Applied Ergonomics 97 (2021) 103528

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Applied Ergonomics
journal homepage: www.elsevier.com/locate/apergo

Review article

The application of additive manufacturing / 3D printing in ergonomic

aspects of product design: A systematic review
Tjaša Kermavnar a, Alice Shannon b, Leonard W. O’Sullivan a, *
a
School of Design, Confirm Smart Manufacturing Centre and Health Research Institute, University of Limerick, Limerick, Ireland
b
School of Design, University of Limerick, Limerick, Ireland

A R T I C L E I N F O A B S T R A C T

Keywords: Additive Manufacturing (AM) facilitates product personalization and iterative design, which makes it an ideal
3D printing technology for ergonomic product development. In this study, a systematic review was conducted of the liter­
Additive manufacturing ature regarding the use of AM in ergonomic-product design, and methodological aspects of the studies were
Ergonomics
analyzed. A literature search was performed using the keywords “3D print*,” “additive manufacturing,” “ergo­
Human factors
nomic*” and “human factors”. Included were studies reporting the use of AM specifically in ergonomic design of
products/prototypes including the detailing of an ergonomic testing methodology used for evaluation. Forty
studies were identified pertaining to the fields of medicine, assistive technology, wearable technology, hand
tools, testing devices and others. The most commonly used technology was fused deposition modeling with
polylactic acid, but the overall preferred material was acrylonitrile butadiene styrene. Various combinations of
objective/subjective and qualitative/quantitative product evaluation methods were used. Based on the findings,
recommendations were developed to facilitate the choice of most suitable AM technologies and materials for
specific applications in ergonomics.

1. Introduction modifications based on user evaluations of prototypes. As user evalua­

Additive Manufacturing (AM), also known as three-dimensional
printing (3DP) technology, is used to build physical objects from digi­
tal 3D-model data, i.e., Computer-Aided Design (CAD) files, by succes­
sive addition of material (ISO/ASTM 52900:2015). Initially AM was
mainly limited to manufacturing prototypes and was synonymous with
Rapid Prototyping (RP) (Carlström and Wargsjö, 2017), but it is being
progressively used for direct fabrication of end products and compo­
nents, and as such also now known as Rapid Manufacturing (RM)
(Hopkinson et al., 2006).
For ergonomic purposes, AM has been increasingly utilized across
diverse fields related to product/prototype design, including in medi­
cine, development of assistive technologies (AT), wearable technologies
(WT), and physical human-machine interfaces (pHMI). The aim of er­
gonomics is to inform the design of safe, comfortable and efficient
products and tasks, based on the study of human characteristics and
human-machine/environment interactions (HFES, 2020). Thus, the
ergonomics-based development of products is typically an iterative
“design-evaluation-redesign” process comprising several design
tions should be performed on full-size physical prototypes of products
and realized in near-final materials (McDonald et al., 2016), AM is an
ideal technology for product/prototype manufacture for ergonomic
testing, in particular in relation to applications requiring bespoke fit to
humans, and also in relation to iterative testing and redesign.
CAD models for AM can be created using 3D-modeling software, but
also through Reverse Engineering (RE) approaches using different
scanning techniques, e.g., 3D scanning, Computer Tomography (CT)
scanning and Magnetic Resonance Imaging (MRI). RE is especially
useful for the reproduction of organic shapes and objects based on in­
dividual anatomy (Carlström and Wargsjö, 2017), allowing for the
design of highly personalized, custom-made ergonomic products.
Recently, advanced computer techniques such as automatic measure­
ment of anthropometric dimensions, skin deformation, posture change,
virtual fit testing, prediction of contact pressure, or estimation of muscle
force have also been applied to 3D-scan data (Ballester et al.; Dai et al.,
2011; Lee et al., 2018; Lei et al., 2012; Reed et al.).
By enabling users’ involvement in the design process, AM can facil­
itate enhanced User-Centered Design (UCD). Moreover, AM methods are

* Corresponding author.
E-mail address: leonard.osullivan@ul.ie (L.W. O’Sullivan).

https://doi.org/10.1016/j.apergo.2021.103528
Received 9 June 2020; Received in revised form 24 May 2021; Accepted 1 July 2021
Available online 10 July 2021
0003-6870/© 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
T. Kermavnar et al. Applied Ergonomics 97 (2021) 103528

becoming increasingly available at affordable prices due to expiring 2. Method

patents and increasing competition, open-source sites and cloud-based
CAD software, which, together with user-friendly interfaces, enables
non-AM experts to create products easily (Jafri and Ali, 2015). Thus, the
use of AM for custom, on-site production of individualized products is
likely to extend to several areas in the future, assisting the progress of
ergonomic product design.
The International Standard ISO/ASTM 52900:2015 classifies AM
technologies into seven categories: (1) Binder Jetting (BJ); (2) Directed
Energy Deposition (DED); (3) Material Extrusion (ME); (4) Material
Jetting (MJ); (5) Powder Bed Fusion (PBF); (6) Sheet Lamination (SL);
and (7) Vat Photopolymerization (VP). These processes are either
liquid-, solid- or powder-based (Wong and Hernandez, 2012). The cat­
egories and sub-categories of AM processes are presented in Fig. 1.
Factors affecting the choice of AM technology for specific applica­
tions include cost, choice of material, post-processing requirements,
requirements of surface finish and dimensional accuracy, possibility of
sterilization, fabrication speed (layer thickness per unit time), and res­
olution (minimum feature area and minimum layer thickness)
(Imširović and Kumnova, 2017; Lee et al., 2017). The most common AM
processes and their applications are described in Table 1 according to
the currently available data. However, it is of note that specifications
like maximum build volume, fabrication speed, and machine cost, as
well as the materials available for use with the individual technologies
are changing with the development of AM.
Recent developments have introduced 4D printing, an AM technol­
ogy that integrates smart materials that change their shape or physical
properties in a useful manner under the influence of external stimuli.
Examples include enhanced smart nanocomposites, shape memory al­
loys, shape memory polymers, actuators for soft robotics, self-evolving
structures, anti-counterfeiting system, active origami, and controlled
sequential folding (Khoo et al., 2015).
The aim of this work was to perform a systematic review of the
literature regarding the use of AM technologies in ergonomics studies
related to product/prototype design and to develop recommendations
regarding the use of this technology and their materials in the context of
ergonomic product design.
2.1. Literature search and study selection
A systematic literature search was performed on May 6, 2020 using
Scopus and EBSCOhost databases. To identify articles of interest, the
following keywords were used: “3D print*” OR “additive
manufacturing,” AND “ergonomic*” OR “human factors” in the title OR
the abstract. The search was limited to papers in the English language,
and articles from trade publications and magazines were excluded. An
additional search was performed on May 14, 2021 using the same da­
tabases and keywords to update the review with studies published in
2020 and 2021. Based on the abstract and full-text review, results not
reporting on the use of AM specifically in ergonomic design of products
or prototypes were excluded. In addition, it was required that the studies
specifically include the description of the ergonomics-testing method­
ology. Relevant studies referenced in the selected papers were also
included. The search results and study selection criteria are presented in
Fig. 2. Two of the authors (T.K. and A.S.) conducted the study search and
selection based on the pre-agreed criteria outlined above. Both re­
viewers identified the same articles for inclusion.
2.2. Data extraction and synthesis
Data and details were extracted from the selected studies under the
following criteria: (1) field of application, product description, stage of
product development, and ergonomic problem addressed; (2) AM pro­
cedure description, from CAD-model acquisition to 3D printing and post-
processing of the prototypes; (3) digital model analyses and/or testing of
physical prototypes for ergonomics evaluation; and (4) findings and
commentary regarding AM technology use and the outcomes from an
ergonomics perspective.
3. Results
3.1. Product fields of application and problems addressed

Forty relevant papers were identified and analyzed. Regarding the

fields of application, 11 products were in the field of medicine, more
specifically, 7 in surgery (2 patient-specific surgical guides, 3 surgical
instruments, 1 surgical robot, and 1 external fixator), 1 in anesthesiology

Fig. 1. Classification of additive manufacturing technologies with bonding principles and typical materials used, based on standard ISO/ASTM 52900:2015,
Imširović and Kumnova (2017), and Lee et al. (2017). BJ – Binder Jetting, CDLP – Continuous Digital Light Processing, DED – Direct Energy Deposition, DLP – Digital Light
Processing, DMLS - Direct Metal Laser Sintering, DOD – Drop On Demand, EBAM – Electron Beam Additive Manufacturing, EBM – Electron Beam Melting, FFF – Fused
Filament Fabrication, LENS – Laser Engineered Net Shaping, LOM – Laminated Object Manufacturing, ME – Material Extrusion, MJ – Material Jetting, MJF – Multi Jet Fusion,
NPJ – Nanoparticle Jetting, PBF – Powder Bed Fusion, SL – Sheet Lamination, SLA – Stereolithography, SLM – Selective Laser Melting, SLS – Selective Laser Sintering, VP – Vat
Photopolymerization.

