Unequal assistance? A systematic review of demographic representation and outcome differences in exoskeleton studies
系统综述了191篇外骨骼研究，发现样本以年轻男性为主（约78%），缺乏种族/民族和人体测量多样性；中等证据表明女性使用背部支撑外骨骼时躯干伸肌活动减少更大，但其他人口统计效应证据不足。
Occupational exoskeletons are increasingly adopted to mitigate work-related physical demands, yet demographic variability in effectiveness remains unclear. This systematic review evaluated demographic reporting in arm- and back-support exoskeleton (ASE/BSE) studies and synthesized evidence on demographic-related outcome differences in response to exoskeleton-use. A total of 191 articles (2019-2024) were analyzed for age, sex, race/ethnicity, anthropometry, device type, and setting. Twenty-five studies incorporated demographic variables in statistical analysis; 24 enabled a best-evidence synthesis of sex-specific effects on muscle activity, kinematics, and subjective responses. Quality was appraised using a modified Downs and Black tool. Most studies were laboratory-based with passive devices, and predominantly young male (∼78%) participants; none reported race/ethnicity, and anthropometric diversity was limited. While methodological quality was generally high, sample representativeness and justification were often lacking. Moderate evidence indicated larger reductions in trunk extensor activity for females using BSEs, while evidence for other demographic effects was insufficient. The limited demographic inclusivity of exoskeleton research limits generalizability. Future research should prioritize diverse recruitment and explore how demographic factors influence device efficacy to ensure equitable design and implementation.