Ambivalent acceptance of active exoskeletons in long-term care: between perceived task-specific support and practical constraints.

Background: Lower back pain (LBP) is prevalent among nursing staff in long-term care facilities. This condition has been linked to repetitive resident handling, sustained non-neutral postures, and cumulative physical workloads. Despite growing interest in exoskeletons as ergonomic and digital assistive technologies (DAT), evidence regarding the implementation of active exoskeletons in real-world nursing practice remains limited. Objective: The objective of this exploratory mixed-methods feasibility study was to evaluate the implementation of the HAL® Lumbar Type active exoskeleton in long-term care settings. Specifically, this study explored feasibility, usability, nurses' acceptance, and descriptive pain-related outcomes under real-world conditions. Methods: A non-randomized exploratory mixed-methods feasibility study was conducted in three long-term residential care facilities in Germany. The HAL® Lumbar Type was introduced for use in routine nursing practice during a 90-day intervention period. Objective utilization and adherence data were not systematically recorded. Quantitative outcomes ( Results: The findings suggested a pattern of ambivalent acceptance. Caregivers reported situational support during forward-leaning and transfer-related activities, particularly through perceived postural stabilization. The aggregated unpaired VAS data showed no descriptive group-level reduction in subjective pain, and individual pain trajectories could not be assessed. Some participants had lower ODI scores at follow-up, whereas the SF-8 trajectories were heterogeneous and partially indicated a lower health-related quality of life. Participants described spatial limitations, device weight, thermal discomfort, restricted mobility, and the time required for donning and adjustment as barriers to routine use. Participants reported using the exoskeleton selectively for specific high-load tasks rather than continuously throughout shifts. Conclusion: The active lumbar exoskeleton was perceived to provide task-specific ergonomic or postural support during selected physical care activities. However, participants' accounts suggested that the perceived practical viability of the device and their willingness to use it may be associated with workflow compatibility, ease of use, perceived fit, and organizational conditions. Long-term adoption beyond the intervention period was not assessed. Future advancements in exoskeleton technology should prioritize lightweight designs, customized fits, and seamless integration strategies into dynamic nursing workflows. Larger longitudinal studies with appropriate comparison groups and objective biomechanical measures are needed to determine the clinical effectiveness and further examine implementation conditions in nursing practice.