intervention (THüKo) including group sessions (1/week) and home exercising (2/week), a placebo ultrasound group (1/week) or a control group (no treatment). HMS was measured as isometric peak torque of hip abduction, adduction, flexion, and extension. Adherence to exercise and safety aspects were monitored as additional outcomes. Results: Baseline adjusted post intervention HMS of the THüKo group were higher compared to the control group (differences of 0.11–0.27 Nm/kg, p < 0.01) and to the placebo ultrasound group (differences of 0.09–0.19 Nm/kg, p < 0.01). Adherence to exercise was high (about 90%). No subject had to refuse from training because of an exercise related adverse event and exercise related pain was only of intermittent nature without sustainable adverse effects. Conclusions: The Tübingen exercise therapy approach has shown to have a significant positive effect on HMS. Its implementation has shown to be feasible and safe according to the percentage of exercise participation and the absence of sustainable adverse events.