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Low back injury risk during repositioning of patients in bed: The influence of handling technique, patient weight and disability
Ergonomics
Abstract
The objective of the study was to investigate the low back load during repositioning of patients in bed and to assess the influence of patient's weight and disability. Nine female health care workers (HCWs) carried out six patient-handling tasks with different patient weight (59 +/- 1, 83 +/- 2 and 110 +/- 4 kg) and handicap (hemiplegia, paraplegia and near-paralysis). The tasks were performed with optional use of simple, low-tech assistant devices (draw and sliding sheets). Peak low back compression exceeded the National Institute for Occupational Safety and Health action level of 3400 N in 25% of all trials (418). The influence of the HCW, i.e. the technique and assistive devices used, was higher than the effect of weight and disability in all tasks studied. ANOVA showed that on average for the six tasks 37%, 10% and 6% of the variance in low back loading was caused by variation in the factors HCW, patient's weight and disability, respectively. The result of this study is relevant for HCWs. It is shown that the repositioning technique and use of friction-reducing devices have higher influence on the low back load of the HCW than the patient's weight and disability.
... Several studies have estimated spine loading on healthcare workers when performing the activities required to reposition patients in bed (Daynard et al., 2001;Schibye et al., 2003;Skotte et al., 2002;Skotte & Fallentin, 2008). These studies all consider boosting, lateral repositioning, and turning. ...
... Previous studies of patient repositioning had a great variety in the types of patients and caregivers included. Several studies of patient repositioning have included different patient weights but only some of those have reported results by patient weight or considered patient weight as a factor in the analysis (Fray et al., 2016;Skotte & Fallentin, 2008;Zhuang et al., 1999). When considering the caregiver, past studies included as many as 77 caregivers in an unbalanced experimental design and 12 caregivers in a full factorial design (Fragala & Fragala, 2014). ...
... Spine compression values from the current study were similar to those of the research group of Skotte and Fallentin (2008) that also used a dynamic biomechanical model with an optimization algorithm for estimating muscle recruitment. Spinal compression from the current study of 2,665 and 2,100 N when boosting and turning a 77-kg patient with a draw sheet was very similar to the respective estimates of 2,616 and 2,044 N by Skotte and Fallentin (2008). ...
Objective
The aim of the study was to estimate the risk of injury when repositioning patients of different weight with commonly used repositioning aids.
Background
Repositioning dependent patients in bed is the most common type of patient handling activity and is associated with high rates of musculoskeletal disorders in healthcare workers. Several studies have evaluated repositioning aids, but typically for a single patient weight and often without estimating risk of injury based on biomechanical analysis.
Method
Ten nurses performed four repositioning activities on three participants (50, 77, 141 kg) using three repositioning aids (pair of friction-reducing sheets [FRS], turn and position glide sheet, air-assisted transfer device) and a draw sheet. Motion capture, hand forces, and ground reaction forces were recorded. Spine loading was estimated using a dynamic biomechanical model.
Results
Hand forces and spine compression exceeded recommended limits for most patient weights and repositioning tasks with the draw sheet. FRS and glide sheet reduced these loads but still exceeded recommended limits for all but the 50-kg patient. Only the air-assisted transfer device reduced forces to accepted levels for all patient weights. Physical stresses were relatively low when turning patients.
Conclusion
Most repositioning aids are insufficient to properly mitigate risk of musculoskeletal injury in healthcare workers. Only the air-assisted transfer device was sufficient to adequately mitigate the risk of injury when moving patients of average or above-average weight.
Application
To safely move dependent patients, a robust solution requires mechanical lifts and may utilize air-assisted transfer devices for patient transfers.
... Our findings aligned with a larger study conducted among 5,017 Danish health care workers in eldercare, who had responded to baseline and follow-up questionnaires (Andersen et al., 2014), which found that persistent use of assistive devices reduced the risk of a back injury, a risk outcome of daily patient transfer. Other studies, performed under laboratory conditions, examined the effect of sliding sheet usage on back pain and disability when repositioning bedridden patients ( Jäger et al., 2013;Skotte & Fallentin, 2008), reaffirming the advantages of sliding sheets during manual patient handling. Jäger and colleagues (2013) built a biomechanical model to assess the lumbar load and the potential for load reduction by applying biomechanically "optimized" transfer modes such as sliding sheets instead of "conventional" techniques. ...
... Their results showed that highest compressive force values were found for conventional performances and lowest values when sliding sheets were applied. Furthermore, Skotte and Fallentin (2008) used also a biomechanical model for calculating the net torque at the L4/L5 joint and found that friction-reducing devices like sliding sheets had even higher influence on the low backload of the caregiver than the patient's weight and disability. ...
Background: Previous studies have discovered that the utilization of sliding sheets in patient care is a valuable technique for repositioning bedridden patients compared with traditional cotton sheets or carriers. Our aim was to examine the effects of sliding sheet usage on work-related musculoskeletal disorders and disability, perceived workload, burnout, and job satisfaction, among nurses and nursing assistants. Method: This repeated measurement study included 41 female nurses and nursing assistants from three internal medicine departments who provided direct patient care. Participants completed an eight-part questionnaire (demographics, Neck Disability Index, Quick Disability of the Arms, Shoulder and Hand Questionnaire, Modified Oswestry Low Back Pain Disability Questionnaire, BackAche Disability Index workload, burnout, and job satisfaction) 4 times during the study period: 3 months prior to the intervention, on the first day of the intervention, and 3 and 6 months after commencement of the intervention. Findings: After 3 and 6 months of sliding sheet usage, pain and disability decreased in the neck ( p < .001); arms, shoulders, hands ( p = .041); and lower back ( p < .001), with an increase in job satisfaction ( p < .001). Discussion/Application to Practice: The findings of our study indicate a clear influence of reducing work-related musculoskeletal pain and disability while increasing job satisfaction when sliding sheets are introduced into nursing practice. Occupational health nurses in health care should consider this type of low-cost intervention as a method for reducing musculoskeletal injury among direct patient care providers.
... Healthcare workers transferring patients, e.g., nurses and nurses' aides, are frequently experiencing back-related problems [9] often due to injuries occurring suddenly and unexpectedly during patient transfers. Several studies show an association between patient transfer and risk of back injury [10][11][12][13][14], and biomechanical studies confirm the high physical loading of the back during such work [15][16][17]. Across the European Union, healthcare workers rate their own health and safety as poorer than the rest of the working population [18], and qualitative interviews indicate that this negatively impacts quality of life and overall satisfaction with the job [19]. Altogether, back injuries can lead to long-term negative physical and psychological consequences [20]. ...
... However, another study showed equally reduced compression forces of the low-back using the ceiling and floor lifts [38]. Similarly, slings also reduce back compression forces albeit not as effectively as lifts [38], whereas utilizing the sliding sheet has been shown to reduce the biomechanical compression force on the low back [16]. In contrast, two recent systematic reviews of longitudinal intervention studies found limited evidence for preventive interventions with assistive devices to reduce musculoskeletal pain and injuries among healthcare workers [39][40][41], indicating that low physical loads and the availability of assistive devices are only a part of the puzzle. ...
The incidence of occupational back injury in the healthcare sector remains high despite decades of efforts to reduce such injuries. This prospective cohort study investigated the risk factors for back injury during patient transfer. Healthcare workers (n = 2080) from 314 departments at 17 hospitals in Denmark replied to repeated questionnaires sent every 14 days for one year. Using repeated-measures binomial logistic regression, controlling for education, work, lifestyle, and health, the odds for back injury (i.e., sudden onset episodes) were modeled. On the basis of 482 back injury events, a higher number of patient transfers was an important risk factor, with odds ratio (OR) 3.58 (95% confidence interval (CI) 2.51–5.10) for 1–4 transfers per day, OR 7.60 (5.14–11.22) for 5–8 transfers per day, and OR 8.03 (5.26–12.27) for 9 or more transfers per day (reference: less than 1 per day). The lack of necessary assistive devices was a common phenomenon during back injury events, with the top four lacking devices being sliding sheets (30%), intelligent beds (19%), walking aids (18%), and ceiling lifts (13%). For the psychosocial factors, poor collaboration between and support from colleagues increased the risk for back injury, with OR 3.16 (1.85–5.39). In conclusion, reducing the physical burden in terms of number of daily patient transfers, providing the necessary assistive devices, and cultivating good collaboration between colleagues are important factors in preventing occupational back injuries among healthcare workers.
... During a partnered MT of the 82-kg patient, the hand force required by T-A equated to 97% of maximum acceptable hand force estimated using the Arm Force Field (La Delfa & Potvin, 2017) approach. Although this suggests that a margin of safety of 3% remains, it is likely that such a margin would diminish quickly with a heavier patient, where patient weight has been shown to influence exposure to caregivers (Skotte & Fallentin, 2008;Wiggermann, 2016). As a result, when using hand force as a surrogate measure of MSD risk associated with manual patient turning, even when using a partnered approach, T-A may still be exposed to an elevated MSD risk. ...
... On the basis of compression and shear force estimates, many patient handling tasks have been shown to exceed recommended threshold limits for compression and shear forces acting on the lower back (McGill et al., 1998;Schibye et al., 2003;Waters et al., 1993). However, consistent with previous research specific to patient turning (Skotte & Fallentin, 2008;Wiggermann, 2016), our results indicate that the internal exposures on the spine are well below the accepted threshold limits (3,400 N for compression and 500 N for shear), regardless of the bed type or caregiver role (McGill et al., 1998;Waters et al., 1993). Nonetheless, it is important to note that turn-assist surfaces reduced internal exposure to the spine, particularly for T-T. ...
Objective:
To quantify differences in physical workload afforded by turn-assist surfaces relative to manual patient turns, and between nursing caregivers (turn-away vs. turn-toward) while performing partnered patient turning.
Background:
Nurse caregivers experience an increased risk of musculoskeletal injuries at the back or shoulders when performing patient-handling activities. Use of turn-assist surfaces can reduce the physical burden and risk on caregivers.
Method:
Whole-body motion capture and hand force measures were collected from 25 caregivers (17 female) while performing partnered manual and technology-facilitated turns. Shoulder and low back angles and L4/L5 joint contact forces were calculated at the instant of peak hand force application for both caregivers.
Results:
Hand force requirements for the turn-away caregiver were 93% of the estimated maximum acceptable force when performing a manual turn. Use of a turn-assist surface eliminated hand forces required to initiate the patient turn for the turn-away caregiver, where their role was reduced to inserting appropriate wedging behind the patient once the facilitated turn was complete. This reduced shoulder moments by 21.3 Nm for the turn-away caregiver, a reduction in exposure from 70% of maximum shoulder strength capacity to 15%. Spine compression exposures were reduced by 302.1 N for the turn-toward caregiver when using a turn-assist surface.
Conclusion:
Use of a turn-assist surface reduced peak hand force and shoulder-related exposures for turning away and reduced spine-related exposures for turning toward.
Application:
Turn-assist devices should be recommended to decrease the risk of musculoskeletal disorder hazards for both caregivers when performing a partnered patient turn.
... When attempts are made to manually reposition patients in bed, it has been well documented that caregivers are at high risk for musculoskeletal injuries (Coggan, Norton, Roberts, & Hope, 1994;Collins, Nelson, & Sublet, 2006;Engkvist, Hagberg, Linden, & Malker, 1992;Enos, 2003;Harber et al., 1985;Hignett, 1996;Jensen, Nestor, Myers, & Rattiner, 1988;Khuder, Schaub, Bisesi, & Krabill, 1999;Knibbe & Friele, 1996;Ljungberg, Kilbom, & Hagg, 1999;Pheasant & Stubbs, 1992;Pompeii, Lipscomb, Schoenfisch, & Dement, 2009;Skotte & Fallentin, 2008;Trinkoff, Lipscomb, Geiger-Brown, & Brady, 2002). Both workers' posture and the weights involved in repositioning place excessive forces on caregivers' musculoskeletal structure. ...
