Cross-cultural analysis of movement patterns and work-related musculoskeletal disorders in Danish and Kuwaiti construction: Implications for targeted exoskeleton design

Cross-cultural differences in work-related musculoskeletal disorders (WMSDs) and movement patterns remain understudied despite their importance for developing targeted ergonomic interventions. This study quantifies and compares WMSD prevalence and movement pattern frequencies between construction workers in Kuwait and Denmark to inform culturally appropriate exoskeleton design. Using the Nordic Musculoskeletal Questionnaire (NMQ) and a custom Movement Pattern Frequency (MPF) survey assessing overhead work, prolonged standing, lifting, and other key activities, data were collected from 117 Kuwaiti and 47 Danish workers. Results revealed counterintuitive findings: Denmark showed higher WMSD prevalence across all body parts (66% vs 34.2% lower back pain), suggesting potential underreporting in Kuwait due to cultural and employment factors. Significant differences emerged in four movement patterns, with Kuwait workers reporting higher frequencies of overhead work and prolonged standing. Movement patterns correlated moderately with WMSDs in Denmark (ρ = 0.460, p < 0.001) but showed negligible correlation in Kuwait (ρ = –0.035), indicating cultural influences on health reporting behaviors. The results directly inform exoskeleton design and deployment strategies, with Denmark showing readiness for exoskeleton implementation targeting integrated movement patterns while Kuwait requires preliminary cultural and organizational interventions. This research provides practical guidance for developing culturally sensitive exoskeleton interventions in construction.