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T. Kermavnar et al. Applied Ergonomics 97 (2021) 103528

Table 1
Characteristics of most common AM processes (ordered alphabetically). Based on Imširović and Kumnova (2017), Lee et al. (2017), Low et al. (2017), Wong and
Hernandez (2012), and the information provided on websites by 3Dnatives, 3DSourced, All3DP, AMFG, CompositesWorld, Dassault Systèmes, Formlabs, Hubs, Sculpteo, and
Thomas Publishing Company.
AM Process description Maximum Layer Resolution Fabrication Machine Machine Material examples Example
technology build thickness (elements/ speed examples cost applications
volume (μm) mm3) (mm/h) (Manufacturer) ($)
(mm)

BJ Particles joined together by 4000 × 50–400 1900 12–36 Viridis3D 30,000 to Ceramic, metal, Industrial
selective deposition of 2000 × (Voxeljet) >450,000 glass, sand, applications,
liquid bonding agent on 1000 VX series polymer, silica sand, architectural
thin layers of powdered (EnvisionTEC) stainless steel, models,
material S-Print, M- ceramic beads, packaging, toys,
Print, M-Flex chromite, zircon, figurines
(ExOne) soda lime glass
PartPro350 xBC
(XYZprinting)
DLP Photosensitive liquid 192 × 5–150 N/A 20–36 FabPro 1000 400 to Photopolymers: Highly-detailed
polymer exposed to 120 × 230 (3D Systems) >250,000 ABS-like, prototypes,
projections of light (mainly Typical B9 Core Series rigid PC-like, semi- jewelry,
UV) emitted by a digital desktop: (B9Creations) flexible PE-like, sculptures,
projector (image of the 58 × 32 × D4K Pro, durable PP-like dentistry,
entire layer at once) 127 Perfactory P4K medical devices
solidifies through series
photopolymerization (EnvisionTEC)
ProMaker L
series (Prodways
Tech)
EBM Melting of powder particles 350 × 50–90 211 25 Q10Plus, >250,000 Steel, Al, Ti, Ni- Aircraft,
using high-voltage electron 350 × 380 Q20Plus, alloys aerospace and
laser beam, followed by Spectra H, A2X automotive
recoater adding and (Arcam) industry,
smoothing another powder military, motor
layer sports,
prosthetics
FFF Thermoplastic material 2000 × 50–400 46 50–150 Extreme 1000 100 to ABS, ASA, PA, PC, Simple
extrusion through a 2000 × PRO (Builder) >250,000 PC-ABS, prototypes,
preheated nozzle, and 1500 DF2, DF3, DI1- PC-ISO, PEI, PLA, automotive,
deposition in thin layers Typical 335 (DediBot) PMMA, PPSF, TPU, aerospace,
that bind and fully solidify desktop: F120, F123 wood, carbon, medical and
by cooling on the substrate 200 × Series, Fortus bronze other industries
200 × 200 family
(Stratasys)
PartPro300 xT
(XYZprinting)
MJ Droplets of photopolymer 1000 × 16–32 15,200 4–15 ProJet family 10,000 to Photopolymers: Realistic,
deposited on working 800 × 500 (3D Systems) >250,000 ABS-like, functional
platform are exposed to UV- Objet family rigid PC-like, semi- prototypes/end
light and solidify through (Stratasys) flexible PE-like, products
photopolymerization Polaris, Magnet- durable PP-like
o-Jet, Ares
(Vader)
SLA Photosensitive liquid 2100 × 25–200 3152 7–36 ProX family (3D 400 to Photopolymers: Highly-detailed
polymer exposed to laser 700 × 800 Systems) 500,000 ABS-like, prototypes,
(mainly UV) or free radicals Typical Aria rigid PC-like, semi- jewelry,
solidifies through desktop: (EnvisionTEC) flexible PE-like, sculptures,
photopolymerization 145 × FORM family durable PP-like dentistry,
145 × 175 (Formlabs) medical devices
ProMaker
P1000 series
(Prodways Tech)
SLM Melting of powder particles 500 × 20–50 211 20–105 Formiga P110 >250,000 Steel, Al, Ti, Ni- Aircraft,
using highly energized CO2- 280 × 360 Velocis, EOS P- alloys, PEEK aerospace and
laser beam, followed by family (EOS) automotive
recoater adding and DMP Dental industry,
smoothing another powder family (3D jewelry,
layer Systems) dentistry,
SLM family medical devices
(SLM Solutions)
EP- family
(Shining 3D)
SLS Sintering of powder 700 × 60–150 211 7–68 Formiga P100, 10,000 to PA, PS, PEKK, Industrial 3D
particles using highly 380 × 380 EOS M100 >250,000 acrylic styrene, printing of
energized CO2-laser beam, (EOS) thermoplastic functional
followed by recoater adding ProX SLS 6100 elastomers, prototypes and
and smoothing another (3D Systems) reinforced polymers certain end
powder layer Lisa (Sinterit)
(continued on next page)

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Table 1 (continued )
AM Process description Maximum Layer Resolution Fabrication Machine Machine Material examples Example
technology build thickness (elements/ speed examples cost applications
volume (μm) mm3) (mm/h) (Manufacturer) ($)
(mm)

EP-C5050 products,
(Shining 3D) dentistry

ABS – Acrylonitrile Butadiene Styrene, Al – Aluminum, ASA – Acrylic Styrene Acrylonitrile, BJ – Binder Jetting, DLP – Digital Light Processing, EBM – Electron Beam
Melting, FFF – Fused Filament Fabrication, MJ – Material Jetting, Ni-alloy – Nickel-based alloys, PA – Polyamide (Nylon), PC – Polycarbonate, PC-ABS – Polycarbonate-
Acrylonitrile butadiene styrene blend, PC-ISO – Medical-grade Polycarbonate, PE – Polyethylene, PEI – Polyethylenimine, PEKK – Polyetherketoneketone, PLA –
Polylactic acid, PMMA – Polymethyl Methacrylate, PPSF – Polyphenylsulfone, PS – Polystyrene, SLA – Stereolithography, SLM – Selective Laser Melting, SLS – Selective
Laser Sintering, Ti – Titanium, TPU – Thermoplastic Polyurethane.

Fig. 2. Literature search results and study selection.

(a laryngoscope handle), 1 in oncology (an oral light applicator), 1 in
neonatology (oxygen-therapy prong support), and 1 was a digital-
stethoscope encapsulation. Eleven products were applied to the field
of AT (2 prostheses, 1 orthosis, 5 exoskeleton components, 2 tactile
displays for the visually impaired and 1 hearing aid), 3 to WT (head
mount, earphones, and insoles), 6 to hand tools (1 electronic drawing
pen, 1 explosive ordnance disposal tool, 2 vibration tool handles, 1 saw
handle, and 1 vacuum tool), 4 to ergonomics-testing devices (foot shells
for pressure-sensitivity evaluation, a thermal manikin head, a trajectory-
tracing platform for augmented reality, physical components of virtual
workspace for mixed reality), 1 arm support, 1 translational/rotatory
control element, 1 device for mounting tissue sections, 1 bottle lid, and 1
personalized parametric chair.
In general, two main ergonomic problems were addressed: 1. poor
dimensional fit or kinematic incompatibility of wearable devices due to
inter-individual body size, shape or biomechanical variability, that
causes discomfort and potential tissue damage; and 2. musculoskeletal
disorders due to non-neutral joint positions or excessive muscle force
resulting in discomfort, pain and early fatigue, especially of the upper
limbs and neck. Other field-specific uses addressed: 3. cumbersome use
of tools due to their shape or dimensions that limit the view or freedom
of manipulation; 4. exposure of tissues to excessive pressure, vibration
or radiation; 5. highly skill-dependent accuracy and success rate of
medical procedures; and 6. high weight, difficulty donning and doffing,
and poor aesthetics of wearable devices.
3.2. Additive manufacturing procedures
3.2.1. Digital models
Digital models were generated directly with CAD software in 24
studies. The most commonly used software was SolidWorks (8), fol­
lowed by Rhinoceros (4) and Catia V5 (3). Eighteen studies did not

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Fig. 3. Types of AM processes used in studies reviewed. BJ – Binder Jetting, DED – Direct Energy Deposition, DMLS - Direct Metal Laser Sintering, EBM – Electron Beam
Melting, FFF – Fused Filament Fabrication, LENS – Laser Engineered Net Shaping, LOM – Laminated Object Manufacturing, ME – Material Extrusion, MJ – Material Jetting,
PBF – Powder Bed Fusion, SL – Sheet Lamination, SLA – Stereolithography, SLM – Selective Laser Melting, SLS – Selective Laser Sintering, VP – Vat Photopolymerization.

specify the software used. 3.2.2. 3D printing and post-processing

In 13 studies, digital models were acquired using scanning tech­
niques. For 3 applications in the medical field, anatomical information
was obtained using CT scans, and for 10 applications, commercial 3D
scanners were used. With commercial surface scanners, body parts and
objects were scanned directly in 3 studies, and in the remaining 7,
molds, casts and body-part impressions were scanned. In two instances,
MRI/CT scans were obtained from existing databases, and five studies
did not specify the type of image-acquisition equipment.
The most common AM technology in the reviewed studies was Fused
Filament Fabrication – FFF (21), followed by Selective Laser Sintering –
SLS (6), Material Jetting – MJ (3), Stereolithography – SLA (3), Binder
Jetting – BJ (1) and Direct Metal Laser Sintering – DMLS (1) (Fig. 3).
Twelve papers did not report on the technology used, while nine studies
used more than one, combining different FFF machines; FFF with BJ,
MJ, SLA and SLS; MJ with SLS; or SLS with SLA. In one study, prototypes
were printed using FFF, SLA and SLS separately for comparison.
Most commonly used AM machines were the EOS Formiga P100 (4,
SLS), Stratasys Objet family (3, MJ), Stratasys Dimension family (3, FFF),

Fig. 4. Materials used in the studies reviewed. ABS – Acrylonitrile Butadiene Styrene, BJ – Binder Jetting, DMLS - Direct Metal Laser Sintering, FFF – Fused Filament
Fabrication, MJ – Material Jetting, N/A – information not provided, PA – Polyamide (Nylon), PLA – Polylactic acid, PPSF – Polyphenylsulfone, SLA – Stereolithography, SLS –
Selective Laser Sintering, TPU – Thermoplastic Polyurethane.