... The tasks were performed with the optional use of simple, low-tech assistant devices (draw and sliding sheets). Peak low back compression exceeded the National Institute for Occupational Safety and Health (NIOSH) action level of 3400 newtons in 25% of 418 trials (Skotte & Fallentin, 2008). ...
Repositioning patients in bed presents an occupational hazard to direct care nursing staff. Much research has been conducted in the area of safe patient handling and movement. However, little progress has been made in reducing risks associated with patient repositioning, especially pulling patients toward the head of the bed. This laboratory study investigated risk reduction achieved by introducing the gravity assist feature into bed system design for post-acute health care. Through the application of gravity assist, the amount of work required to reposition a simulated 200-pound patient was reduced by 67%. This reduction in work should reduce some of the occupational risk for nurses.
... Common manual patienthandling tasks include lifting, repositioning, and transferring a patient from a bed to another location (another bed, wheelchair, bathtub, or toilet). Previous studies found that these manual patienthandling tasks substantially increased caregivers' physical stress and discomfort, especially in their upper extremities and low-back regions (Drew, Kozey, & Moreside, 2015;Garg, Owen, Beller, & Banaag, 1991;Marras et al., 1999;Skotte & Fallentin, 2008). ...
... To reduce these physical stresses during manual patient handling, various engineering controls, such as friction-reducing slide sheets, slide boards, and air-assisted transfer devices, have been developed and evaluated (Bartnik & Rice, 2013;Drew et al., 2015;Pellino, Owen, Knapp, & Noack, 2006;Skotte & Fallentin, 2008;Weiner, Kalichman, Ribak, & Alperovitch-Najenson, 2017). These studies demonstrated that these engineering controls further reduced hand forces and perceived exertion of caregivers compared with conventional cotton draw sheets. ...
Objective::
The aim of this study was to evaluate the efficacy of commercially available friction-reducing patient-transfer devices in reducing biomechanical stresses on caregivers and patients.
Background::
Caregivers suffer from high prevalence of work-related musculoskeletal disorders, which is associated with manual patient handling. However, there is not enough information available on the efficacy of various friction-reducing devices in reducing biomechanical stresses in the upper extremities and low back.
Method::
During patient-transfer tasks performed by 20 caregivers, we measured hand force; shoulder and trunk posture; shoulder moment; muscle activity in the flexor digitorum superficialis, extensor digitorum communis, biceps, triceps, trapezius, and erector spinae; and usability ratings from four devices: a draw sheet, a repositioning sheet, a slide board, and an air-assisted device. In addition, triaxial head acceleration of mock patients was measured to evaluate patients' head acceleration.
Results::
The slide board and air-assisted device significantly reduced hand force ( p < .001), shoulder flexion ( p < .001), shoulder moment ( p < .001), muscle activities of caregivers ( p < .004), and patients' head acceleration ( p < .023) compared with the draw sheet. However, no significant differences in biomechanical measures were found between the repositioning and draw sheets. The air-assisted device consistently showed the lowest biomechanical stresses and was most preferred by participants.
Conclusion::
Reduction in caregivers' biomechanical stresses and mock patients' head acceleration indicates that a slide board and an air-assisted device can be effective engineering controls to reduce risk of injury.
Application::
The study results can provide a recommendation for engineering controls to reduce biomechanical stresses for both caregivers and patients.
... A recent systematic review showed that, among all healthcare tasks, patient transfer is associated with the greatest risk for developing lowback pain (LBP) and injuries among nurses and nursing assistants (9). Shedding light on the mechanisms, biomechanical studies show high loadings on the spine during patient handling, which often exceeds the 3400 N safety limit recommended by the National Institute of Occupational Safety and Health (10)(11)(12)(13). ...
... Although perceived changes from behavioral interventions should be interpreted with caution, the present subjective measures suggest that improvements in technique and quality of the patient transfer, as well as associated use of AD, may have occurred following the intervention, regardless of how often the AD were used. This is supported by a biomechanical investigation (10) showing that the between-subject variation in low-back compression forces during patient handling, in situations with and without AD, is high, and may not only be related to muscle strength or anatomical differences. This indicates that there seems to be individual differences in patient handling techniques and quality, which may be improved through better communication and guidance in the use of AD. ...
Objectives This randomized controlled trial (RCT) evaluated the effect of a participatory organizational intervention for improved use of assistive devices (AD) in patient transfer. Methods We randomly allocated 27 departments from five hospitals in Denmark to a participatory intervention (14 clusters, 316 healthcare workers) or a control group (13 clusters, 309 healthcare workers). The intervention consisted of 2×2 hour workshops with managers, the hospital's health and safety staff, and 2-5 healthcare workers from each department. Based on an assessment of barriers and solutions conducted prior to randomization, participants developed an action plan for implementing department-specific solutions for improving the use of AD. Use of necessary AD (using digital counters as primary outcome), and general use of AD (using accelerometers as secondary outcome), pain intensity in the low-back, work-related back injuries during patient transfer, and communication and guidance in the use of AD were measured at baseline, 6 and 12 months. Results Use of necessary AD (primary outcome), low-back pain, and back injuries did not change in the intervention compared with control group at 12-month follow-up. However, general use of AD measured with accelerometers as well as communication and guidance improved significantly in the intervention versus control group. Conclusion The intervention did not result in more frequent use of the necessary AD but led to more general use of AD, as well as increased communication and guidance.
... However, complete avoidance of manual lifting was the most important factor (Martin et al., 2009;Schoenfisch et al., 2013), e.g. by implementing no-lifting policies. Even low-tech devices (draw and sliding sheets) may reduce the risk independently of patients' weight and disability (Skotte and Fallentin, 2008a). Several studies have suggested that easy access to a variety of patient-handling equipment, adequate ergonomic training and managerial focus on the physical work environment may reduce the frequency and duration of nurses' physical health problems and absence from work (Essendrop et al., 2002;Holm and Wendelboe Johannsen, 2004;Lyng, 2007;Tullar et al., 2010). ...
... In the literature there is generally agreement that patienthandling is associated with an increased risk of low-back pain and injuries among nursing staff (Brandt and Bjørnskov Hansen, 2011;Faber Hansen et al., 2004;Fallentin et al., 2007a;Jensen, 1998;Skotte and Fallentin, 2008a). A large prospective cohort study from Denmark showed that nurses with daily patienthandling tasks had almost twice the risk of sustaining workrelated back injuries compared with nurses without daily patienthandling (Andersen et al., 2014). ...
This study evaluated an intervention for patient-handling equipment aimed to improve nursing staffs' use of patient handling equipment and improve their general health, reduce musculoskeletal problems, aggressive episodes, days of absence and work-related accidents. As a controlled before-after study, questionnaire data were collected at baseline and 12-month follow-up among nursing staff at intervention and control wards at two hospitals. At 12-month follow-up, the intervention group had more positive attitudes towards patient-handling equipment and increased use of specific patient-handling equipment. In addition, a lower proportion of nursing staff in the intervention group had experienced physically aggressive episodes. No significant change was observed in general health status, musculoskeletal problems, days of absence or work-related accidents. The intervention resulted in more positive attitudes and behaviours for safe patient-handling and less physically aggressive episodes. However, this did not translate into improved health of the staff during the 12-month study period.
... Various ergonomic devices have been developed over the past few years to assist in reducing the mechanical load during patient handling activities (Skotte and Fallentin, 2008;Drew et al., 2016). For example, the use of friction-reducing sliding sheets has reduced the risk of musculoskeletal injury among caregivers when compared to traditional cotton sheets, due to lower spinal compression (Bartnik and Rice, 2013). ...
... Despite the importance of assistive devices for safe repositioning of patients in bed, their impact on the nurses' body structure has not been adequately studied (Peterson et al., 2007;Skotte and Fallentin, 2008). Furthermore, Freiberg and his colleagues (Freiberg et al., 2016), following a systematic literature search, claim that there is no convincing evidence (from low-quality studies) for the preventability of musculoskeletal complaints and diseases by the use of small aids (bed ladders, anti-slide mats, slide boards/transfer, boards, handling belts/gait, transfer mats, slide sheets, and slings). ...
Repositioning of passive patients in bed creates health risks to the nursing personnel. Therefore, appropriate assistive devices should be used. Our aim was to find the optimal assistive device for reducing musculoskeletal load while moving a passive patient in bed. Torso kinematic inputs evaluated by the Lumbar Motion Monitor (LMM) and perceived load (Borg scale) were measured in female nurses performing 27 patient transfers [represented by a mannequin weighing 55 (12 nurses), 65 (24 nurses) and 75 kg (12 nurses) in bed] using a regular sheet, a sliding sheet and a carrier. The lowest rates of perceived exertion were found when the sliding sheet and/or carrier were used, for all tasks (p ≤ 0.009). According to the predicted risk for Low Back Disorder (LBD) based on the LMM inputs, negligible differences between assistive devices were found. In a 75 kg mannequin, the participants were able to perform all tasks only by using a sliding sheet. Utilizing sliding sheets is an advantageous technique in comparison to traditional cotton sheets and even carriers.
... Patients may experience increased shear and friction forces and a reduction in therapeutic torso angle. 2 Caregivers may be required to reposition patients up in bed frequently, a patient handling maneuver that has been shown to cause musculoskeletal disorders. 3,4 Although pressure ulcer etiology is multifactorial in nature, shear forces caused by HOB elevation were defined as one of the primary causes of pressure ulcers as early as 1958 ...
... Repositioning patients in the bed is one of the most risky tasks that caregivers perform. 3,4 Therefore, by reducing overall patient migration, the numbers of occurrence for pull up in bed maneuvers may also be reduced. Supplemental Digital Content Table (available at: http://links.lww.com/ ...
Patient migration, or the amount of movement toward the foot of the bed, has been shown to significantly vary because of the mechanical design differences in hospital beds. Previously, the amount of migration was measured immediately following head-of-bed articulation in healthy subjects. This study not only evaluates how much migration occurs immediately after head-of-bed articulation but also measures additional migration during a standard 2-hour repositioning period in subjects with limited mobility.
... The purpose of this study was to determine the peak compressive and shear forces on an intervertebral disc between the L5 and S1 vertebrae of the caregiver during patient repositioning, and to discuss potential risks of the patient repositioning activity. We first found that the peak compressive and shear forces during patient repositioning were 43% and 81% smaller than the NIOSH safety criterion (1, [9,[19][20][21][22]. Collectively, our results suggest that the patient repositioning may be considered a relatively safe activity. ...
... This is where the results from the present study make their muchneeded entrance. Previously, it has almost solely been the results of laboratory studies illuminating the estimated load of various types of transfer, but even during these circumstances, details are sorely lacking (45)(46)(47)(48)(49). While the methodologies cannot be directly compared, it should be highlighted that the 3D biomechanical evaluation study by Skotte et al. report similar findings: the authors state that patienthandling tasks could classified into three groups characterized by lifting, repositioning or turning, with a corresponding gradual decrease in low-back loading (46). ...
Purpose
Work-related musculoskeletal disorders are prevalent among healthcare workers. These workers experience high rates of low-back pain; partly due to the high physical demands of patient transfers. Understanding the specific transfer scenarios that contribute to high physical loads is therefore crucial for developing strategies to improve working conditions.
