Goal: The clinical investigation aims to evaluate the usability of passive exoskeletons, their impact on daily living activities, and the perceived experience of patients with shoulder musculoskeletal disorders. This will be assessed through specific validated questionnaires. Participant Population: The study will enroll 15 participants diagnosed with shoulder musculoskeletal disorders, including rotator cuff tears, adhesive capsulitis, and glenohumeral osteoarthritis. Participants must be employed in physically demanding jobs that require frequent upper limb activity. Main Questions: * How does the integration of passive exoskeletons in daily activities influence usability and functional performance in patients with shoulder musculoskeletal disorders? * To what extent does the use of passive exoskeletons improve the perceived physical effort and quality of life in these patients? * How do patients perceive the comfort and effectiveness of passive exoskeletons during the execution of daily living tasks? Participant Tasks: * Comprehensive shoulder physical examination. Instruction on the proper use of the Paexo passive exoskeleton and customization of its settings. * Execution of workplace-relevant tasks (e.g., lifting, overhead reaching) with and without the exoskeleton. * Evaluation of usability, comfort, and perceived workload using validated scales such as the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and Technology Acceptance Model (TAM).
Shoulder musculoskeletal disorders, such as rotator cuff injuries, adhesive capsulitis, and osteoarthritis, severely impact daily activities due to pain, reduced mobility, and muscle weakness. These conditions limit tasks like lifting, reaching, and even simple activities such as dressing or combing hair, significantly affecting patients' quality of life. While traditional physiotherapy can help, barriers such as limited access and poor adherence to home exercises hinder its effectiveness. This has led to the exploration of new rehabilitation methods, particularly passive exoskeletons. Passive exoskeletons, which use mechanical components like springs to assist movement without external power, have shown potential in reducing muscle strain and supporting tasks requiring arm elevation or lifting. These devices are lightweight, cost-effective, and easy to use, but research on their application for patients with musculoskeletal disorders is limited. This study aims to assess the impact of passive exoskeletons on joint functionality, pain reduction, and performance of activities of daily living (ADLs) in patients with shoulder disorders. It will also evaluate the usability and comfort of the devices using validated questionnaires. Participants will be enrolled from the FPUCBM Unit of Traumatology and Sports Medicine and undergo experimental sessions involving movement tasks with and without the exoskeleton. The study will measure biomechanical effects, pain levels, and user satisfaction, with the ultimate goal of integrating passive exoskeletons into clinical rehabilitation protocols to improve patient outcomes.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
15
The passive exoskeleton is used to assist patients with shoulder musculoskeletal disorders during the performance of activities of daily living (ADLs), such as overhead reaching and lifting. The device helps reduce biomechanical load and muscle strain, providing support for the shoulder joint.
The rehabilitation protocol involves the use of a passive exoskeleton during physical tasks to improve shoulder function and reduce pain. Patients perform specific exercises while wearing the exoskeleton, which is tailored to their individual needs.
The usability of the passive exoskeleton is evaluated using validated scales, such as the System Usability Scale (SUS), to assess its comfort, effectiveness, and overall satisfaction. The assessment also includes patient feedback on the ease of use and perceived benefits of the device during rehabilitation sessions.
Fondazione Policlinico Universitario Campus Bio-Medico
Rome, Italy, Italy
Measurement of Joint Range of Motion (ROM)
Joint Range of Motion (ROM) will be evaluated using stereophotogrammetric systems, and wearable sensors during the execution of movements with and without the exoskeleton
Time frame: a single session up to one year from the subject's enrollment
Pain Assessment using the Visual Analogue Scale (VAS) before and after exoskeleton use
Pain levels will be measured using the Visual Analogue Scale (VAS) before and after exoskeleton use. The VAS provides a quantitative measure of pain intensity, with scores ranging from 0 (no pain) to 10 (worst pain imaginable).
Time frame: a single session up to one year from the subject's enrollment, before and after exoskeleton use
Evaluation of the American Shoulder and Elbow Surgeons Score (ASES)
The ASES score will be used to evaluate shoulder function and pain. This clinical scale assesses both pain and the ability to perform daily activities, with higher scores indicating better function. The total score ranges from 0 to 100, with 0 representing the worst shoulder function and 100 indicating the best possible outcome.
Time frame: a single session up to one year from the subject's enrollment
Evaluation of the Disabilities of the Arm, Shoulder, and Hand Score (DASH)
The DASH questionnaire will assess disability and symptoms in people with upper limb musculoskeletal disorders. Higher scores indicate greater disability. The total score ranges from 0 to 100, with 0 representing no disability and 100 indicating the most severe disability.
Time frame: a single session up to one year from the subject's enrollment
Evaluation of the Short Form Health Survey 36 (SF-36)
The SF-36 will evaluate overall health-related quality of life, covering physical functioning, bodily pain, and general health perceptions. Higher scores indicate better health status. The total score ranges from 0 to 100, with 0 representing the poorest health status and 100 indicating the best possible health status.
Time frame: a single session up to one year from the subject's enrollment
Evaluation of the Shoulder Pain and Disability Index (SPADI)
The SPADI will measure pain and disability associated with shoulder pathology. It consists of two subscales: pain and disability, with higher scores indicating greater impairment. The total score ranges from 0 to 100, with 0 representing no impairment and 100 indicating the most severe impairment.
Time frame: a single session up to one year from the subject's enrollment
Heart Rate evaluation with and without the exoskeleton
Heart rate will be monitored using wearable sensors during tasks performed with and without the exoskeleton. The heart rate will be recorded in beats per minute to evaluate the physiological response to movement efficiency and task execution.
Time frame: a single session up to one year from the subject's enrollment
Electromyographic Activity (EMG) evaluation with and without the exoskeleton
Muscle activity in key shoulder muscles, such as the anterior deltoid and upper trapezius, will be measured using electromyographic (EMG) sensors during movement execution with and without the exoskeleton. The EMG signal will be recorded in millivolts (mV) to quantify the level of muscle activation and the physiological response during movement execution.
Time frame: a single session up to one year from the subject's enrollment
Respiratory Rate Evaluation with and without exoskeleton
Respiratory rate will be monitored using wearable sensors during tasks performed with and without the exoskeleton. The respiratory rate will be recorded in breaths per minute to assess the physiological response and efficiency of breathing during movement execution.
Time frame: A single session up to one year from the subject's enrollment
Evaluation of the Usability Level of the passive exoskeleton using the System Usability Scale (SUS)
The usability of the passive exoskeleton will be assessed using the System Usability Scale (SUS), a standardized questionnaire consisting of ten statements rated on a five-point Likert scale from "Strongly Disagree" to "Strongly Agree." Higher scores indicate better usability.
Time frame: a single session up to one year from the subject's enrollment
Evaluation of the Patient satisfaction with the exoskeleton using the Technology Acceptance Model (TAM)
Patient satisfaction with the exoskeleton will be measured using the Technology Acceptance Model (TAM), which evaluates technology acceptability and usability, focusing on perceived ease of use and usefulness. Scores range from 0 to 100, with higher scores indicating greater acceptance and usability.
Time frame: a single session up to one year from the subject's enrollment
Assessment of Patient-Perceived Workload Using the NASA Task Load Index (NASA-TLX)
Patient workload will be assessed using the NASA Task Load Index (NASA-TLX), which evaluates perceived workload across several dimensions, including mental demand, physical demand, temporal demand, performance, effort, and frustration. Scores range from 0 to 100, with higher scores indicating a greater perceived workload.
Time frame: a single session up to one year from the subject's enrollment
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