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Table 2
Selected studies, the product details, AM procedure used and ergonomics aspects studied.
Field of Study # AM Procedure Ergonomics
application Product
Model Technology Study objective Ergonomics Testing
(Development stage)
Template/ Software AM process Ergonomic problem Participants/ Method/approach
Scanning Printer addressed # Iterations (if
method (Manufacturer) Product/prototype detailed)
Material

Medicine 1 CT Mimics 14.1 FFF Mentally-demanding and 1 Surgeon (surgical Evaluation of tumor
Surgical jig for femur Magics RP Fortus 400mc potentially hazardous procedure on 1 resection accuracy,
osteosarcoma version 14 (Stratasys) conventional navigation- cadaveric femur operative time
resection PPSF guided osteotomy and 1 patient) measurement.
(End product) BJ approach that requires
Zprinter 310 simultaneous monitoring
(Zcorporation) of virtual images on the
Ceramics navigation display and
manipulation of the
oscillating saw in the
operative field.
Surgical jig with
anatomically shaped
cutting blocks matching
bone surface at the
defined resection level.
Custom ceramic bone
models for trial
positioning of the jig
prior to surgery.
2 CT N/A N/A Experience-dependent 10 experienced Simulated bone cutting
Surgical guide for N/A conventional procedure surgeons + with pneumatic
pelvic bone tumor (N/A) accuracy, mentally- 14 in-training oscillating saw on
resection PA demanding continuous residents synthetic bone models:
(Prototype for tracking and registration measurement of bone-
ergonomic steps that cause errors and cutting accuracy and
evaluation) are time-consuming. operative time.
Patient-specific
instrument for desired
resection strategy.
Bone-specific guide
surface for easy
positioning.
3 None Catia V5 R21 SLS Uncomfortable arm 6 novice clinicians Stapedotomy on a
Disposable Cartesian Formiga P100 position, tremor, limited surgical phantom:
Robot (EOS) view and manipulation evaluation of
for stapedotomy PA2200 degrees of freedom. positioning accuracy
(Prototype for Medical robot for and forces applied.
ergonomic telemanipulation of
evaluation) tissues.
4 COMET LED- Unigraphics DMLS Technology-related 15 neurosurgeons Fine microsuturing of
Microforceps replica 2M NX 6 Eosint M270 differences in surface and sciatic nerve
(Prototype for (Steinbichler) (EOS) mechanical properties anastomosis on white
ergonomic Stainless Steel influencing use between albino rat with original
evaluation) PH1 original microsurgical instrument and 3D-
instruments and their printed replica.
additively-manufactured Subjective evaluation
replicas. (3-point Likert-like
Replica of microforceps scale) of texture, force
for neurosurgery. applied, needle
holding, specific use.
Measurement of
applied force for tip
matching.
Surface roughness
analysis.
Medicine 5 None SolidWorks SLS Reduced usability/ N/A Simulated inguinal
(Cont.) Army-Navy retractor, HiQ performance of polymer 4 iterations hernia repair on human
scalpel handle, (Sinterstation) replicas of metal cadavers:
forceps, hemostats, DuraForm EX instruments that requires iterative improvement
needle driver design modifications. of shape, dimensions,
(Prototype for Surgeon-specific basic and strength of surgical
ergonomic set of instruments. instruments according
evaluation) to surgeon’s feedback.
6 None Autodesk FFF Skill-dependent success 40 medical Endotracheal
Laryngoscope 123D Cubicon Single rate of endotracheal students intubation of airway
support grip (HighVision) intubation; limited glottic manikin with
(Prototype for TPU view. Macintosh
(continued on next page)

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Table 2 (continued )
Field of Study # AM Procedure Ergonomics
application Product
Model Technology Study objective Ergonomics Testing
(Development stage)
Template/ Software AM process Ergonomic problem Participants/ Method/approach
Scanning Printer addressed # Iterations (if
method (Manufacturer) Product/prototype detailed)
Material

ergonomic Add-on ergonomic laryngoscope (blade

evaluation) support grip. size 3) with/without
the grip.
Measurements:
intubation time,
number of intubation
attempts, first-
intubation attempt
success rate, overall
success rate, airway CL
grade, peak force at tip
of blade.
7 None Autodesk MJ Light delivery using 10 healthy subjects Applicators positioned
Oral light applicator Fusion 360 Objet30 Pro inconvenient posts, + for 10 min:
for photodynamic (Stratasys) holders, reflectors or light 5 patients Discomfort rating on 5-
therapy VeroBlue pipes; need for patient point scale (physical
(End product) VeroBlack sedation. discomfort, fatigue/
Anterior/posterior, numbness, possibility
buccal and retromolar of immediately
light applicators in repeating procedure).
child, middle and adult 35 min of light delivery
size for improved with breaks every 10
comfort, precision and min:
stability of uniform light Treatment success
delivery in conscious evaluation.
subjects.
8 CT SolidWorks SLA Experience-dependent, 3 patients 20–25 weeks of
Fracture external SPS600B complex manipulation of external fixator use:
fixator (Shaanxi conventional external - fracture healing
(End product) Hengtong fixators, patients’ and success monitoring.
Intelligent surgeons’ excessive - clinician and patient
Machine Co.) exposure to radiation, feedback at usability
Resin patient dissatisfaction workshops: task
with usability and analysis, observation,
esthetics, leading to non- interviews.
compliance.
Patient-specific external
fixator geometry based
on computer simulation
of fracture reduction for
fixation-pin positioning.
Personalized form and
aesthetics.
9 None SolidWorks FFF Uncomfortable body and 80 surgeons CAD-model stress
Laparoscopic forceps Objet Studio Dimension hand position, looking 2 iterations analysis.
handle Catalyst EX uPrint into a monitor; discomfort Subjective evaluation
(Prototype for (Stratasys) and pain in hand, wrist, (5-point scale): grip,
ergonomic ABS Plus-P430 arm, neck, shoulder. functionality, comfort,
evaluation) MJ Function-based wrist posture.
Objet260 Connex modification of add-on
(Stratasys) handle: pistol-type grip,
ABS Plus-P430 increased hand-handle
VeroWhite contact area, neutral
TangoPlus wrist position.
Handle size based on
hand anthropometrics
and grip strength
measurements of 282
South Indian males:
adjustment to
minimum, maximum
and mean hand size
made possible by rubber
inserts.
10 None N/A FFF Use error due to device 1 physician Usability testing: 10-
Digital-stethoscope Prusa i3 features and use 6 iterations item system usability
encapsulation with (BQ) environment. scale (6-point scale; 0
ECG-sensing PLA 4 models of device = totally disagree, 5 =
capabilities TPU housing. totally agree)
(continued on next page)

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Table 2 (continued )
Field of Study # AM Procedure Ergonomics
application Product
Model Technology Study objective Ergonomics Testing
(Development stage)
Template/ Software AM process Ergonomic problem Participants/ Method/approach
Scanning Printer addressed # Iterations (if
method (Manufacturer) Product/prototype detailed)
Material