Methods
This study utilized electromyography to measure muscle activity in the erector spinae muscles during patient transfers, performing measurements in real-life hospital settings to identify the physical load associated with different transfer scenarios. Using linear mixed models, the 95th percentile ranks of the normalized root mean square (nRMS) values were analyzed for a range of different patient transfers.
Results
The results revealed significant differences in physical load across various patient transfer scenarios. High-load activities included sitting to lying down or lying down to sitting (nRMS 32.7, 95% CI: 28.9–36.6) and lifting the upper body (32.4, 95% CI: 28.8–35.9), while low-load activities such as supporting patients while walking or standing (21.9, 95% CI: 18.6–25.1) and mobilizing in bed (19.9, 95% CI: 16.1–23.8) required less muscle activation. Moderate-load activities included bed to chair transfers (28.1, 95% CI: 24.9–31.3) and lifting the head (26.3, 95% CI: 22.7–29.9).
Conclusion
Understanding the physical load associated with different patient transfer scenarios allows for better organization of work in healthcare settings. These novel findings emphasize the need for effective task allocation, rotational schedules, and the use of assistive devices to distribute physical load and reduce injury risk.
... These injuries are strongly linked to job tasks requiring forceful exertion, repetitive movements, and awkward postures [9]. Manual transfers, which involve lifting and moving the care recipient, often exceed safe limits for back forces, exposing caregivers to increased biomechanical risks, including compressive and shear forces on the lumbar spine [2,10,11]. During manual transfers, caregivers spend approximately 25% of their time in a trunk flexion greater than 30 degrees, leading to repetitive awkward bending and rotation of the trunk [6,7,12]. ...
Background: Caregivers experience high rates of occupational injuries, especially during wheelchair transfers, which often result in back pain and musculoskeletal disorders due to the physical demands of lifting and repositioning. While mechanical floor lifts, the current standard, reduce back strain, they are time-consuming and require handling techniques that subject caregivers to prolonged and repeated non-neutral trunk postures, increasing the risk of long-term back injuries. Aims: The aim was to assess the time efficiency and ergonomics of the powered personal transfer system (PPTS), a robotic transfer device designed for bed-to/from-wheelchair transfers. Methods: We evaluated transfers with the PPTS and mechanical lift with eight able-bodied participants who assisted with transfers between a bed and a wheelchair. Inertial measurement units (IMUs) were placed on participants to track their motion and assess trunk joint angles during transfers. Results: The PPTS significantly reduced the transfer time (144.31 s vs. 525.82 s, p < 0.001) and required significantly less range of motion for trunk flexion (p < 0.001), lateral bending (p = 0.008), and axial rotation (p = 0.001), all of which have been associated with back injuries. Additionally, the PPTS significantly reduced the time caregivers spent in non-neutral trunk postures, potentially lowering injury risks. Conclusions: These findings suggest that the PPTS improves transfer efficiency and caregiver safety, offering a promising alternative to the current standard of care for wheelchair-to/from-bed transfers.
... In-bed patient handling activities are one of the most frequent activities performed by healthcare workers [5,15,16]. This typically involves repositioning supine patients, such as repositioning up in bed (boosting), lateral repositioning and turning [17,18]. The initial friction of the patient against the bed could increase the risk of overexertion while caregivers are pushing or pulling their patients [5,6,19]. ...
This study evaluated the effects of a back-support exoskeleton on the trunk and hip joint angles, lower back muscle activity and heart rate during four patient handling tasks: assisting a patient from sitting to lying, laterally repositioning the patient and turning the patient in two directions. Eight participants performed these tasks with and without the exoskeleton. Results demonstrated a significant reduction in the lower back muscle activity, but less pronounced effects for other tasks involving minimal trunk flexion. Hip flexion angles were reduced for all tasks when the exoskeleton was worn. The amount of reduction in the muscle activity and changes in the trunk and hip angles varied by task. The exoskeleton did not affect the heart rate across all tasks. The exoskeleton appeared to be more effective in tasks requiring substantial trunk flexion, indicating its potential benefits for reducing lower back muscle strain during such activities.
... However, another study found similar reductions in compression forces on the low back when using both ceiling, floor lifts and sliding sheets (Holmes et al., 2010). Two longitudinal intervention studies have found limited evidence supporting preventive interventions with assistive devices in reducing musculoskeletal pain and injuries among healthcare workers (Skotte & Fallentin, 2008). ...
Healthcare providers face numerous challenges in lifting and mobilizing overweight and obese patients, which often lead to musculoskeletal disorders (MSDs). To address this, hospitals implement safe patient handling and mobility (SPHM) programs, including mechanical lift equipment, policies, and training. This study surveyed 134 healthcare workers in five Veterans Administration Medical Centers who regularly used SPHM programs. According to findings, handling bariatric patients frequently correlated with higher chronic back pain risk. Injuries occurred when not using powered equipment. Improvements like sufficient time with equipment and clear policies reduced injury likelihood. Equipment was crucial in preventing musculoskeletal injuries and pain. Findings emphasize using powered equipment and updating SPHM programs based on worker feedback for better patient handling practices.
... A recent study reported that arm forces and spine compression exceed safe limits when repositioning people in bed [35,36]. The PPTS presents a significant advantage in this regard by eliminating the need for manually repositioning the care recipient between the head and foot of the bed. ...
Caregivers that assist with wheelchair transfers are susceptible to back pain and occupational injuries. The study describes a prototype of the powered personal transfer system (PPTS) consisting of a novel powered hospital bed and a customized Medicare Group 2 electric powered wheelchair (EPW) working together to provide a no-lift solution for transfers. The study follows a participatory action design and engineering (PADE) process and describes the design, kinematics, and control system of the PPTS and end-users’ perception to provide qualitative guidance and feedback about the PPTS. Thirty-six participants (wheelchair users (n = 18) and caregivers (n = 18)) included in the focus groups reported an overall positive impression of the system. Caregivers reported that the PPTS would reduce the risk of injuries and make transfers easier. Feedback revealed limitations and unmet needs of mobility device users, including a lack of power seat functions in the Group-2 wheelchair, a need for no-caregiver assistance/capability for independent transfers, and a need for a more ergonomic touchscreen. These limitations may be mitigated with design modifications in future prototypes. The PPTS is a promising robotic transfer system that may aid in the higher independence of powered wheelchair users and provide a safer solution for transfers.
... While, the size of the workforce is also under pressure, with recruitment and retention of staff causing concern in many quarters [Buerhaus, 2009]. That said, the type of lifting technique, and whether or not the clinician elects to use a frictionreducing device, can be more important in terms of the load borne by the lower back than either the patient's weight or dependency [Skotte and Fallentin, 2008]. Unfortunately, while healthcare providers are generally very aware of the risks and do encourage the use of safe patient handling techniques, or 'no lift' policies, the injury statistics suggest that compliance may be less than ideal. ...
Pressure Ulcer (PU) Prevention Guidelines typically recommend that vulnerable patients be physically repositioned every 2-4 hours, although the risk of caregiver injury is rarely discussed. Some guidelines, concerned with the fabric and construction of slings, continue to mandate the removal of lift equipment from beneath the patient after use and, despite a weak evidence base, this might lessen repositioning frequency and discourage safe practice. A pragmatic solution may be a flexible, breathable, quick-drying, low-friction lift sheet, designed to work in synergy with a pressure-redistributing mattress and which replaces the standard sheet. A series of standardised laboratory tests compared key performance characteristics of two sheet textiles: a 100% cotton hospital bed sheet and the Maxi Transfer™ sheet, a novel synthetic lift sheet. Results showed that when compared to the cotton sheet, the synthetic sheet was more breathable, had lower heat retention properties, superior wicking and better synergy with the therapeutic mattress. Regular repositioning, the cornerstone of PU prevention, is most likely to occur when clinicians have immediate access to lifting equipment. Replacing the standard bed sheet with an advanced textile, lifting device, may positively impact concordance with repositioning protocols, improve tissue microclimate and so improve patient outcomes and, importantly, caregiver safety.
... The present finding is in line with a previous study, where turning the patient was identified as a procedure with the highest WMSDs exposure (72.69%) and very high-risk using the Quick Exposure Check method (Yan et al., 2017). In contrast, another study that applied the 3-dimensional (3D) biodynamic model showed that turning the patient subtask had a lower risk (L4/L5 mean peak compression force: 2044 ± 399N) compared to transverse repositioning (mean peak of 3167 ± 939N) (Skotte and Fallentin, 2008). These disparities could be attributed to the absence of assistants during the repositioning task in the reviewed study. ...
Bed to stretcher patient transfer by nurses involves significant manual force at various postures and could lead to work-related musculoskeletal disorders (WMSDs). Motorized Patient Transfer Device (MPTD) is a newly available patient transfer intervention and its WMSDs risk have not yet been studied. The existing REBA assessment is unable to track the continuous load changes and to represent the actual load applied. The load cell set-ups in previous studies were unable to obtain the hand forces of lateral pushing. This study aimed (1) to identify and compare the hand forces for all the subtasks involved in sliding board and MPTD using the data from force plates and IMUs; (2) to evaluate the REBA score by using both instantaneous measured force and constant estimated force settings within a cycle of patient transfer task; and (3) to evaluate the WMSDs risk of the sliding board and MPTD. Seven nurses carried out all the tasks using the MPTD and the sliding board. Postural angles and external forces from the nurses were measured using Inertial Measurement Units (IMUs) and force plates, respectively, as the inputs for the automated REBA system. The hand force was comparatively higher for the subtasks of the lateral pushing (302.64 ± 136.45N) and lateral pulling (359.67 ± 150.14N) compared to the rest of the subtasks. The constant estimated force notably underestimated the REBA score for the lateral pushing by 1.76 points (95% Confidence Interval; CI [1.42, 2.10], p < 0.001). MPTD significantly reduced the mean peak REBA score by 4.21 (95% CI [3.77, 4.65], p < 0.001) and external force acting on the nurses by 180.41N (95% CI [111.68, 249.14], p < 0.001) compared to the sliding board. These findings proved that MPTD can reduce the WMSDs risk, pushing, and pulling force for the patient transfer.
Relevance to the industry: MPTD should be implemented in the hospital for the lateral transfer instead of using the sliding board. Its main benefit is eliminating the strenuous subtasks of lateral pushing and pulling. It can handle any type of patient such as bedridden, dependent, big size or overweight patient.
... Between 2000 and 2008 research into occupational biomechanics grew from predominantly static models, which were nonetheless able to estimate the compressive force acting on the lumbar intervertebral discs, to multidimensional models that explored the dynamics of movement; for the lumbar spine such models have underscored the importance of physical exposure factors in relation to the risk of low back pain in the health care sector (Skotte and Fallentin 2008;Marras 2008, Jager et al. 2013). ...
This study examines the evolution of MAPO method for estimating the frequency of overloading tasks in healthcare workers during different shifts.
The data presented were collected from 51 in-patient wards (25 hospitals and 26 nursing homes), and 917 workers: the frequency of MPH tasks is a complementary value to the MAPO exposure level, which is useful to implement a prevention plan targeted toward the reduction of overloading tasks. Based on the frequency of manual patient handling, it appears that the afternoon shift is at greatest risk, with tasks liable to cause overloading occurring within a frequency range of 70-85 per worker.
The study analyzes different pieces of equipment and their relative percentages of use, concluding that, overall, they are underutilized (especially minor aids and height-adjustable beds).
Practitioner summary The organizational data collected in hospitals and nursing homes confirms the availability of patient handling aids and equipment, but also indicates that they are underutilized with respect to the frequency of overloading tasks.
... In formal care settings, ergonomic tools such as powered hospital beds, powered lifts, slide sheets, inflatable transfer equipment, and slide boards have been introduced to reduce mechanical loading while performing patient handling tasks (Drew et al., 2015;Evanoff et al., 2003;Skotte and Fallentin, 2008). Among these devices, slide sheets may be the least costly and most readily accessible intervention for informal caregivers. ...
