Long-term availability of powered exoskeleton for ambulation in domestic context: A cross-sectional study to assess safety, usage pattern, and satisfaction after long-term use.

STUDY

DESIGN

Cross-sectional study.

OBJECTIVE

To quantify the safety, usage pattern, and satisfaction of seven subjects with paraplegia after prolonged home use of a commercial powered overground exoskeleton.

SETTING

Centro Protesi Inail, the prosthetic centre of the Italian workers' compensation authority.

METHODS

The participants were recalled for a single-day assessment. Five domains were investigated: i.

SAFETY: occurrences of adverse events. ii. Active use, usability, and satisfaction: Number of gait steps and stair steps with exoskeleton, System Usability Scale (SUS), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST). iii. Health status and independence: Short Form-36 (SF-36), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder Scale (GAD-7), VO2 consumption associated to a sub-maximal arm crank ergometer test, Modified Ashworth Scale (MAS), Jobe's test and Speed's test, Spinal Cord Injury Measure (SCIM). iv. Perceived benefits: Self-perceived pain severity (VAS scale), Self-perceived bowel and bladder management (5-Likert scale). v. Performance: 6 min Walking Test (6MWT), 10 Meters Walking Test (10MWT).

RESULTS

Most recruited subjects were able to use the exoskeleton actively and safely throughout the observation period, experiencing an overall improvement across all domains of investigation. In one case, the ambulation time was lower due to the unavailability of the caregiver.

CONCLUSIONS

Home supply of powered exoskeleton for ambulation could be part of a rehabilitation program to support individuals with paraplegia in their daily life. However, the presence of a qualified caregiver emerged as dominant factor for technology abandonment.