(Early prototypes for Conductive,

proof of concept and carbon based
ergonomic composite
evaluation) filament
(diaphragm)
Medicine 11 None SolidWorks FFF Pressure-induced necrosis 5 neonates Clinical observation of
(Cont.) Patient-specific prong Ultimaker 2+ of nasal interior wall and 6 iterations necrosis occurrence.
support to prevent (Ultimaker) perinasal tissues caused
nasal necrosis caused coupled with by prongs/masks.
by prongs/masks for Discov3ry Patient-specific prong
oxygen therapy of paste extruder support to relieve
premature infants Medical grade interface pressure.
(Early prototypes for room-
proof of concept, end temperature-
product) vulcanizing
silicone rubber
Assistive 12 NDI Polaris Matlab SLS Micro-misalignments in 2 participants 8-kg weight placed on
Technologies Exoskeleton forearm Vicra Formiga P100 wearable technology shell for 30 s:
shell (Northern (EOS) caused by inter-subject Interface pressure
(Early prototype for Digital N/A variability. measurement with
proof of concept) Instruments) Individualized forearm Prescale LLLW film,
shell based on limb Fujifilm
geometry for enhanced
fitting accuracy and
increased contact area
to lower peak pressure.
13 None N/A Polychrome 3D Guiding efficacy of tactile 46 blind, 5 tasks simulating
Tactile map printing maps with flat-relief blindfolded low reading tactile map at
(Prototype for N/A symbols. vision and home to learn about a
ergonomic (N/A) Tactile map with blindfolded new place.
evaluation) N/A volumetric (3D) tactile sighted; Measurement of
symbols. different levels of duration and
experience with discrimination errors
tangible graphics of tactile symbol
locating.
14 None N/A FFF Manufacturing- 3 subjects with Measurement of
Braille display Dimension Elite technology-dependent total vision loss, geometrical
(Prototype for (Stratasys) readability of Braille able to read Braille dimensions and
ergonomic ABS characters and comfort in printing defects.
evaluation) FFF reading. Subjective evaluation
Custom low-cost 4 versions of printed (5-point Likert scale) of
3D printer word “laboratory” in printed-word
PLA Braille: readability, effort for
- embossed paper; reading, tactile comfort
- layered FFF with during reading.
professional-level
printer;
- layered FFF with low-
cost printer;
- continuous-flow FFF
with low-cost 3D
printer.
15 None Matlab SLS Kinematic incompatibility 1 participant Motion capture of
Exoskeleton elbow Catia Formiga P100 between the upper limb forearm movement
joint (EOS) and exoskeleton; high relative to the upper
(Early prototype for PA interaction forces, arm during elbow
proof of concept) MJ pressure sores, inability to flexion-extension using
Objet30 achieve long wearing an electromagnetic
(Stratasys) times. tracking system;
Endur Individualized Calculation of required
exoskeleton elbow joint joint geometry;
considering carrying Comparison of custom
angle and soft tissue exoskeleton joint with
movement. natural elbow motion
and revolute joint.
16 None SolidWorks N/A Upper-limb function 1 healthy human Motion-capture:
Upper limb soft N/A impairment in patients 4 patients post comparison of
exoskeleton (N/A) with dyskinesia, and stroke exoskeleton and
(Prototype for N/A limited ability to perform human movement
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Table 2 (continued )
Field of Study # AM Procedure Ergonomics
application Product
Model Technology Study objective Ergonomics Testing
(Development stage)
Template/ Software AM process Ergonomic problem Participants/ Method/approach
Scanning Printer addressed # Iterations (if
method (Manufacturer) Product/prototype detailed)
Material

ergonomic activities of daily living. trajectories.

evaluation) Soft bionic exoskeleton EMG: comparison of
robot with 7 degrees of muscle force during
freedom for assistance water-drinking motion
with shoulder, elbow, with and without
forearm and wrist device assistance.
movement. Motion-assisted
experiments on
patients:
- wrist and forearm
rotation range;
- lifting hand to mouth.
Assistive 17 Plaster cast of Skanect FFF Spastic hand: progression 1 child/Cerebral Evaluation of orthosis
Technologies Low-cost wrist-hand- upper limb 3ds Max 3DCloner of deformities, decreased Palsy (7-point scale): user,
(Cont.) fingers orthosis – (EtechBrasil) functionality; extreme 2 therapists family, occupational
(End product) 3D scan of cast PLA cases of size and therapists’ perception.
Kinect 360 deformity; difficulty
(Microsoft) donning, high weight,
poor aesthetics of splints;
user discomfort and
number of visits to obtain
orthosis.
Personalized,
lightweight orthosis
based on limb geometry
data.
18 Stump mold Customizer FFF Inability to perform daily 1 child amputee Anthropometric
Transradial – Rhinoceros CubeX Duo activities, write, close 1 iteration measurements:
mechanical 3D scan of mold Meshmixer (3D Systems) zippers/buttons. biceps circumference,
prosthesis ATOS I 2M PLA User-specific forearm length, hand
(End product) (GOM) FFF lightweight prosthesis; length.
Sethi3D AiP easy attachment/ Picking up simple
(Sethi3D) placement and objects, writing,
TPU activation; comfortable closing zippers/
fit at the left limb; buttons using an
simple hygiene; larger adapter.
contact surface and
increased friction at
palm and fingers; thumb
rotation; personalized
aesthetics.
19 Cast of impaired N/A FFF Impaired functional range 5 children with Southampton Hand
Adaptive device for hand Prusa MK2 of the hand, negative mild Assessment Procedure
improving impaired – (Prusa Research) psychological effects due symbrachydactily test, adapted for
hand function in mild 3D scan of cast N/A to adaptive-device-related children: comparing
symbrachydactily N/A social rejection/stigma. the functional range of
(End product) (Artec 3D) Assistive device for the impaired hand with
impaired hand function the healthy, based on
improvement, printed in time recordings.
child’s favorite color. - Testing of impaired
hand with and without
the device.
- 2–3 weeks of training
program: 4 activities
(rolling a dice to throw
six, throwing a ball in a
cup, placing dominos
in a shape, eating with
a fork) or playing any
type of board game.
- Testing of dominant
hand and retesting of
impaired hand with
and without the device.
20 Ear canal and N/A FFF Size and shape-related fit 1 test subject 1-min wearing of each
Anatomical hearing concha mold N/A and comfort of hearing prototype.
aid with impression (N/A) aids. Subjective evaluation
(Prototypes for silicone (®ABR) PLA 48 prototypes: (7-point Likert scale) of
– SLA - full-shell/half-shell fit and comfort.
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Table 2 (continued )
Field of Study # AM Procedure Ergonomics
application Product
Model Technology Study objective Ergonomics Testing
(Development stage)
Template/ Software AM process Ergonomic problem Participants/ Method/approach
Scanning Printer addressed # Iterations (if
method (Manufacturer) Product/prototype detailed)
Material

ergonomic 3D scan of mold N/A - with/without ear-

evaluation) N/A (N/A) canal extension
(RangeVision) ABS - 12 scaled sizes:
SLS 70–125%
N/A
(N/A)
PA
21 Motion capture N/A N/A Rigid back-support N/A Perceived discomfort
Scissor-hinge with Vicon Vero N/A structures limit the range during lifting (3
mechanism for active 2.2 (N/A) of motion and only assist repetitions) wearing
back-support N/A with very specific the device: rating of
exoskeleton movements. discomfort at the neck,
(Early prototype for Scissor-hinge upper back, lower
proof of concept and mechanism for an active back, buttock (11-point
ergonomic back-support scale; 0 = no
evaluation) exoskeleton that adapts discomfort at all, 10 =
to the user to assist with extreme discomfort)
the complete set of
postures assumed
during back-loading
tasks.
Assistive 22 3D scan of right N/A N/A Fatigue, muscular effort, 4 healthy young Transmission stiffness
Technologies Reinforced hand N/A localized interface males test;
(Cont.) glove of a soft wrist (N/A) pressure peaks, and Transmission
exosuit for flexion ABS comfort during static displacement test;
assistance holding and lifting of Static holding 1.5-kg
(Prototype for loads ≤ 3 kg. weight for 3 min, with
ergonomic Highly-compliant forearm and hand
evaluation) plastic glove aligned horizontally,
reinforcement for with and without
optimal actuator-to- exosuit assistance;
wrist force transfer. 15 repetitions of 60◦
wrist flexion at 35◦ /s
and 70◦ /s, holding 1.5-
kg weight, with and
without exosuit
assistance.
Measurement: EMG
(m. flexor carpi
radialis, m. flexor carpi
ulnaris, m. extensor
carpi ulnaris, m.
extensor digitorum)
Wearable 23 None N/A FFF Arm fatigue and 15 participants 100 trials of testing of
Technologies Head-mounted DaVinci 1.0 shoulder/neck discomfort accuracy and speed of
display frame (XYZprinting) due to extended periods of task performance.
(Prototype for N/A arm elevation and Subjective evaluation
ergonomic downwards gaze. of interaction
evaluation) Frame to angle head- experience.
mounted display in 4
different angles
downwards toward
user’s hands.
24 Left ear Shinning FFF Improper fit of standard 6 test subjects Design verification by
Earphones impression Version MostFun earphones. (usability testing) wearing printed
(Prototypes for (ABR ear 1.7.1. (Chengdu Anthropometric earphone for 1 h with
ergonomic impression Rhinoceros MostFun SandT measurements and no discomfort/pain,
evaluation) silicone) 4.0 Co.) characteristic and while running/
– Matlab TPU anthropometric point skipping.
3D scan of ear coordinate
impression identification on 310
Einscan-S young Chinese people.
(Shining3D) Classification of shapes
of auricular conchae
into 24 groups and use
as reference for
earphone design.
25 None SolidWorks FFF Pain and discomfort at 23 production Preliminary testing:
Insoles Fortus the feet during work. workers - Questionnaire of pain
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Table 2 (continued )
Field of Study # AM Procedure Ergonomics
application Product
Model Technology Study objective Ergonomics Testing
(Development stage)
Template/ Software AM process Ergonomic problem Participants/ Method/approach
Scanning Printer addressed # Iterations (if
method (Manufacturer) Product/prototype detailed)
Material