Manual patient handling tasks put formal and informal caregivers at risk of musculoskeletal injury. Intervention research to reduce risks to informal caregivers is limited. This study examined effects of slide sheet use when individual informal caregivers performed patient boosting and turning tasks. Three methods of slide sheet use and a baseline method (no slide sheet) were compared, to reposition a 70 kg individual. Muscle activity, ground reaction force, posture, and rating of perceived exertion were significantly affected by task method. Erector Spinae activity was reduced in boosting and turning away tasks with the slide sheet. Shoulder elevation, torso angle, and normalized vertical ground reaction force were also reduced with the slide sheet during boosting. The turn towards task was generally not improved with the slide sheet. Overall, using a slide sheet provided biomechanical benefits to individual caregivers performing two common patient handling tasks: boosting and turning patient away from caregiver.
... A força exercida para a realização destas tarefas depende não só do peso da vítima, mas também de outros fatores tais como o peso da maca, o peso do equipamento médico e o número de indivíduos envolvidos na movimentação. Cada vítima é singular, tem peso e dimensões corporais distintas; alguns conseguem colaborar no movimento, outros não, dependendo da situação de saúde em que se encontram (Taylor, Skotte, & Fallentin, 2008 . ...
Os Técnicos de Emergência Pré-Hospitalar estão sujeitos a uma grande diversidade de situações, vendo-se muitas vezes obrigados a atuar rapidamente e sob condições de pressão, tornando esta profissão altamente exigente. Este estudo foca-se na análise da perceção dos sintomas músculo-esqueléticos destes técnicos, em função dos fatores sociodemográficos e dos fatores de risco psicossociais. Este estudo transversal foi baseado num questionário que inclui os fatores sociodemográficos, a versão média
portuguesa do Copenhagen Psychosocial Questionnaire II, e a versão portuguesa do Questionário Nórdico Músculo-Esquelético. A amostra é composta por 51 Técnicos de Emergência Pré-Hospitalar pertencentes ao Instituto Nacional de Emergência Médica. A idade média da amostra é de 35.7 anos e 70.6% dos elementos são do sexo masculino. A presença de sintomas músculo-esqueléticos foi mais evidente na região lombar, seguida da região dorsal e dos ombros. Foram identificadas diferenças estatisticamente significativas, em pelo menos um segmento, em 16 das 22 escalas analisadas. Essas diferenças foram encontradas principalmente nos segmentos dos ombros, zona cervical e dorsal, revelando, nestes casos, uma associação entre os sintomas músculo-esqueléticos e os fatores de risco psicossociais. O investimento na melhoria do ambiente psicossocial de trabalho é essencial, de modo a reduzir a presença de sintomas músculo-esqueléticos.
Emergency Medical Technicians deal with a wide variety of situations, having frequently to perform their tasks in a fast pace of work and under pressure, making their job highly demanding, both on a physical and emotional level. This paper focuses on analysing the perception of musculoskeletal symptoms among these professionals, based on the socio demographic characteristics and psychosocial risk factors. This study was built on a cross-sectional questionnaire that comprised socio-demographic characteristics, the Portuguese medium version of Copenhagen Psychosocial Questionnaire II and the Portuguese version of the standardized Nordic Musculoskeletal Questionnaire. The sample included 51 Emergency Medical Technicians from the Portuguese National Institute of Medical Emergency. The average age of the sample was 35.7 years and 70.6% of it were male professionals. The presence of musculoskeletal symptoms was higher in the low back area, followed by the upper back and shoulders sections. There were found statistical differences, at least in one section, in 16 of the 22 analysed scales, mainly in the shoulders, neck and upper back sections, revealing an association between musculoskeletal symptoms and psychosocial risk factors in these cases. Investing in the improvement of the psychosocial work environment it’s a necessary action to avoid and reduce the musculoskeletal symptoms.
... In both turn assist and manual turning conditions, peak L5/S1 compressive load and peak hand force were low relative to the 3400 N and 255 N injury thresholds, indicating low risk of injury in the turning activity. The spinal load and hand forces observed in the current study for manual turning were consistent with that of previous studies (Table 2), especially when considering differences in patient weight, repositioning methods, and instrumentation (Budarick et al., 2019;Skotte and Fallentin, 2008;Vieira and Kumar, 2009;Wiggermann, 2016). ...
Repositioning patients in bed is the most common patient handling activity and is associated with musculoskeletal disorders in caregivers. Hospital bed features may mitigate the risk of injury. The current study investigated the effect of bed features on the physical stress on caregivers. Ten nurses were recruited to perform three repositioning activities. Hand forces were recorded, and spine loading was estimated using a dynamic biomechanical model. Results demonstrated that except for the peak L5/S1 compressive load in the turning task, the use of assistive features significantly reduced the physical stresses for all repositioning activities. However, recommended thresholds for injury were still exceeded in many conditions. Compared with spinal load, hand force was much higher relative to the injury thresholds, suggesting a greater risk of shoulder and upper extremity injuries than low back injury. Mechanical lift equipment remains the safest and most robust way to reposition a patient.
... Although all this depends on many factors, primarily the organization of work and the health system infrastructure, the fact is that in modern medicine, the focus must be on the prevention of musculoskeletal disorders, which will ultimately lead to benefits for the employer himself, but also enable better quality of work. With all of the above, the physiological changes in the musculoskeletal system that accompany females (still the majority of nurses are females) further complicate this problem (13,14,15). Workplace optimization is an imperative. ...
Background: The use of trolleys for transporting the patients and lifting and lowering them in the trolley is a repeated activity in the daily work of a nurse, and a very common cause of the load of the lumbosacral part of the spine and the consequent pathological deformity, and the onset of clinical symptomatology of painful lumbo-sacral syndrome. The high level of excessive biomechanical stress is associated with the established practice of using standard medical wheelchairs to move patients inside the hospital. The process itself depends on the characteristics of the patient, his or her weight, as well as his/her cooperativeness, but primarily depends on the nurse's mobility. Although nurses strive to be in a position that reduces the load on the lumbosacral part of the spine during practice, this is often impracticable due to the patient's inconsistency. Objective: To present the ergonomic analysis of the medical nurse's workplace while lifting the patient into the wheelchair and to display solution for improving working conditions and prevention of musculoskeletal disorders. Results: By ergonomic module of this software, we got results that present load on lumbosacral region of spine of medical nurses during their daily activities, especially in the position of lifting and lowering patients. It was concluded that maximal spinal loading decreases significantly and becomes less than critical (3,100 N) in the case of a wheelchair that has ability to automatically lift and lower patient. Conclusions: The use of hospital wheelchairs with an mechanism for the automatic lifting and lowering of patients and with a sliding seat will reduce the load on the lumbosacral region of the spine, prevent the onset of lumbosacral pain syndrome, facilitates work for the medical nurse and allows nurse to handle the patient on her own. The prevention of lumbosacral pain syndrome improves the quality of work of the nurse and extends the working life. Use of this type of wheelchair is justified in terms of cost-benefit analysis.
... In general, pulling force and spinal load were lower when using such repositioning aids compared with a draw sheet. However, most studies only investigated one type of repositioning aid and only a few studies have tested the effects of different patient weight levels on the physical stresses on caregivers (Fray et al., 2016;Skotte and Fallentin, 2008). The relative benefit of different repositioning aids has not been systematically investigated. ...
Manual patient handling is a major cause of musculoskeletal disorders (MSDs) among caregivers. Pulling patients up in bed (PUIB) is one of the most frequently performed patient handling activities, for which repositioning aids are usually recommended. However, it is not clear how to choose repositioning aids for a patient of a given weight, such that the risk of MSDs can be reduced. The current study investigates the physical stresses on caregivers across three patient weight levels, and for common types of repositioning aids during the PUIB activity. Ten caregivers were recruited to preform PUIB tasks while motion capture, ground reaction force, and hand reaction force were measured. Spinal compressive load (L5/S1) was estimated using AnyBody Modeling System software. Repositioning aids and patient weight significantly affected the physical stresses on caregivers. Peak L5/S1 compressive load, peak pulling force, and perceived exertion were lowest for the air-assisted repositioning devices, second lowest for the friction reducing sheet, second highest for the turn and position systems, and highest for the draw sheet. Except for the air-assisted repositioning device, other tested repositioning aids are not adequate to mitigate the risk of MSDs. A mechanical lift should be considered as a robust alternative to repositioning aids that can safely accommodate all patient regardless of weight.
... 6,9 The most documented extrinsic factors are physical demands of the nursing and midwifery professions which includes bending, twisting and turning to carry out routine procedures such as bathing, dressing, injecting seating and transferring the patient. 1,10,11,12 Conversely, obesity and poor conditioning status have been reported as the most important intrinsic risk factors among these health workers population. 11,13 Current literatures have indicated that there is a global shortage of nurses and midwives and the situation is predicted to worsen as many nurses and midwives quit the profession or retire prematurely due to numerous occupational hazards. ...
Background: To determine the prevalence of work-related musculoskeletal disorders (WMSDs) among nurses and midwives, the associated job risk factors and the adopted coping strategies so as to provide baseline information in Ghana. Design: A cross-sectional study. Participants: One hundred and five (105) registered general nurses (RGN), 16 registered community health nurses (RCHN) and 13 registered midwives (RM) were purposively recruited for the study in Ledzokuku-Krowor Municipal (LEKMA) Hospital, in the Greater Accra Region of Ghana. Interventions: An adapted self-administered questionnaire was used to obtain information regarding demographics, prevalence and pattern of WMSDs, associated job risk factors and the reported coping strategies commonly employed by the participants. Point-prevalence of WMSDs, coping strategies and risk factors were summarized with percentage. The prevalence was further analyzed with regression analysis to determine its correlation with BMI, age, years of experience and type of profession at p<0.05 level of significance. Results: The 12-months prevalence was 79.0%, 53.8% and 18.8% for the RGN, RM, and RCHN respectively. Lifting or transferring of dependent patients 70(52.1%), inadequate training on injury prevention 63(46.5%) and working in awkward or cramped positions 53(39.6%) were the most perceived job risk factors. Forty-six (34.3%) participants commonly sought assistance from colleagues in handling heavy patients, 44(32.8%) modified their positions and 27(20.3%) modified their caring procedure as coping strategies. Conclusion: There was high point prevalence of self-reported WMSDs among the sampled nurses and midwives and lifting of patients was identified as the major risk factor. The findings have implication for body mechanics know-how of the nurses and midwives.
... Peak moments at the low back decreased by 22-44%, depending on the task. This confirms previous reports of decreased low back exposures with recommended manual patient handling techniques [9,24,30]. Peak resultant moments at the right shoulder increased using the recommended techniques for two of the five tasks, with no change in a third task and increases in two tasks; left shoulder peak moments decreased in four of five scenarios. The identified moment increases suggest possible exposure transfers from the low back to the shoulder. ...
BACKGROUND: Manual patient handling completed by nurses can include unexpected or strenuous exertions, potentially leading to injury. Lifting guidelines focus on mitigating primarily limiting low back exposures, and the influence of these techniques on the shoulder is unknown. OBJECTIVE: To quantify shoulder loading during manual patient handling tasks and determine whether approaches intended to limit low back exposures negatively affect shoulder demands. METHODS: Twenty novice university-aged females completed five manual patient handling tasks before and after a training session. Participants simulated handling a partial weight bearing patient, and joint load magnitudes were calculated. Strength demands were interpreted in the context of available population capability ranges. RESULTS: Using recommended techniques decreased peak low back loading in most scenarios (p= 0.01-0.02), but had variable effects on shoulder loading. Peak loading in the shoulders increased by 97-107% in the Sit-to-Chair task following training. Using recommended techniques for Turn Toward decreased mean population strength requirements at the back to 35% of capability while increasing shoulder requirements to 100% capability. CONCLUSIONS: Recommended manual patient handling techniques mitigate low back exposures but likely transfer demands to other body regions, specifically the shoulder.
