Abstract:

Introduction:
Low back pain at the workplace is one of the main health problems and it implies a high rate of absenteeism in our country. It is a multifactorial health condition. Many preventive strategies are used so far to reduce risk factors at work, being the use of exoskeletons the most innovative. The literature is clear about the benefits of using exoskeletons: reduction of fatigue and lumbar muscular activation; accompanied by a possible improvement in the performance of the worker. However, as studies have shown so far, the exoskeleton not only produces benefits but can cause some drawbacks such as discomfort expressed by users likely to be attenuated or eliminated if it is placed correctly to adapt in the best way to the different areas of adhesion. Simulation is a teaching methodology that can use simple and/or sophisticated technology to educate a specific target audience through guided experience and interactions. When used you can go from decontextualized situations to realistic ones. It is being used by varied industries to train staff as well as a quality assessment tool. The present study is a proposal of a designed course based on simulation on how to place exoskeletons correctly.

Methods:
A new course using a mixed method of regular training (expositional one) and simulation was designed and piloted. Two simulation cases using SimZone models by Rousine were designed and validated by expert consensus. The designed course consists of a four stages course:
(i) theoretical basics of exoskeleton (functioning, uses, types, benefits…);
(ii) theoretical and training on basics of placing the exoskeleton;
(iii) simulation 1 on simzone 0 aiming to transfer the knowledge into practice “how to correctly place and take off the exoskeleton and
(iv) simulation 2 on simzone 1 to apply the former situation into the workplace.

Also, a guide for teachers, simulation instructors, and a scenario with exoskeletons was developed. The guide also included the checklists to assess the procedure and give workers feedback during the actions and a satisfaction questionnaire to gather information about the course. Participation was voluntary and the pilot study was held in the Master's degree in Simulation Methodology Master’s degree of the University of Vic-University of Central Catalonia.

Results:
The experts conclude that the guide created for the cases and the template assessment were useful and achievable. The pilot study with a sample of 6 participants allows assessing the viability of the curse purpose. Participants in the pilot were enthusiastic about the gained experiences using simulation. At the same time, the cases were proven to work for their purpose. The two-hour activity was subsequently piloted two times during the second term of 2019-2020 and review by experts on 4 different occasions. A total of 6 experts (5 in simulation and 1 in simulation and ergonomics) and 7 students participated. Moreover, participants agreed that the simulation helped them understand how to properly place the exoskeleton and require specific and guided training.

Conclusion:
Our exploratory results show that simulation methodology in simzones 0 and 1 is useful to explore and create awareness on how to properly use exoskeletons. The approach stimulates personal and emotional involvement, as well as reflection. The pedagogical efficacy remains to be evaluated with larger samples and pre and post-intervention assessments in the workplace.

Keywords:

Low Back Pain, Exoskeleton device, Ergonomics, Simulation Training/methods, Logistics, Lifting, Workplace, Occupational Health, Prevention.