(Prototype for (Stratasys) User-specific insoles for experienced at the foot:

ergonomic ABS maximized insole-foot 5-point scale; figure:
evaluation) contact area to reduce sole of the foot, divided
and redistribute into five areas.
pressure under the foot. - Measurement of
pressure distribution
and peak pressure at
the foot during 10 m
walk
Testing with 3D-
printed insole:
- EMG of low-back and
leg muscles during 5 h
of working activity
- Measurement of
pressure distribution
and peak pressure at
the foot
Hand Tools 26 None N/A N/A Personal preferences and 117 grade 3 and 4 Video-recording of
Children’s electronic N/A usability of electronic elementary school students’ pen-holding
drawing pen (N/A) drawing pens for children, students position and pen use.
(Prototypes for N/A depending on pen shape Time recording of
ergonomic and style. image-tracing test on
evaluation) 3 prototypes of drawing paper.
pens with circular, Subjective evaluation:
quadrangular, and - Preliminary intuitive
triangular cross-section. ranking of prototypes’
suitability for drawing
with explanation.
- Pen suitability re-
evaluation after image-
tracing test.
27 None N/A N/A Learnability, efficiency, 13 professional Post-use evaluation (7-
Civil engineering N/A memorability, errors, and users point scale) of:
explosive ordnance (N/A) satisfaction of tools/jigs 10 iterations effectiveness,
disposal tools and jigs N/A for Air Force operations. (EODB), N/A efficiency, safety,
(Prototype for An Explosive Ordnance iterations (ARB) utility, learnability and
ergonomic Disposal Bracket and memorability of
evaluation) Autonomous Robot devices.
Brackets.
Hand Tools 28 6 alginate SolidWorks N/A Musculoskeletal disorders 1 participant’s Subjects gripped the
(Cont.) Vibration tool handle models of hand- N/A due to hand-arm hand impressions handle attached to an
(Prototype for grip (N/A) vibration. 12 healthy males exciter (frequency
ergonomic impressions ABS 6 anatomically-shaped tested range: 0–1000 Hz) with
evaluation) – handles to reduce constant force:
3D scanning of vibration transmitted to - measurement of
hand-grip the wrist. vibration transmitted
impressions from handle to wrist;
N/A - subjective evaluation
of ease of holding the
tool and vibration
perception (Borg’s CR-
10 scale).
29 6 alginate SolidWorks N/A Musculoskeletal disorders 15 right-handed Preliminary
Low-frequency models of hand- N/A due to hand-arm male anthropometric
vibration tool handle grip (N/A) vibration. measurement:
(Prototype for impressions ABS Anatomically shaped middle finger length,
ergonomic – handle to minimize thumb length, grip
evaluation) 3D scanning of gripping force and diameter.
hand-grip increase contact area. Hand-arm vibration
impressions measurement.
N/A Subjective rating (7-
point scale) of shape,
fit, grip, performance,
pressure on hand,
numbness in fingers,
cramped muscle.
30 None N/A FFF Comfort, efficiency and 5 participants Subjective evaluation
Vacuum tool for N/A safety of a vacuum tool (3-point scale) after 10
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T. Kermavnar et al. Applied Ergonomics 97 (2021) 103528

Table 2 (continued )
Field of Study # AM Procedure Ergonomics
application Product
Model Technology Study objective Ergonomics Testing
(Development stage)
Template/ Software AM process Ergonomic problem Participants/ Method/approach
Scanning Printer addressed # Iterations (if
method (Manufacturer) Product/prototype detailed)
Material

picking plastic bottles (FusedForm) for manual handling of bottles handled of:
in recycling center N/A bottles. handle length, handle
(Prototype for Tool for pick-place tasks diameter, tool weight,
ergonomic that can be manipulated suction cup position,
evaluation) by robot and/or activation button
operator. position.
Human-robot
collaboration test.
31 None N/A FFF Material-related comfort 10 healthy young Subjective comfort
Foxtail saw handle CR-10 S4 and performance of tool participants rating during a sawing
(Prototype for (Creality) handles, uneven contact task (pushing and
ergonomic TPU pressure distribution for pulling with relatively
evaluation) (experimental) common handles. high grasping forces):
PLA (control) 4 optimal-size handles: comfort-rating
- 3 relative densities of questionnaire (8-point
cellular TPU scale; 1 = totally
metamaterial (6%, 10%, uncomfortable, 7 =
14%) totally comfortable).
- 1 rigid PLA
Ergonomics- 32 N/A Rhinoceros FFF Foot pressure sensitivity 7 scanned Pressure-induced
Testing Foot shells for Ultimaker 2+ testing. 21 healthy tested discomfort threshold
Devices pressure-sensitivity (Ultimaker) 6 experimental foot measurement at 20
evaluation PLA shells for pressure- points of the foot in 2
(End product) sensitivity testing: positions, using
- 3 sizes: 37–39, 40–43, advanced force gauge
44-47 meter with cylindrical
- 2 positions: foot flat, PLA indenter (10-mm
toe-off (heel lifted 65 diameter, 3-mm fillet
mm) radius).
- 20 holes (diameter 11
mm) for indenter
33 100 MRI scans N/A N/A Headgear heat transfer / 60 min exposure of 3
Anthropometric from ICBM N/A testing. commercial helmet
thermal manikin database (N/A) 3D model of 50th types to air flow in
head for heat transfer N/A percentile biophydelic open-loop wind tunnel
quantification of western head with with controlled air
headgear heating elements, velocity, temperature,
(End product) temperature sensors and relative humidity;
surface openings for external heat source
sweating simulation. simulation.
Convective and
radiative heat
exchange
measurement.
34 CT scans from N/A FFF Augmented-reality 10 subjects with Simulation of cutting
Trajectory-tracing skull and Dimension Elite display testing. normal visual flat parts in an
platform for acetabulum (Stratasys) Rectangular plate, and acuity industrial
augmented reality datasets ABS replicas of a portion of manufacturing process,
head-mounted skull and acetabulum and complex surgical
display testing with 3 spherical incision tasks:
(End product) markers; templates for - trajectory-tracing
trajectory-accuracy accuracy and duration.
testing. - user experience
evaluation (5-point
Likert scale).
Ergonomics- 35 None N/A FFF Mixed-reality assessment N/A Simulation of assembly
Testing Physical components N/A of industrial workstations. task (assembly of two
Devices of virtual workplace (N/A) Real-size and weight components) and
(Cont.) for mixed-reality N/A physical replicas of a mounting of assembled
ergonomic groove and support, part at the welding
assessment of manipulated by the station.
industrial operator during In-silico ergonomic
workstations simulation. analysis: lumbar
(End product) loading, RULA.
Miscellaneous 36 None Catia FFF Incorrect body posture 29 dentists (21 with 1 week of support use.
Arm support for N/A leading to MSDs in high risk of MSDs) Subjective evaluation
dentists (N/A) dentists. questionnaire.
(Prototype for PLA Height-adjustable arm RULA
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Table 2 (continued )
Field of Study # AM Procedure Ergonomics
application Product
Model Technology Study objective Ergonomics Testing
(Development stage)
Template/ Software AM process Ergonomic problem Participants/ Method/approach
Scanning Printer addressed # Iterations (if
method (Manufacturer) Product/prototype detailed)
Material

ergonomic support attached to

evaluation) dental unit.
37 None N/A FFF Interface shape 20 healthy students Preliminary test of 2
Adaptive N/A requirements for 3 iterations control-element shapes
translational/ (N/A) precision/high-force using 3-finger and full-
rotatory control ABS manual operation hand power grip:
element SLS controls. - positioning accuracy
(Prototypes for Formiga P100 N/A and speed
ergonomic (EOS) measurement;
evaluation, ABS - force/torque
end product) transmission
measurement.
Grip force
measurement during
prototype use.
Subjective comfort
evaluation.
38 None Fusion 360 SLA Suboptimal efficiency of 2 professionals Comparison of tissue-
Device for mounting Form 2 SLA conventional methods for N/A iterations section mounting time
tissue sections (Formlabs) mounting tissue sections using the traditional
(End product) white, onto slides. and new method.
transparent resin Mechanized device for
FFF mounting tissue sections
I3 MK2S onto slides in buffer
(Prusa Research) solution
PLA
39 None N/A N/A Comfort and perceived 18 healthy females Opening a bottle with
Bottle lid N/A exertion related to the the lid twisted with the
(Prototypes for (N/A) shape of bottle lids.. maximum force of a
ergonomic PLA 3 lid designs: healthy 20-year old
evaluation) - 2 shapes (square, male.
hexagonal) Subjective evaluation:
- serrate texture - perceived exertion
- concave areas for (Borg’s CR-10 scale) ;
finger grip - User satisfaction (5-
point scale, custom
questionnaire);
- Comfort (custom
questionnaire);
Grip-type analysis.
Miscellaneous 40 Motion capture Grasshopper N/A Interpersonal differences 5 females, 5 males Interface-pressure
(Cont.) Personalized using Kinect v2 Rhinoceros Robotic arm 3D in preferred sitting distribution
(behavior-based) camera printer posture. measurement
parametric chair Interface- (N/A) Chair design, based on Comfort evaluation:
(Early prototype for pressure N/A participant’s posture interview
proof of concept) measurement and interface pressure
using pressure- distribution during
sensing comfortable sitting.
wearables

and Stratasys Fortus (2, FFF).
Overall, the preferred AM material was Acrylonitrile Butadiene
Styrene – ABS and variations of it (11). For FFF, Polylactic acid – PLA
was most commonly used (9), followed by ABS (6), Thermoplastic
Polyurethane – TPU (5), and Polyphenylsulfone – PPSF (1). With SLS,
Polyamide – PA was most common (3), but ABS and DuraForm EX were
also employed. With MJ, versions of Vero material were favored (3), but
also ABS Plus-P430 and Endur were used. ABS and an unspecified
photosensitive resin were used in SLA, stainless steel in DMLS, and ce­
ramics in BJ. In twelve cases, the material was not specified. Materials
used in the reviewed studies are summarized in Fig. 4.
Five studies reported on the prototype build time, which ranged from
5 min for a Braille display (Loconsole et al., 2016), to 12 h for a pair of
insoles (Khadijah et al., 2018). The requirement for post-processing of
the printed objects was reported in six papers and consisted of physical
removal of support material and residue, surface finishing, cleaning and
sterilization, component binding and addition of fixation and comfort
material.
3.2.3. Advantages and disadvantages of AM technologies
Certain advantages and disadvantages of individual AM technologies
and materials were reported across the reviewed studies. Petropolis
et al. (2015) found that the most common combination of PLA and FFF
allows for printing of finer details when compared to ABS or Poly­
ethylene Terephthalate – PET. However, for products like bottle lids, the
hardness of PLA was found to negatively influence user experience
(Manzano-Hernandez et al., 2019). For FFF, Fu and Luximon (2020)
highlighted the roughness of the prototype surface and the influence of
printing layer thickness on product size. Weiss et al. (2017) also reported
difficult removal of support structures. Loconsole et al. (2016) compared
layered and continuous-flow FFF when producing Braille writings and
found that the former can only be used with 3D printers capable of finer