... High perceived stress on low backs and shoulders has been reported by caregivers during manual lifting and transferring of patients ( Garg, Owen, Beller, & Banaag, 1991a, 1991bGarg, Owen, & Carlson, 1992;Owen & Garg, 1989;Owen, Keene, & Olson, 2002); these manual tasks are physically demanding and often involve unfavorable conditions (e.g., awkward posture, forceful exertion, and strenuous movements) that may result in high mechanical load on caregivers' shoulders and low backs ( Belbeck, Cudlip, & Dickerson, 2014;Garg et al., 1991aGarg et al., , 1991bNelson et al., 2008;Owen et al., 2002). Biomechanical studies have reported that the compressive force on low backs associated with manual patient-handling tasks may exceed the National Institute for Occupational Safety and Health (NIOSH) recommended safe limit (3,400 N), thus increasing the risk for low back pain among nursing personnel ( Daynard et al., 2001;Garg et al., 1991aGarg et al., , 1991bJäger et al., 2013;Keir & MacDonell, 2004;Lloyd & Baptiste, 2006;Marras, Davis, Kirking, & Bertsche, 1999;Marras, Knapik, & Ferguson, 2009;McGill & Kavcic, 2005;Skotte & Fallentin, 2008 Mon 2017 Workplace HealtH & Safety and suggested that this high incidence and prevalence of low back pain among nursing staff might be a major reason for nursing personnel leaving the nursing profession or considering job transfer. [AQ: 3] To reduce WMSDs among nursing personnel, various interventions have been implemented, including worker education, organizational policies, ergonomics programs, and use of various types of assistive equipment (e.g., sit-to-stand lift, full body sling lift, ceiling lift, lateral transfer devices) designed to attenuate the biomechanical stressors associated with manual patient-handling tasks ( Cohen et al., 2010;de Ruiter & Liaschenko, 2011;Garg & Kapellusch, 2012;McCoskey, 2007;Rogers, Buckheit, & Ostendorf, 2013;Tang, Poklar, et al., 2017;Wardell, 2007). ...
Nursing personnel, particularly caregivers who frequently perform manual patient transfer tasks, are at risk for work-related musculoskeletal disorders (WMSDs). The purpose of this study was to perform biomechanical evaluations of bed-to-wheelchair transfer using two low-cost assistive devices: walking belt and gait belt. Twenty-eight college students, serving as caregivers, transferred 14 students, serving as patients. “Caregiver” spinal loading and strength requirements at major joints were measured using a 3D Static Strength Prediction Model. “Caregiver”-perceived stresses were assessed using the Borg CR-10 Scale. “Patient” safety and comfort ratings were determined using Likert-type scales. The findings indicated that transferring “patients” using walking belts with a pulling technique produced significantly lower biomechanical stress than using gait belts. “Patients” also felt more comfortable and safer during walking belt transfers. It is recommended that health care facilities should consider use of walking belts in place of gait belts to transfer partially weight-bearing patients.
... healthcare work display a high prevalence of musculoskeletal pain and long-term sickness absence (Andersen et al., 2012b;Boschman et al., 2012;Eriksen, 2003;Freimann et al., 2013;Long et al., 2013;Videman et al., 2005). Indeed, frequent and/or heavy backloading during patient handling is known to increase the risk of musculoskeletal injuries and low back pain among healthcare workers (Andersen et al., 2014;Burdorf and Sorock, 1997;da Costa and Vieira, 2010;Jensen et al., 2012;Skotte and Fallentin, 2008;Smedley et al., 1998Smedley et al., , 1995. ...
Background
While physical exercise is beneficial for back and neck-shoulder pain, only few intervention studies have evaluated effects on pain in multiple body regions. Furthermore, direct measurement of pain threshold can provide additional information to self-reported pain intensity.
Objectives
To evaluate the effect of workplace versus home-based physical exercise on pressure pain threshold (PPT) and musculoskeletal pain intensity in multiple body regions.
Study design
Secondary analysis of an examiner-blinded, cluster randomized controlled trial with allocation concealment.
Method
Two-hundred female healthcare workers from 18 departments at three hospitals were cluster-randomized to 10 weeks of: 1) home-based physical exercise (HOME) performed alone during leisure time for 5 × 10 min per week or 2) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 min per week and up to 5 motivational coaching sessions. PPT (neck, lower back, lower leg) and perceived pain intensity in multiple body regions (feet, knee, hips, lower and upper back, elbow, hand, shoulder, neck, and head) were measured at baseline and 10-week follow-up.
Results
In some of the body regions, PPT and pain intensity improved more following WORK than HOME. Between-group differences at follow-up (WORK vs. HOME) were 41 kPA [95% CI 13–70, effect size (ES): 0.22] for PPT in the lower back, and −0.7 [95% CI -1.0–0.3, ES: 0.26] and −0.6 points [95% CI -0.9–-0.2, ES: 0.23] for pain intensity in the lower back and feet, respectively. HOME did not improve more than WORK for any of the measurements.
Conclusion
Physical exercise recommendations for healthcare workers should consider the setting, i.e. performing supervised group-based exercise at work and motivational coaching sessions is more effective than exercising alone at home.
... Following this study, laboratory research by Schibye et al [20] illustrated the effect of lifting technique, showing that a self-chosen technique results in higher levels of spinal loading compared with the recommended patient transfer technique. This finding was further confirmed by another laboratory study showing that low back compression forces were influenced more by the health care worker's technique and use of appropriate assistive devices than the weight and disability of the patient being repositioned in bed [21]. From the literature cited above, it appears that the appropriate use of assistive devices is of great importance when the goal is to decrease the prevalence of MSDs and the accompanying high amount of sickness absence in this population of nurses. ...
Background:
More than one third of nurses experience musculoskeletal pain several times during a normal work week. Consistent use of assistive devices during patient transfers is associated with a lower risk of occupational back injuries and low back pain (LBP). While uncertainties exist regarding which type of assistive devices most efficiently prevent LBP, exposure assessments using technological advancements allow for quantification of muscle load and body positions during common work tasks.
Objective:
The main objectives of this study are (1) to quantify low back and neck/shoulder muscle load in Danish nurses during patient transfers performed with different types of assistive devices, and (2) to combine the exposure profile for each type of assistive device with fortnightly questionnaires to identify the importance of muscle load (intensity and frequency of transfers) and body position (degree of back inclination and frequency) on LBP intensity and risk of back injury during a patient transfer.
Methods:
A combination of technical measurements (n=50) and a prospective study design (n=2000) will be applied on a cohort of female nurses in Danish hospitals. The technical measurements will be comprised of surface electromyography and accelerometers, with the aim of quantifying muscle load and body positions during various patient transfers, including different types of assistive devices throughout a workday. The study will thereby gather measurements during real-life working conditions. The prospective cohort study will consist of questionnaires at baseline and 1-year follow-up, as well as follow-up via email every other week for one year on questions regarding the frequency of patient transfers, use of assistive devices, intensity of LBP, and back injuries related to patient transfers. The objective measurements on muscle load and body positions during patient handlings will be applied to the fortnightly replies regarding frequency of patient transfer and use of different assistive devices, in order to identify risk factors for back injuries related to patient transfers and intensity of LBP.
Results:
Data collection is scheduled to commence during the winter of 2017.
Conclusions:
The design of this study is novel in its combination of technical measurements applied on a prospective cohort, and the results will provide important information about which assistive devices are associated with intensity of LBP and risk of back injury related to patient transfers. Furthermore, this study will shed light on the dose-response relationship between intensity, duration, and frequency of patient transfers and the intensity of LPB in Danish nurses, and will thereby help to guide and improve electronic health practices among this population.
... Moving patients that are unable to reposition themselves is the primary contributor to the high injury rates among nurses and nurse assistants (Eriksen, 2004;Yassi, 2013). Although turning lighter patients is not associated with a high risk of injury relative to other patient handling tasks, sliding or repositioning even the lightest patients in bed is one of the patient handling tasks that puts caregivers at the greatest risk of musculoskeletal injury (Skotte, 2008;Wiggermann, 2016). With limited space to turn a patient, caregivers must perform this lateral repositioning in addition to turning the patient. ...
When patients are placed in a bed that is too small to allow them to turn from supine to side lying, caregivers are at an elevated risk of injury because of difficulty to turn the patient and patients may experience greater discomfort and risk of pressure injuries. Currently, no guidance is available for what patient sizes are accommodated by the standard 91.4-cm (36-in) wide hospital bed, and no studies have evaluated the relationship between anthropometric attributes and space required to turn in bed. This study included 47 participants (24 female) ranging in body mass index (BMI) from 20 to 76 kg/m2. Anthropometric dimensions were measured and the envelope of space required to turn from supine to side lying was determined using motion capture. Linear regressions were performed to estimate the relationship between anthropometry and space occupied when turning. The anthropometric attributes most highly correlated to space required to turn were waist circumference (R2 = 0.91) and BMI (R2 = 0.88). These findings can be used to design products that better accommodate the needs of patients and their caregivers.
... Thus, although patient handling activities receive more attention in the studies previously published in the literature for being more associated with the development of lumbar spine injuries (20,21), all the activities performed by these workers should be analyzed in risk assessments. ...
Introduction
In the hospital environment, several types of professionals must be involved in continuous working shifts, under working conditions that are often unsatisfactory.
Objective
The objective of the present study was to analyze the biomechanical risk factors for work-related musculoskeletal disorders (WRMD).
Material and methods
This was a cross-sectional, exploratory, descriptive and quantitative study and its analysis considered 15 workers, in three shifts. A questionnaire containing personal information and general data regarding the work environment was applied. The REBA protocol was used for posture assessment, once the workers were recorded while performing their activities. The results were presented descriptively.
Results
In light of the results obtained, the working day was found excessive, particularly considering the weekly frequency and period of time of the working shifts. The REBA protocol showed that the positions adopted presented high risk for the development of WRMD in all nine activities evaluated.
Conclusion
The nursing activities were characterized as stressful for the workers involved.
... A recent systematic review stated that patient handling/transfer represents the highest risk factor for developing lower back disorders (injuries and lower back pain) among nurses and nursing assistants [6]. The relationship between patient transfers and back disorders is supported by biomechanical investigations demonstrating that patient transfers often involve loadings on the spine that exceeds the 3400 N safety limit recommended by the National Institute for Occupational Safety and Health [7][8][9][10]. Further, support is given by studies demonstrating that patient transfer is the precipitator of 72-89% of all filed musculoskeletal injuries among healthcare workers in hospital settings [2,11,12]. ...
