Functionality and comfort of use of various types of medical exoskeletons in the patients’ subjective judgment

Abstract

Background: Impaired mobility is an increasing global health challenge associated with population aging and the rising prevalence of chronic diseases, leading to lower-limb dysfunction and long-term disability. Wearable lower-limb exoskeleton robots (ERs) have emerged as promising tools for gait rehabilitation; however, evidence regarding user-perceived comfort, safety, and functionality remains limited, particularly from the perspective of experienced users. Materials and methods: A cross-sectional survey was conducted among 59 adult users of medical lower-limb ERs in Poland. A purpose-developed structured questionnaire assessed the subjective perceptions of comfort, functionality, stability, and usability across different ER configurations, including variations in actuation systems, structural design, and human–robot interfaces. Descriptive statistics and nonparametric comparative analyses were applied. Results: The ERs equipped with four actuators were generally perceived as sufficiently functional, with overall ratings ranging from moderate to good. Strap-based interface systems were preferred over in-shoe fastening due to shorter fitting times and improved usability. The ability to abduct the lower limbs in the seated position was identified as a particularly valuable feature. Key limitations included insufficient stability during standing and walking, discomfort related to body-device contact, and restricted adaptability. Users emphasised the need for enhanced motion modes, broader velocity ranges, and improved adjustability. Importantly, a strong demand was expressed for increased safety while maintaining independence from external assistive devices. Conclusions: The user-centred evaluation highlighted critical design priorities for future ER development, particularly in terms of stability, adaptability, and ease of use. Incorporating patient-reported experiences into the design and clinical implementation of ERs may improve comfort, functional outcomes, and user acceptance, thereby enhancing the effectiveness of rehabilitation interventions.