13
T. Kermavnar et al. Applied Ergonomics 97 (2021) 103528

Table 3
Advantages and disadvantages of common AM processes based on the reviewed studies and the previous guidance by Lee et al. (2017), Imširović and Kumnova (2017),
Wong and Hernandez (2012), Carlström and Wargsjö (2017) and Guerin and Da Costa (2016). BJ – Binder Jetting, DMLS - Direct Metal Laser Sintering, EBM – Electron
Beam Melting, FFF – Fused Filament Fabrication, LENS – Laser Engineered Net Shaping, LOM – Laminated Object Manufacturing, MJ – Material Jetting, SLA – Stereolithography,
SLS – Selective Laser Sintering.
ADVANTAGES DISADVANTAGES

Short High Large Good Complex Good Wide range Printing of Printing Printing of Multi- Low Long Poor
build resolution build dimensional geometry surface of materials polymers of metals composites material cost build resolution
time volume accuracy finish printing time

BJ £ £ £ £ £ £
EBM £ £ £ £ £
FFF £ £ £ £ £ £ £
LENS £ £ £ £
LOM £ £ £ £ £ £ £
MJ £ £ £ £ £ £ £
SLA £ £ £ £ £ £ £
DLP £ £ £ £ £ £
DMLS £ £ £ £ £
SLS £ £ £ £ £ £ £

details, whereas the latter is necessary when using low-cost 3D printers.
SLS was found to offer production time short enough to allow for
next-day prototype improvements, but requires additional curing of
printed objects to avoid fluid absorption and staining due to porous
surfaces (George et al., 2017). Fu and Luximon (2020) noted the
roughness of the SLS-printed object’s surface and PA powder falling off
the surface. Hein et al. (2018) noted that PA prototypes were incapable
of sustaining high forces at the joints of their exoskeleton design, and
George et al. (2017) found insufficient strength of DuraForm EX for
direct adaptation to fully functional medical instruments. Other re­
ported disadvantages of SLS include the anisotropic effects of build
orientation (Entsfellner et al., 2014; George et al., 2017), and insuffi­
cient resolution to ensure good form and fit of hinges (George et al.,
2017).
With DMLS, the texture of a stainless steel microforceps replica was
also rougher and the applied force requirement higher compared to the
original instrument, produced by subtractive manufacturing (Singh
et al., 2016). Whereas SLA provided a smooth surface finish and was
therefore found to be more suitable than FFF and SLS for hearing-aid
prototypes (Fu and Luximon, 2020).
Several advantages of AM-compatible digital 3D models were iden­
tified in the reviewed studies as well. Firstly, CAD models can be easily
adapted to different users’ anthropometrics (Li et al., 2020) and
different AM techniques/materials without additional costs (Entsfellner
et al., 2014). Furthermore, the possibility of archiving and reusing in­
dividuals’ anatomical models and personalized devices can lower the
cost and time involved in custom-device development (Rosenmann
et al., 2018). Finally, the shareability of digital models enhances the
reproducibility of scientific studies (Kim et al., 2018).
3.3. Ergonomic evaluation of the AM-generated products
Products and prototypes were evaluated using different combina­
tions of objective/subjective and qualitative/quantitative ergonomics
methods. Objective methods were used in 29 studies, of which 23 were
quantitative and 6 qualitative; subjective methods were used in 26
studies, 17 being quantitative and 10qualitative, one study used both.
Both objective and subjective methods were used in 15 studies.
Subjective ergonomics methods were based primarily on usability
testing of shape, fit, functionality, ease of use, physical dis-/comfort and
aesthetics evaluation, and overall user satisfaction assessment. For
quantitative assessment, rating scales were employed in 17 studies:
Likert or Likert-similar scales consisting of either 3, 5, 6, 7, 8 or 11 points
(15), and Borg’s CR-10 scale (2). Subjective qualitative assessment
consisted of user feedback acquired through observation, interviews and
questionnaires.
Objective ergonomics methods were used mainly for prototype-
functionality assessment and user-performance evaluation with and
without the ergonomic intervention in simulated or actual settings.
Analyzed were success rate, accuracy and speed of task performance;
overall posture and the position and functional range of body parts;
kinematic compatibility with natural body movement; applied force,
force/torque transmission to body parts, pressure distribution and its
effect on tissue viability; muscle activity; hand-arm vibration; and heat
exchange. In one study where a thermal manikin was developed for
ergonomics testing of headgear (Mukunthan et al., 2019), live partici­
pants were not included.
In eight studies, 1–10 iterations were made throughout product
development; in two instances, the number of iterations was not speci­
fied. Nine studies used 3–48 different prototype configurations
simultaneously.
The reviewed studies are summarized and organized chronologically
according to fields of application in Table 2.
MEDICINE: 1 – Wong et al. (2012), 2 – Cartiaux et al. (2014), 3 –
Entsfellner et al. (2014), 4 – Singh et al. (2016), 5 – George et al. (2017),
6 – Kim et al. (2018), 7 – Mallidi et al. (2019), 8 – Li et al. (2020), 9 –
Sreekanth et al. (2020), 10 – Baptista et al. (2020), 11 – Mirnia et al.
(2021); ASSISTIVE TECHNOLOGY: 12 – Reimer et al. (2014), 13 – Gual
et al. (2015), 14 – Loconsole et al. (2016); 15 – Rosenmann et al. (2018),
16 – Hein et al. (2018), 17 – Li et al. (2018), 18 – da Silva et al. (2019),
19 – Haring et al. (2019), 20 – Fu and Luximon (2020), 21 – Roveda et al.
(2020), 22 – Chiaradia et al. (2020); WEARABLE TECHNOLOGY: 23 –
Devine et al. (2017), 24 – Ji et al. (2018), 25 – Khadijah et al. (2018);
HAND TOOLS: 26 – Chen and Cheng (2016), 27 – Shields et al. (2016),
28 – Tony et al. (2019), 29 – Tony and Alphin (2019), 30 – Hernandez
et al. (2020), 31 – Cupar et al. (2021); ERGONOMICS-TESTING DE­
VICES: 32 – Buso and Shitoot (2019), 33 – Mukunthan et al. (2019), 34 –
Condino et al. (2020), 35 – Bruno et al. (2020); MISCELLANEOUS: 36 –
Hallaj and Razi (2016), 37 – Weiss et al. (2017), 38 – Habbal et al.
(2019), 39 – Manzano-Hernandez et al. (2019), 40 – Zeng and Qiu
(2021). ABS – Acrylonitrile Butadiene Styrene, BJ – Binder Jetting, DMLS -
Direct Metal Laser Sintering, FFF – Fused Filament Fabrication, MJ – Ma­
terial Jetting, N/A – information not provided, PA – Polyamide (Nylon), PLA
– Polylactic Acid, PPSF – Polyphenylsulfone, SLA – Stereolithography, SLS –
Selective Laser Sintering, TPU – Thermoplastic Polyurethane.