Background
Epidemiological studies have shown that patient transfer is a risk factor for back pain, back injuries and long term sickness absence, whereas consistent use of assistive devices during patient transfer seems to be protective. While classical ergonomic interventions based on education and training in lifting and transferring techniques have not proven to be effective in preventing back pain, participatory ergonomics, that is meant to engage and motivate the involved parties while at the same time making the intervention maximally relevant, may represent a better solution. However, these findings are largely based on uncontrolled studies and thus lack to be confirmed by studies with better study designs. In this article, we present the design of a study which aims to evaluate the effect and process of a participatory organizational intervention for improved use of assistive devices. Methods
The study was performed as a cluster randomized controlled trial. We recruited 27 departments (clusters) from five hospitals in Denmark to participate in the study. Prior to randomization, interviews, observations and questionnaire answers (baseline questionnaire) were collected to gain knowledge of barriers and potential solutions for better use of assistive devices. In April 2016, the 27 departments were randomly allocated using a random numbers table to a participatory intervention (14 clusters, 324 healthcare workers) or a control group (13 clusters, 318 healthcare workers). The participatory intervention will consist of workshops with leaders and selected healthcare workers of each department. Workshop participants will be asked to discuss the identified barriers, develop solutions for increasing the use of assistive devices and implement them in their department. Use of assistive devices (using digital counters -, primary outcome, and accelerometers and questionnaire - secondary outcome), perceived physical exertion during patient transfer, pain intensity in the lower back, occurrence of work-related back injuries during patient transfer, organizational readiness to change, knowledge on how to perform proper patient transfer, social capital and work ability (secondary outcomes) were assessed at baseline and will also be assessed at 1 year follow-up. Process evaluation will be based on qualitative and quantitative data to assess the implementation, the change process, and the impact of context aspects. DiscussionThe study will evaluate the effect and process of a participatory intervention on improving the use of assistive devices for patient transfer among hospital healthcare workers. By using cluster-randomization, as well as process- and effect evaluation based on objective measures we will contribute to the evidence base of a promising intervention approach. Trial registrationClinicalTrials.gov (NCT02708550). March, 2016.
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The peak compressive forces at L5/S1 during patient transfers have been estimated. However, no study has considered the actual patient body weight that caregivers had to handle during transfers. We developed a simple kinematic model of lifting to address this limitation. Fifteen prospective health care providers transferred a 70-kg individual who mimicked a patient (“patient”) from bed to wheelchair. Trials were acquired with the patient donning (weighted) and doffing (unweighted) a 5-kg weight belt. Trials were also acquired with and without knee assistance and a mechanical lift. During trials, kinematics and kinetics of transfers were recorded to estimate the peak compressive force at L5/S1 using static equilibrium equations. The peak compressive force was associated with the transfer method ( P < .0005), and the compressive force was 68% lower in lift-assisted than manual transfer (2230 [SD = 433] N vs 6875 [SD = 2307] N). However, the peak compressive force was not associated with knee assistance, nor with a change in the patient body weight. Our results inform that mechanical loading exceeding the National Institute for Occupational Safety and Health safety criterion occurs during patient transfers, confirming a high risk of lower back injuries in caregivers. However, the risk can be mitigated with the use of a mechanical lift.
Due to increased work demands, personal support workers (PSWs) are experiencing more work-related injuries. However, little is known about PSW work tasks and their corresponding physical demand. The purpose of this study was to identify critical tasks that are physically demanding and completed frequently as identified by PSWs. Additionally, we identified contextual factors (i.e., environmental-, situational-, patient-related) that influenced physical demands. We surveyed 443 community-based PSWs working in Canada who rated the physical demand associated with client care tasks and identified contextual factors that can increase task specific physical demands. Transferring/repositioning patients, dressing, and bathing were perceived as most demanding. Patient weight and mobility influenced the level of physical demand required for most tasks. These data provide a foundation to develop physical employment standards and task specific education and training to prevent PSW injuries.
Background:
Manual patient handling is the most frequently reported risk factor for work related musculoskeletal disorders in healthcare. Patient handling tasks are routinely performed manually without assistive devices and can create awkward postures and high loads for nurses and allied health professionals (AHPs). However, AHPs, notably physiotherapists, also utilize therapeutic handling to facilitate patient movement during rehabilitation.
Objectives:
To comprehensively map the literature surrounding manual patient handling (without assistive devices) by healthcare practitioners.
Methods:
AMED, CINAHL, MEDLINE, SPORTDiscus, and EMBASE databases were searched. Grey literature was sourced from Google Scholar, EThOS, Open Grey, Health and Safety Executive, National Institute for Occupational Safety and Health and Work Safe Australia. Literature published in English between 2002 and 2021 was included.
Results:
Forty-nine records were included: 36 primary research studies, 1 systematic review and 12 'other' including narrative and government reports. Primary research was predominantly observational cross-sectional (n = 21). The most common settings included laboratories (n = 13) and hospitals (n = 13). Seven research questions were identified, with patient handling practices (n = 13) the most common. Nurses formed the largest practitioner population (n = 13) and patients were often simulated (n = 12). Common outcomes included tasks performed (n = 13) and physical demands during patient handling (n = 13).
Conclusion and implications of key findings:
This comprehensive scoping review identified that most research was observational, investigating nurses in hospitals or laboratories. More research on manual patient handling by AHPs and investigation of the biomechanics involved in therapeutic handling is needed. Further qualitative research would allow for greater understanding of manual patient handling practices within healthcare. CONTRIBUTION OF THE PAPER.
Objective:
To assess the risk and prevalence of work-related musculoskeletal disorders (WMSDs) in spine and cranial surgeons METHODS: A cross-sectional analytic study composed of a risk-assessment and a questionnaire-based survey was conducted. The risk-assessment for WMSDs was performed on young volunteer neurosurgeons using the Rapid Entire Body Assessment (REBA) tool. The survey-based questionnaire was distributed using the Google Forms software among the relevant official WhatsApp groups of the Egyptian Society of Neurological Surgeons (ESNS) and the Egyptian Spine Association (ESA).
Results:
Thirteen volunteers with a median service of 8 years were assessed for the risk of WMSDs revealing moderate to very high risk of WMSDs, with risk index > 1 for all assessed postures. A total of 232 respondents completed the questionnaire, 74% of which reported WMSDs symptoms. Pain was experienced by the vast majority (96%), with neck pain being the most common (62.8%), followed by low back pain (56.0%), shoulder pain (44.5%) and wrist/finger pain (43.9%). Pain was experienced for 1 to 3 years by most respondents, however, the majority did not reduce their case-volume, seek medical advice or stop working when they experience pain. The survey revealed shortage in the literature studying ergonomics, calling for more ergonomic education and furnishing of working environment of neurosurgeons.
Conclusion:
WMSDs is prevalent among neurosurgeons affecting their ability to work. Ergonomics need further awareness, education and interventions to reduce WMSDs, especially neck and low back pain which proved to be substantially interfering with work ability.
This special issue deals with the different techniques of rehabilitation and improvement of postural function
Background:
High physical exertion during healthcare work is a documented risk factor for musculoskeletal pain, long term sickness absence and disability pension. Understanding the underlying factors of physical exertion is important to make the necessary preventive efforts in the working environment.
Objective:
This study investigates factors associated with high physical exertion during healthcare work.
Methods:
A total of 2047 Danish health care workers replied to a questionnaire about work and health. Associations (odds ratios; OR) of physical exertion (outcome variable) with the number of patients and self-reliant patients, frequency and type of assistive device use, BMI, leisure time activity, smoking, and age were modelled using mutually adjusted binary logistic regression.
Results:
Factors associated with high physical exertion (OR and 95% CI) were high frequency of daily patient transfers 1.35 (1.23 - 1.48), less self-reliant patients 0.74 (0.62 - 0.89), less frequent use of necessary assistive devices 1.82 (1.50 - 2.21), as well as more frequent use of sliding pieces 1.23 (1.04 - 1.46), wheelchairs 1.23 (1.02 - 1.49), bed adjustments 0.88 (0.77 - 1.00) and intelligent beds 0.83 (0.71 - 0.95) during patient transfer. Age and lifestyle factors (BMI, smoking, and leisure time physical activity) were not associated with high physical exertion.
Conclusions:
The character of patient transfer specific healthcare work is associated with increased odds for high physical exertion whereas life-style factors are not. Thus, proper use of specific assistive devices and avoiding uneven distribution of difficult patients through appropriate planning may be protective strategies for lowering physical exertion during healthcare work.
Introduction.
Repositioning of patients with reduced or impaired mobility could lessen pressure ulcers (PU). Automated preventive devices can support nurses, but user acceptance must be determined with valid and reliable tools. This study measured user acceptance of an automatic lateral turning device, using a self-developed questionnaire.
Method.
The study included 194 nurses in leadership positions from 75 institutions. A two-page user acceptance questionnaire was designed and tested for internal validity (exploratory factor analysis; EFA) and reliability (Cronbach’s-α). A linear regression analysis was used to test the model’s theoretical framework.
Results.
The overall response rate was 74.9%. The EFA revealed five exploratory factors (“pain/well-being”, “ PU prevention”, “handling”, “nurse support”, and “obese patient support”) from the two outcomes (“general satisfaction” and “can replace manual repositioning”). The adjusted r² was 0.607 for “general satisfaction”, with the maximum standardized β for “PU prevention” (0.476), “pain/well-being” (β = 0.197) and “handling” (β = 0.145). The adjusted r² for “can replace manual positioning” was 0.458. The β for “nurse support” was 0.264, followed by “pain-wellbeing” (β = 0.224) and “obese patient support” (β = 0.218).
Conclusion.
The psychometric testing results were satisfactory. Overall user acceptance of the automatic lateral turning device was high. A positive evaluation of the system’s functionality, regarding the prevention of PU, is essential for patient and staff satisfaction, as well as user recommendation.
Background:
Manual patient handling is a major cause of low back pain among healthcare staff. The sliding sheet is an assistive device designed to aid healthcare staff performing patient repositioning in bed. The use of sliding sheets in healthcare facilities is currently relatively rare because of the perceived additional time required compared with non-assisted handling. However, the details of the time difference between techniques and the barriers to the use of sliding sheets have not been examined in depth.
Objectives:
We sought to evaluate differences in working time and subjective fatigue between the use of sliding sheets and non-assisted handling techniques for patient repositioning, in order to understand the factors preventing the use of sliding sheets among nurses.
Design:
We conducted a comparative study with an experimental design.
Settings:
The study was conducted in the nursing practice room at a university in Japan.
Participants:
We recruited 30 pairs of nurses and care receivers. All nurses were under 60 years old, with experience in lateral turning and repositioning in the process of changing diapers in clinical settings. Those with a previous or current medical history of low back pain were excluded. Care receivers were older adults (65-80 years old). We excluded adults with bedsores, body mass index values >30, or restricted joint motion due to femoral trochanteric fracture or compression fracture. Thus, 27 pairs were included in the final analysis.
Methods:
The care receivers were instructed to behave as if they were bedridden patients with no limb movement, and as if they had contracture and difficulty communicating. Nurses repositioned the patient using three techniques assigned as interventions in random order: repositioning by one person using a sliding sheet (Sheet), repositioning by two people without a sliding sheet (Double), and repositioning by one person without a sliding sheet (Single). Working time was the primary endpoint for comparative analysis among the three technique conditions.
Results:
The results revealed that the Sheet technique required significantly more time than the non-assisted techniques. However, when total staff time was taken into consideration, the Sheet technique outperformed the Double technique. Moreover, the Sheet technique was associated with significantly lower levels of subjective fatigue, compared with the Double technique.
Conclusions:
The use of a sliding sheet can substantially reduce caregiver burden when performing patient repositioning, and requires less staff time than manual techniques involving more than one caregiver.
Background:
Devices to lift, transfer, and reposition patients are recommended for healthcare workers' and patients' safety, but their intended use has yet to be fully realized.
Objective:
The aim of this study was to describe hospital nursing staff use of lift/transfer devices and the presence of factors at the time of lifts/transfers with potential to influence whether devices are used.
Methods:
Participants were 108 US nursing staff in a university-based medical center and two community hospitals. A self-completed questionnaire was used to collect demographic and work characteristics, typical frequency of patient lifts/transfers, training in and typical use of lift equipment, and specific factors that could influence use. Proportional distributions of lifting/transferring and repositioning frequencies in a typical shift, amount of equipment use, and factors present were examined overall and across worker and work-related characteristics.