14
T. Kermavnar et al.
DISADVANTAGES
Limited Limited part Poor Poor Anisotropic Residual
build complexity surface strength of nature of internal
volume finish product product stresses
£ £
£ £
£ £
£ £ £ £
£ £ £ £
£ £
£ £
£ £
£ £ £ £
4. Discussion
Forty studies reporting the use of AM in ergonomic design of prod­
ucts and prototypes were included in this systematic review. Most
studies applied AM to the design of medical and assistive devices, with
the remainder relating to the design of wearable non-assistive devices,
hand tools, ergonomics-testing devices, and other applications. The
oldest study in the selected papers was published in 2012 and described
a patient-specific surgical guide for bone tumor resection, printed using
PPSF with FFF (Wong et al., 2012). In fact, in 2009, the patent for FFF
expired, followed by the patents for SLS in 2014 and SLA in 2014–2016,
which led to a substantial increase in the accessibility and affordability
of AM, and a consequent rise in the number of applications and manu­
factured parts (3ders.org; Popescu and Laptoiu, 2016).
Recommended AM technologies and materials for the individual
applications were identified based on the systematic review and are
discussed below. The role of AM in product personalization and mass
customization is also addressed, as well as the importance of usability
testing and iterative design for the development of ergonomic products.
4.1. Fields of application and corresponding AM technology and material
choice
In ergonomics, AM can either be used A) to produce mock-ups that
aid in the initial ideation phase of product development, B) for iterative
prototyping to facilitate ergonomic assessment of various designs, or C)
for the production of end products, especially when highly-complex or
user-specific objects are required. Each of these applications has its
distinct requirements that influence the choice of AM process and ma­
terial. Some of the typical uses of AM, also identified among the
reviewed studies are discussed below, and important considerations
regarding the individual AM technologies and materials are detailed at
the end of Discussion.
4.1.1. Early prototypes and iterative product development
Low cost and short build time that allow for several quick iterations
are often important requirements for early prototypes intended for
design conceptualization and ergonomics testing. Where there are no
requirements for specific durability, strength or hardness, high resolu­
tion or heat-resistance of early models, FFF using ABS or PLA, or LOM
using paper or polymer film can be the technologies of choice. Addi­
tionally, the option of a range of materials with various properties, the
possibility of multi-material printing, and large build volume of FFF can
be advantageous in creating low-fidelity models to simulate the inten­
ded mechanical properties of the designed product.
Applied Ergonomics 97 (2021) 103528
Specific Support Post- Products Limited Health High
atmosphere structures processing sensitive to range of hazard cost
required required required UV and materials during
moisture printing
£
£
£ £
£
£
£ £ £ £
£ £ £
£ £ £
£
£ £
For low-cost prototypes in the later stages of product development
that need to more closely resemble the surface quality of the end
product, SLA or DLP can be used. However, these technologies typically
only allow for printing of single materials at a time, thus, post-print
assembly is required for objects consisting of materials with different
properties (e.g., flexible and rigid, or materials of different colors). This
can be avoided with the use of MJ which enables multi-material print­
ing, but at the price of increasing the prototype production cost.
4.1.2. End products
4.1.2.1. Medical devices. Medical devices for invasive procedures
generally need to be biocompatible, sterilizable, and must maintain their
dimensional and mechanical properties after sterilization (Popescu and
Laptoiu, 2016). It is important that they are impact-resistant and resis­
tant to breakage under mechanical stress. Surgical guides must be
dimensionally accurate and rigid enough not to deform during use
(Popescu and Laptoiu, 2016; Ramakrishna et al., 2001), whereas sur­
gical instruments must also be fatigue-resistant, have good
strength-to-weight ratio and good surface finish (Singh et al., 2016). In
many cases, medical devices must be biologically inert, and the possi­
bility of having complex geometric shapes is also desirable.
The choice of material for surgical instruments depends on their
function. Where material flexibility is required (e.g., forceps), printing
in medical-grade PA with SLS, or titanium-base alloys with SLM/DMLS/
EBM produces detailed, fatigue-resistant instruments with a good
strength-to-weight ratio. When high stiffness is required (e.g., needle
driver, retractor, scalpel handle), instruments can be printed using
medical-grade glass-filled PA with SLS, or stainless steel with SLM,
DMLS or EBM. To produce plastic instruments with highly detailed
hinges, SLA is most appropriate.
Surgical guides are mainly constructed during preoperative plan­
ning; thus, long build time is not necessarily a limitation. Being based on
gross anatomy, high resolution is not a strict requirement. Fatigue-
resistance of surgical guides is not of critical importance for many ap­
plications, as they are single-use. Therefore, high-quality but costly
surgical guides can be produced using medical-grade PA with SLS
(Popescu and Laptoiu, 2016). Slightly more economical, highly detailed
guides can be produced using medical-grade acrylate resins with SLA
(Popescu and Laptoiu, 2016); ABS- or PC-like resin can potentially also
be used. Guides printed using medical-grade ABS or PPSF with FFF have
poorer mechanical properties and surface finish, but are produced faster
and at lower cost (Popescu and Laptoiu, 2016; Shi et al., 2007).
4.1.2.2. Assistive technologies. The primary requirements of prostheses,
15
T. Kermavnar et al.
orthoses and exoskeletons are their ability to withstand high forces and
repeated use, biocompatibility of parts in contact with skin, and good
strength-to-weight ratio. Resistance to disinfectant fluids can be
important as well, and in many cases the possibility of large build vol­
umes, complex geometry, good surface finish, and accessible price of the
end-product are also required. These conditions are best met by PA and
TPU printed with SLS, or titanium with SLM/DMLS/EBM where very
high forces are present. Due to the anisotropic nature of printed objects,
FFF is only appropriate for non-load-bearing parts that are not exposed
to repetitive mechanical loading.
4.1.2.3. Wearable technologies. The requirements of WT are similar to
those of AT, although not as high regarding product strength and
fatigue-resistance. Thus, various polymer materials can be printed using
SLA or DLP for small objects that require high resolution and good
surface finish, or the less expensive FFF for larger objects where poor
resolution and surface finish do not represent a drawback. The more
expensive MJ also offers high resolution and good surface finish. How­
ever, products built by MJ, SLA, and DLP are susceptible to UV and
thermal degradation over time. Both, FFF and MJ support simultaneous
printing of different materials which is an advantage. Some SLA printers
also allow for multi-material printing, but that is not typical for this
technology.
4.1.2.4. Hand tools. Tool handles and pHMI need to be relatively strong
and fatigue-resistant, and possibly resistant to disinfectant fluids, espe­
cially when they are intended for public use. For pHMI, high-resolution,
complex-geometry printing can be required, whereas tool handles
require good strength-to-weight ratio. For both, the possibility of multi-
material printing and good surface finish can be advantageous. Thus,
SLA and MJ of ABS-, PA-, PC- or PP-like materials meet the requirements
for highly detailed pHMI, and SLS of PA those of tool handles and
simpler, more robust pHMI.
4.1.2.5. Devices for ergonomics testing. Ergonomics-testing devices often
need to be highly durable to withstand repetitive use, but short pro­
duction time and high resolution are usually not required. Thus, PA, and
the more expensive PEEK, PEI, and TPU printed with SLS are a suitable
choice for such products. When anisotropicity of the printed part is not a
drawback, ABS, PC, or TPU can also be used with the more affordable
FFF. When surface smoothness at the interface with the human body is
essential, postprocessing (e.g., sanding and polishing) should be
considered, rather than the use of photopolymer-based technologies.
The latter are appropriate mainly when mechanical loading of the
printed object is expected to be low, but high fidelity and/or material
transparency are of key importance.
4.2. Product personalization
The possibility of quick, cost-effective fabrication and modification
of geometrically complex prototypes facilitates the integration of user
requirements and user testing in product development (Walker and
Maracaja, 2020). Thus, AM technology can advance ergonomics-based
UCD of products by enabling users to participate in the development
of highly personalized tools and devices, so that they are safe,
comfortable, efficient to use and aesthetically pleasing. This can help
solve important problems, particularly in the AT and medical fields, e.g.,
non-use or abandonment of purchased assistive device (Phillips and
Zhao, 1993), or the mismatch between personal preferences of surgical
approaches and the possibilities offered by standard surgical in­
struments. An example of the beneficial impact of user participation in
formal and aesthetic development of products is increased engagement
of AT users in device use and therapeutic process (Rosenmann et al.,
2018). Clinician involvement in medical instrument design could enable
mass customization of surgical instruments according to personal
16
Applied Ergonomics 97 (2021) 103528
preferences and operative techniques (George et al., 2017). Such cus­
tomization and enhanced functionality of instruments could, in turn,
make medical procedures easier, reduce operating time and improve the
clinician’s comfort, as well as minimize procedure invasiveness, thereby
optimizing clinical outcomes (Choi and Kim, 2015; Javaid and Haleem,
2018; Kumar et al., 2016).
With RE and AM, patients’ anatomy can be physically reproduced to
better understand the pathology and facilitate preoperative planning,
implant and bioartificial-tissue design, and medical education and
training (Hoang et al., 2016; Javaid and Haleem, 2018; Popescu and
Laptoiu, 2016; Rengier et al., 2010). The possibility of
surgical-instrument development based on preoperative virtual resec­
tion planning allows for direct transfer of the planned procedure to the
physical surgical field (Cartiaux et al., 2014; Wong et al., 2012). It can
also enable development of simple all-in-one solutions for bone resec­
tion and custom prosthesis reconstruction (Wong et al., 2012).
In general, the use of highly personalized objects based on in­
dividuals’ anatomy can increase comfort (e.g., in tool handles, pros­
theses and orthoses) and efficiency (e.g., positioning of patient-specific
surgical guide), but only for the person they are designed for. This can
present a drawback especially in the case of handles, based on a single
individual’s anatomy, such as those described by Tony et al. (2019) and
Tony and Alphin (2019). In addition, when using RE, inaccuracies of
digital models arising from scanning processes and the transfer to
Standard Tessellation Language (STL) need to be considered (Popescu
and Laptoiu, 2016). Moreover, lighting conditions and temperature
change may also result in changes in the scan data (Singh et al., 2016).
Geometrical data of the user’s body can be of limited value if obtained
incorrectly, e.g., when product shapes based on scanned geometry do
not consider tissue deformation that occurs at the contact of the body
with other objects (Reimer et al., 2014). Where the movement of the
scanner or the subject is present, medium resolution of scanning pro­
vides higher fitting accuracy than high resolution, due to high noise
common with the latter (Reimer et al., 2014).
4.3. Usability testing and iterative design
Usability and measures for quality in use are described in ISO stan­
dards (ISO 9241–11:2018; ISO/IEC 25022:2016). According to ISO/IEC
25022:2016, quality in use of a product can be measured by the effec­
tiveness (i.e., tasks completed, objectives achieved, errors in a task, tasks
with errors, and task error intensity), efficiency (i.e., task time, time
efficiency, cost-effectiveness, productive time ratio, unnecessary ac­
tions, and fatigue) and satisfaction (i.e., overall satisfaction, satisfaction
with features, discretionary usage, feature utilization, proportion of
users complaining, proportion of user complaints about a particular
feature, user trust, user pleasure, and physical comfort) of intended
users at achieving their goals. Of the 40 reviewed studies, two used
subjective qualitative evaluation methods only, and nine only objective
quantitative methods. In the former case, no quantifiable evaluation
criteria were used that would enable comparison of competing designs
in terms of effectiveness, efficiency or user satisfaction; whereas in the
latter case, user satisfaction with the product was not directly addressed.
Due to the ease of CAD-model sharing that allows for good reproduc­
ibility of studies, measurable objective and subjective results would
allow for comparison among similar studies, which could, in turn,
facilitate the development of effective ergonomic solutions.
Among the reviewed studies, only six employed iterative design
modifications. In UCD and HF, iterative design based on usability testing
is essential, as it leads to measurable improvements between the first
and last iterations (Bailey, 1993). Future studies employing AM in er­
gonomics could easily introduce multiple iterations in their design
process by choosing the appropriate AM process for early prototyping.
T. Kermavnar et al. Applied Ergonomics 97 (2021) 103528

4.4. Important considerations regarding the choice of AM technology and

Properties and applications of most common AM materials based on the reviewed studies, Lee et al. (2017), (Bourell et al., 2017), Guerin and Da Costa (2016), (Tappa and Jammalamadaka, 2018), and Honigmann et al.
(2018) (Simplify3D). ASA – Acrylic Styrene Acrylonitrile, ABS – Acrylonitrile Butadiene Styrene and ABS-like resin, PA – Polyamide (Nylon), PC – Polycarbonate and PC-like resin, PEEK – Polyether Ether Ketone, PEI – Poly­

Plus, TPU – Thermoplastic Polyurethane, Co-Cr – Cobalt-Chrome-base alloys, SSt – Stainless Steel, Ti – Titanium; BJ – Binder Jetting, DMLS - Direct Metal Laser Sintering, EBM – Electron Beam Melting, FFF – Fused Filament
ethylenimine, PLA – Polylactic Acid, PPSF – Polyphenylsulfone, PP – Polypropylene and PP-like resin, S1 – Stratasys Bio-Compatible Material, S2 – Stratasys Dental Material, S3 – Stratasys Fullcure RGD 720, S4 – Stratasys VeroWhite

BJ EBM FFF LENS LOM MJ SLA DMLS SLS

materials

£
£

£
£

£
£
Presently, several different AM technologies and materials are

£
£
available, each with their own advantages and disadvantages which
make them appropriate for some applications but not for others. Thus,

£
the choice of technology should be made on a case-by-case basis to

£
adequately address the most critical requirements of the printed object
(Redwood et al., 2017). It can be guided by cost and accessibility, ma­

£
£
terial choice, geometric accuracy, mechanical properties, durability, or
surface-finish quality of parts, or by other factors.

£
£
Across the reviewed studies, FFF was by far the most commonly used

AM PROCESS

£
£
£
£
£
£
£
£
£

£
AM technology, with PLA and ABS as the favored materials. ABS is
commonly chosen due to its high strength, toughness and impact

£
£
-resistance, flexibility, durability (Al-Dulimi et al., 2021; Tan et al.,

£
£
£

£
£
2020), and temperature-resistance, whereas PLA is favored for its
biodegradability, accessibility, and price (Pham et al., 2018). It is,

Fabrication, LENS – Laser Engineered Net Shaping, LOM – Laminated Object Manufacturing, MJ – Material Jetting, SLA – Stereolithography, SLS – Selective Laser Sintering.

High
cost
however, important to acknowledge the poor surface finish quality with

£
£

£
a distinct staircase effect typical for this technology, particularly when

(autoclavable)
Heat resistant
low-cost machines are used (Madden and Deshpande, 2015). Moreover,
the printed objects tend to have low tensile and flexural strengths, and
their mechanical properties are largely influenced by build orientation,
infill and raster orientation (Madden and Deshpande, 2015; Shih et al.,

£
£
£
£
£
£

£
£

£
£
2017; Vlasceanu et al., 2018). Support structures are also required that

resistance
can be difficult to remove in some cases. Thus, taking into consideration

chemical
its favorable cost, build time, and CAD-to-prototype ease (Madden and

Good
Deshpande, 2015), the most appropriate use of FFF in ergonomics is for

£
£
£
£
£

£
early-prototype production.

surface
SLS was the second most used technology, and PA the favored ma­

finish
Good
terial. PA is recognized particularly for its robustness (Tan et al., 2020)

£
£
and flexibility. It is important to note that SLS is characterized by grainy
surface finish which can be undesirable when the printed objects are in
dimensional
contact with sensitive tissues, especially for longer periods of time (e.g., accuracy
hearing aid), or when a certain amount of movement relative to the body
High

£
surface is expected during use (e.g., prosthetic socket). The surface
quality and resolution of SLS can also impair the movement of highly
weight ratio
strength-to-

detailed parts relative to each other (e.g., in hinges). However, it can be

advantageous when friction at the interface with the body needs to be
Flexible Good

£
£

£
high to prevent displacement of the device (e.g., colorectal stent).
Moreover, because powder-based technologies do not require additional
support structures, very complex parts can be produced using
£

£
£
non-assembly printing.
Apart from the smooth surface finish characteristic for SLA, its ac­
resistant
Impact

curacy was also found to be slightly better than that of SLS in previous
£
£
£
£
£
£

£
£
studies (Madden and Deshpande, 2015). However, SLS is more
cost-effective and requires no support structures that would have to be
Resistant to Resistant to
scratching

removed after printing (Madden and Deshpande, 2015). Both, SLA and
SLS do not provide sufficient strength of very small, thin parts (Madden
£

and Deshpande, 2015), therefore, metal-based AM technologies (e.g.,

SLM, DMLS, EBM) should be considered for such applications.
breakage

Finally, a common drawback of the technologies based on photo­

polymerization (i.e., DLP, MJ, SLA) is that they tend to produce brittle
£
£
£
£
£
£
£
£
£

£
£

objects that lose their mechanical strength with exposure to moisture

resistant
Biocompatible Fatigue-

and sunlight (Redwood et al., 2017). Thus, when smooth surface is

required, as well as good mechanical properties, these technologies can
£
£
£
£
£
£

£
£
£
£

be used to produce molds for casting of the desired materials. This

PROPERTIES

approach is especially useful for the production of silicone objects (e.g.,

earbuds, epitheses), also because very few 3D-printable materials with
properties similar to silicone are currently approved for human use.
£
£
£
£
£
£

£
£
£
£
£
£

£
£

To provide a quick reference, Tables 3 and 4 have been developed

comparing important properties of the most commonly used AM tech­
PEEK

PPSF

Vero
TPU
POLYMERS ASA
ABS

PLA
PET
PEI

Co-

SSt
PA
PC

PP

Cr

nologies and materials respectively. Quantitative data for AM technol­

Ti

ogies is provided in the Introduction (Table 1). It is of note that material

properties vary depending on the AM technology (Wong and Hernandez,
METALS
Table 4

2012).

17
T. Kermavnar et al.
4.5. Limitations
There may be other studies that fall outside the search and inclusion
criteria of this systematic review. However, we would expect the key
findings above to represent the current state regarding AM- technology
use in ergonomic product design.
5. Conclusions
Our systematic search identified 40 studies that reported on the use
of AM in ergonomic design of products and prototypes, the majority
from the fields of medical and assistive devices but also wearable de­
vices, hand tools, ergonomics-testing devices and others. The most
commonly used AM technologies and materials were FFF with PLA and
ABS, and SLS with PA.
AM technology in combination with reverse engineering enables
cost-effective manufacture of user-specific products regarding their
shape, size and aesthetics, among other attributes. The possibility of
quick fabrication and modification of prototypes was found to facilitate
iterative design based on user feedback, although very few studies
exploited this approach. Usability testing employed various combina­
tions of objective/subjective and qualitative/quantitative evaluation
methods. Most commonly used were objective quantitative methods,
followed by subjective quantitative methods. The majority of studies
employed more than one type of evaluation method.
Some advantages and disadvantages of 3D-scanning techniques, in­
dividual AM technologies and materials were identified, based on which
recommendations were made for future studies. Matrices were devel­
oped comparing properties of the most commonly used AM technologies
and materials to provide a quick reference.
Declaration of competing interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Acknowledgements
This publication has emanated from research supported under a
research grant from Science Foundation Ireland (SFI) under Grant
Number SFI 16/RC/3918 (CONFIRM Smart Manufacturing Research),
co-funded by the European Regional Development Fund, and the Na­
tional Children’s Research Centre in conjunction with the Irish Research
Council.
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