Results:
Although trained in equipment use, only 40% used equipment for at least half of lifts/transfers. During lifts/transfers, factors often present included patient unable to help with lift/transfer (91.3%) or of a size/weight where participant needed assistance to help lift/transfer (87.5%); availability of others who could assist with manual lift (86.3%) or use of lift equipment (82.4%); and equipment functioning properly (86.4%), having supplies available (82.5%), and being easy to retrieve from storage (81.6%). During repositioning tasks, physical assistance was "always/almost always" provided from coworkers (83.3%) and often perceived as "very helpful" (92.6%) in reducing physical demands. Physical assistance from patients was less common (14.0% "always/almost always") yet perceived as "very helpful" by 66.3%. One fifth always used friction-reducing devices.
Discussion:
Despite training in their use, nursing staff use of available lift equipment and assistive devices is limited. Factors present at the time of lifts/transfers that may influence equipment/device use reflect a complex mix of patient, worker, equipment, and situational characteristics.
The paper presents a program for social adaptation of servicemen discharged of military service in the Republic of Bulgaria and makes analyses of its main characteristics. The program is scrutinized as a model applying an integrated approach to solving the problems of discharged servicemen and the members of their families. That approach implies both a comprehensive solution and a change in the social environment outlining its complex nature determined by the social and pedagogical orientation it the structure and contents. The main conclusions concern the opportunities of the application of a model as a good practice of social adaptation through human factor development.
Social adaptation of servicemen discharged of military service is a complex process requiring complex actions and involvement of different structures. Examining its development through the example of the Republic of Bulgaria provides implications on its role and outlines the main features and shortcomigs in the existing system, positive and negative trends in its development. Conclusions consider the need of the application of approaches towards skills acquirement so as to raise the level of skills and employability.
The paper presents analyses of different aspects of social adaptation - social and psychological, moral and legal. The accent on the individual and the group behavior is substantiated by the review of the classical understanding in different subjects which provides for a complex view and understanding of the social adaptation as a process. The study makes important conclusions on the need of further research in the concept and its framework.
Current evidence demonstrates why turning and positioning patients in bed presents a serious occupational risk of musculoskeletal disorders for caregivers. Results of the laboratory study investigating a new method of turning and positioning patients in bed are presented. The study was designed to evaluate how this new method reduced the risk of occupational musculoskeletal disorders to caregivers and may improve outcomes for patients.
The aim of this study is to identify factors associated with musculo-skeletal pain reduction during workplace-based or home-based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0-10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed alone during leisure-time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi-adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure-time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home-based exercise in reducing musculo-skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo-skeletal pain.
This paper describes the cause of excessive shear forces and the link between shear forces on the low back and injury. Guidelines are provided for the ergonomist to minimize the danger.
Handling patients in bed using a piqué (a waterproof padded sheet placed under the patient) is associated with a high incidence of risks for the spine with, in particular, the activity of pulling and turning the patient with the pique representing the highest risk. Fifteen female nursing aides were evaluated for compression and shear forces at the L5/S1 joint and for selected muscular activities in the trunk and shoulders. Films, force platforms and EMG recordings supplied the data; dynamic segmental analyses were performed to calculate reaction forces at L5/S1, and a planar single-muscle equivalent was used to estimate internal loads. Different execution parameters were examined including execution velocity, height of bed, direction of effort, leg position and knee support. A ‘free’ task, and a manual task not involving the pique, were also investigated. Recommendations are made for reducing spinal loading. The results also suggest that a change of direction in the trunk motion may present some risks when associated with handling of heavy loads. Furthermore transfer of problems from a particular joint to other joints is likely to occur.
The effects of height-adjustable beds in hospitals on the subsequent prevalence of low-back problems among nurses depend on the capacity to reduce low-back stress by bed-height adjustment. This capacity was investigated in the present study.
Professional nurses performed patient-handling tasks at a standard and an individually chosen bed height. Peak values and time integrals of spinal compression and shear forces were estimated with dynamic biomechanical modeling.
The bed-height adjustment led to lower values of time-integrated compression (average 8.8% lower), peak shear force (average 9.3% lower), and time-integrated shear force (average 18.1% lower). No significance was found for the effect on peak compression, nor for the results for each individual task. This finding can be explained by the minor adjustments made in comparison with the standard height or by the application of different criteria for bed-height adjustment.
The decreasing time-integrated forces and peak shear force, without a concomitant rise of peak compression, speak in favor of the use of height-adjustable beds in nursing.
In 1985, the National Institute for Occupational Safety and Health (NIOSH) convened an ad hoc committee of experts who reviewed the current literature on lifting, recommend criteria for defining lifting capacity, and in 1991 developed a revised lifting equation. Subsequently, NIOSH developed the documentation for the equation and played a prominent role in recommending methods for interpreting the results of the equation. The 1991 equation reflects new findings and provides methods for evaluating asymmetrical lifting tasks, lifts of objects with less than optimal hand-container couplings, and also provides guidelines for a larger range of work durations and lifting frequencies than the 1981 equation. This paper provides the basis for selecting the three criteria (biomechanical, physiological, and psychophysical) that were used to define the 1991 equation, and describes the derivation of the individual components (Putz-Anderson and Waters 1991). The paper also describes the lifting index (LI), an index of relative physical stress, that can be used to identify hazardous lifting tasks. Although the 1991 equation has not been fully validated, the recommended weight limits derived from the revised equation are consistent with or lower than those generally reported in the literature. NIOSH believes that the revised 1991 lifting equation is more likely than the 1981 equation to protect most workers.
Lifting and transferring patients have been identified as frequent precipitating factors or causes of low back problems among nurses. This study systematically evaluated six different transfer methods (three manual and three mechanical) completed by two female nurses working as a team to transfer two totally dependent patients (heavy, 95 kg and light, 56 kg). The patient transfers were completed on a rehabilitation unit of a large university hospital. Each transfer was videotaped and the short (150 cm) and tall (178 cm) nurse each performed the lead and assist roles using all six methods for both patients for a total of 24 transfers. A biomechanical software program referred to as the "3-Dimensional Static Strength Prediction Program (3DSSPPTM)" was used to model each patient transfer, and to compute the peak compressive force on the L5/S1 disc, as well as estimate the percent of the population with sufficient strength capability to transfer patients. The results of biomechanical analysis revealed that the low back compression forces exceeded the back compression design limit recommended by the National Institute for Occupational Safety and Health (NIOSH) (3400N). For the manual transfer methods peak compressive forces greater than 10,000 N were predicted, which far exceeded the NIOSH upper limit of 6400 N. When mechanical lift devices were used, the back compression forces were below the back compression design limits. This study reinforces the need to utilize a mechanical lift device when transferring totally dependent patients with only two nurses.
Although patient handlers suffer from low-back injuries at an alarming rate worldwide, there has been limited research quantifying the risk for the specific tasks performed by the patient handlers. The current study used both a comprehensive evaluation system (low-back disorder risk model) and theoretical model (biomechanical spinal loading model) to evaluate risk of LBD of 17 participants (12 experienced and five inexperienced) performing several patient handling tasks. Eight of the participants were female and nine were male. Several patient transfers were evaluated as well as repositioning of the patient in bed; these were performed with one and two people. The patient transfers were between bed and wheelchair (fixed and removable arms) and between commode chair and hospital chair. A 'standard' patient (a 50 kg co-operative female; non-weight bearing but had use of upper body) was used in all patient handling tasks. Overall, patient handling was found to be an extremely hazardous job that had substantial risk of causing a low-back injury whether with one or two patient handlers. The greatest risk was associated with the one-person transferring techniques with the actual task being performed having a limited effect. The repositioning techniques were found to have significant risk of LBD associated with them with the single hook method having the highest LBD risk and spinal loads that exceeded the tolerance limits (worst patient handling job). The two-person draw sheet repositioning technique had the lowest LBD risk and spinal loads but still had relatively high spinal loads and LBD risk. Thus, even the safest of tasks (of the tasks evaluated in this study) had significant risk. Additionally, the current study represented a 'best' case scenario since the patient was relatively light and co-operative. Thus, patient handling in real situations such as in a nursing home, would be expected to be worse. Therefore, to have an impact on LBD, it is necessary to provide mechanical lift assist devices.
Nursing personnel have a high prevalence of back problems related to patient handling. The demand for evaluation of techniques for patient handling tasks motivates the development of reliable and easy to use biomechanical models. Complete dynamic analyses are complicated to carry out and when simpler analyses are sufficient they should be used instead. The aim of the study was to find out if two patient handling tasks could be analyzed “semidynamically”, i.e. by ignoring the inertial effects from single body segments. The two taska were (1) turning patient in bed and (2) moving the patient up the bed, respectively, and twelve physiotherapists participated as subjects. Two persons collaborate in moving the patient using a drawsheet and a friction-reducing plastic sheet. Motions, ground force reactions and subjective ratings of exertion were registered. Body segment accelerations, free moments of ground reactions and net moments at the lower back were determined. It was found that the tasks did not require fully dynamic analyses since the segmental contributions to the inertial effects were negligible. Large values of the free moment of ground reaction revealed asymmetry and twisted postures in one of the tasks, though it at first appeared to be a largely two-dimensional situation.
Handling patients in bed using a piqué (a waterproof padded sheet placed under the patient) with, in particular, the activity of pulling and turning the patient, is associated with a high incidence of risks for the spine. Six female subjects, not experienced with the task, were evaluated for spinal loadings at the L5/S1 joint, for selected muscular activities in the trunk and shoulders and for work-energy factors. Films, force platforms and EMG recordings supplied the data; dynamic segmental analyses were performed to calculate reaction forces at L5/S1, and a planar single-muscle equivalent was used to estimate internal loads. Three treatments were administered which allowed comparisons to be made for two hand grip positions on the piqué (close to the patient vs. a 15 cm distance) and two movement patterns (continuous vs. interrupted with a pause). It was hypothesized that moving the hand grips away from the patient would favour a straighter-back position and a reduction of spinal loadings; it was also hypothesized that non-interrupted motions involving changes of direction of efforts would be more strenuous for the spine. Analyses of variance with repeated measures were conducted and the locations of significant differences were made with Scheffé method of multiple comparisons. Conflicting results were obtained for the hand grip positions but the results suggest that the partition of a task into several operations (with pauses) is indicated. Recommendations are made to examine more thoroughly trunk postures or back curvatures in relation to spinal loadings.
Sumario: The purpose of this study was to examine the above parameters for their effects on the kinematics and kinetics of the motion. Evaluation of spinal loads at L5/S1 and EMG activity for selected muscle groups provides important information for the development of preventive measures and the institution of safe training methods
The lifting burden of a nursing aide during work in a geriatric ward was determined by using a force-plate. Three lifting operations were performed for all patients needing lifting assistance. At the same time as the forces obtained from the force-plate were recorded, the lifts were photographed. The lifting burden during nursing often equalled or exceeded the recommendations of various authors concerning permissible maximum weight loads during different types of lifts. The lifts were often performed under unfavourable conditions and seldom with an "ideal" lifting technique.
A laboratory study was conducted in an effort to reduce back stress for nursing personnel while performing the patient handling tasks of transferring the patient from bed to wheelchair and wheelchair to bed. These patient handling tasks were studied using five manual techniques and three hoist-assisted techniques. The manual techniques involved one-person and two-person transfers. One manual technique involved a two-person lift of the patient under the arms; the others used a rocking and pulling action and included the use of assistive devices (a gait belt using a two-person transfer, a walking belt with handles using a one-person and a two-person transfer, and a patient handling sling with cutout areas to allow for a hand grip (Medesign( for a one-person transfer(. The three mechanical hoists were Hoyer, Trans-Aid and Ambulift. Six female nursing students with prior patient transfer experience served both as nurses and as passive patients.
Static biomechanical evaluation showed that pulling techniques, as compared to lifting the patient, required significantly lower hand forces and produced significantly lower erector spinae and compressive forces at the Ls/S1, disc (P≥0·01). Shear force, trunk moments and the percentage of females who were capable of performing the transfers (based on static strength simulation) also favoured pulling methods. Perceived stress ratings for the shoulder, upper back, lower back and whole body were lower for pulling methods than those for lifting the patient (P≤0·01).
Patients found the pulling techniques, with the exception of when using the gait belt, felt more comfortable and more secure than the lifting method (P≤0·01). However, a number of subjects believed that the patient handling sling (Medesign) and the walking belt with one person making the transfer would not work for those patients who could not bear weight and those who were heavy, contracted or combative. A walking belt with two persons was the preferred manual method. Two out of three hoists (Hoyer lift and Trans-Aid) were perceived by the nurses to be as physically stressful as manual methods. Patients found these two hoists to be more uncomfortable and felt less secure than with three of the five manual methods (one- and two-person walking belts and Medesign). Ambulift was found to be the least stressful, the most comfortable, and the most secure among all eight methods. Pulling techniques and hoists took significantly longer amounts of time to make the transfer than manually lifting the patient (P≤0·01).
The two-person walking belt using a pulling technique and Ambulift are recommended for transferring patients from bed to wheelchair and wheelchair to bed. A large-scale field study is needed to verify these recommendations.
A laboratory study was conducted to evaluate five different manual techniques (two-person manual lifting; rocking and pulling the patient using a gait belt with two persons; walking belt with one and two persons) and three different mechanical hoists (Hoyer lift, Trans-Aid and Ambulift) for transferring patients from wheelchair to shower chair and shower chair to wheelchair. Six female nursing students with prior patient transfer experience served both as nurses and as passive patients. Static biomechanical evaluation showed that the mean trunk flexion moments, erector spinae muscle forces and compressive and shear forces at the L5S1 disc for the four pulling methods ranged from 92 to 125 Nm, 1845 to 2507 N, 1973 to 2641 N and 442 to 580 N, respectively, as compared to about 213 Nm, 4260 N, 5050 N and 926 N for two-person manual lifting. Perceived stress ratings for the shoulder, upper back, lower back and whole body were significantly lower for pulling methods than those for lifting the patient (p less than or equal to 0.01). Patients found pulling techniques, except the gait belt, to be more comfortable and secure than the lifting method (p less than or equal to 0.01). However, most of the nurses believed that Medesign and the one-person walking belt would not work on those patients who cannot bear weight and those who are heavy, contracted or combative. A two-person walking belt was the most preferred method. Two out of three hoists (Hoyer lift and Trans-Aid) were perceived by the nurses to be more stressful than one- and two-person walking belts. The patients found these two hoists to be more uncomfortable and less secure than with three of the five manual methods (one- and two-person walking belts and Medesign). Pulling techniques and hoists took significantly longer amounts of time to make the transfer than manually lifting the patient (p less than or equal to 0.01). The two-person walking belt, using a gentle rocking motion to utilize momentum and a pulling technique, and Ambulift are recommended for transferring patients from wheelchair to shower chair and shower chair to wheelchair.
Tasks associated with patient handling may present nursing aides with some risk of injuring the lumbar spine. The purpose of this study was to estimate the forces at L5/S1 and to assess mechanical work and energy transfers in a task consisting of raising a patient (a 72·6thinsp; kg manikin) from a chair using three different methods: (A) with the hands; (B) with the forearms behind the patient's back at shoulder level; and (C) with a belt held at waist level. Six male subjects took part in the experiment. Spinal forces were estimated from a static and planar mathematical model used in conjunction with cinematography techniques, a force platform and EMG recordings. External forces and the internal forces (compression and shear at L5/S1) were determined from free-body diagrams and static equations. The model was analysed for its sensitivity in estimating patterns of EMG forces, intra-discal and musculo-ligamentous forces, intra-abdominal pressure and inertial forces. The model was found to discriminate between the relative demands imposed on the spine by the different lifting methods, but the absolute values of the forces remain uncertain because of the uncertainty residing in many of the model's hypotheses. The method requiring a belt to lift the patient was found to be considerably more strenuous for the spine and also to require a larger amount of work; it should therefore not be recommended as a task for nursing aides.
In the present laboratory study five two-person manual lifting techniques were evaluated as to the amount of physical exertion required of the nurses. Ten female volunteers served as nurses; two healthy volunteers (weight: 55 kg and 75 kg) served as passive patients. The working postures and motions were recorded on videotape. The data thus obtained were used in a anatomical-biomechanical analysis. The perceived exertion by the nurses was measured as well. In almost all situations the compressive forces on the nurse's spine exceeded their acceptable limit of 3425 N. Differences between the lifting techniques were most obvious when the 55 kg patient was lifted. Ratings of the perceived exertion (RPE scores) were higher in symmetrical handling than in asymmetrical handling. The three techniques using asymmetrical hand positions produced less subjective stress. RPE scores and rotation of the back were negatively correlated. Rotating the back when moving a patient from one side to the other seems to ease the task. On the whole, the results of the biomechanical evaluation are in line with the subjective perception of the nurses. In both instances the barrow lift appeared to be the most strenuous one; the Australian lift resulted in low compressive forces and a moderate level of perceived exertion.
We conducted a case-referent study to identify and quantify work-related and non-work-related risk indicators for reported over-exertion back injuries among nursing personnel. The source population was all nursing personnel employed in the Stockholm County hospitals during a 32-month period. The 240 cases and 614 referents completed questionnaires about occupation, type of clinic, working hours, shift work, patient transfers, perceived exertion, back pain, prior back injury, job strain, body mass index (BMI), smoking, immigrant status, physical training, and self-rated fitness. The highest relative risks (RR) were observed for work-related factors: working at an orthopedic clinic (RR = 5.2; 95% CI = 2.7-10.2), > or =1 patient transfer/shift (RR = 2.7; 95% CI = 1.6-4.5), and working full-time (RR = 2.4; 95% CI = 1.6-3.6). Training in the use of transfer devices, and regular use of transfer devices, reduced the relative risk from patient transfer. Among the non-work-related factors, only body mass index > or =25 kg/m2 and immigrant status was associated with a slight increase in relative risk.
By means of video recording, measurement of ground reaction forces, and biomechanical modeling of the lower part of the body, the low back loading of nurses during patient handling can be estimated. In this study the force exerted on the bedside by a nurse during different patient handling tasks was measured, and the contribution to the moment at the L4/L5 joint was investigated. It is shown that the bedside reaction moment contributes significantly to the total moment, and could lead to substantial over-estimation if not appropriately included in the calculations, when using an upward biomechanical model for estimating the spinal load of nurses during patient handling tasks.
Back injuries are a serious problem for nursing personnel who perform frequent patient-handling activities. Common prevention strategies include body mechanics education, technique training, and ergonomic interventions such as the introduction of assistive equipment. This investigation assessed and compared the effectiveness of two patient-handling approaches to reducing injury risk. One strategy involved using improved patient-handling technique with existing equipment, and the other approach aimed at eliminating manual patient handling through the use of additional mechanical and other assistive equipment. Both intervention arms received training in back care, patient assessment, and use of the equipment available on their particular wards. An analysis of compliance with interventions and the effects of patient-handling methods on both peak and cumulative spinal compression and shear during various tasks was conducted. Results showed greater compliance with interventions that incorporated new assistive patient-handling equipment, as opposed to those consisting of education and technique training alone. In several tasks, subjects who were untrained or non-compliant with interventions experienced significantly higher peak spinal loading. However, patient-handling tasks conducted with the aid of assistive equipment took substantially longer than those performed manually. This, along with variations in techniques, led to increases in cumulative spinal loading with the use of patient-handling equipment on some tasks. Thus, the use of mechanical assistive devices may not always be the best approach to reducing back injuries in all situations. No single intervention can be recommended; instead all patient-handling tasks should be examined separately to determine which methods maximize reductions in both peak and cumulative lumbar forces during a manoeuver.
The objective of this study was to investigate the low-back loading during common patient-handling tasks. Ten female health care workers without formal training in patient handling performed nine patient-handling tasks including turning, lifting and repositioning a male stroke patient. The low-back loading was quantified by net moment, compression, and shear forces at the L4/L5 joint, measured muscle activity (EMG) in erector spinae muscles and rate of perceived exertion (RPE; Borg scale). The experiments were videotaped with a 50Hz video system using five cameras, and the ground and bedside reaction forces of the health care worker were recorded by means of force platforms and force transducers on the bed. The biomechanical load was calculated using a dynamic 3D seven-segment model of the lower part of the body, and the forces at the L4/L5 joint were estimated by a 14 muscles cross-sectional model of the low back (optimisation procedure). Compression force and torque showed high task dependency whereas the EMG data and the RPE values were more dependent on the subject. The peak compression during two tasks involving lifting the patient (4132/4433N) was significantly higher than all other tasks. Four tasks involving repositioning the patient in the bed (3179/3091/2932/3094N) did not differ, but showed higher peak compression than two tasks turning the patient in the bed (1618/2197N). Thus, in this study the patient-handling tasks could be classified into three groups-characterised by lifting, repositioning or turning-with different levels of peak net torque and compression at the L4/L5 joint.
The objective of the study was to assess the changes in the mechanical load on the low-back when shifting from a self-chosen to a recommended patient-handling technique. Nine female health care workers without formal education in patient-handling carried out 8 different tasks involving moving, turning and lifting situations. By means of a dynamic 3D biomechanical model of the lower part of the body, peak torque, compression and shear forces at the L4/L5 joint were compared using the two different patient-handling techniques. In 5 of the 8 tasks, a significant reduction was observed in spinal loading. Application of the recommended technique decreased the compression value significantly for all tasks with a mean value above 3000 N. For the two tasks with the highest compression values when using the self-chosen technique (4223, 4446 N), the loading was reduced with 36% and 25%, respectively. If the principles behind the recommended technique are implemented and maintained, a decrease in the risk of low-back disorders during patient-handling should thus be expected.
Care aides (CAs) and licensed practical nurses (LPNs) in intermediate care (IC) facilities experience high risks of injury. Workload measures were examined in eight IC facilities to ascertain their relationships with musculoskeletal injury rates, pain, burnout, and self-reported health. Workload was measured using (1) focus groups and telephone interviews to obtain CA/LPN perceptions; (2) systematic observation (numbers of tasks performed in shift); and (3) CA-to-resident staffing ratios. Controlling for resident dependency and facility funding, all workload measures were correlated with staff injury rates and burnout. Facilities with low injury rates had better CA/LPN-to-resident staffing ratios and fewer tasks. The differences in staffing reflected differences in how organizations prioritized and allocated resources. Thus, workload is an important determinant of injuries and increased staffing levels correlate with decreased injuries.
Injury rates in Intermediate Care (IC) facilities are high and the factors related to these injuries are unclear. The objectives of this exploratory sub-study, which is part of a large multi-faceted study in 8 IC facilities are to: (1) evaluate EMG measured over a full-shift in the back and shoulders of 32 care aides (CAs) as an indicator of peak and cumulative workload (n = 4 x 8 facilities); investigate the relationship between EMG measures and injury indicators; and explore the relationship between EMG measures and other workload measurements. Lumbar EMG was converted to predicted cumulative spinal compression and ranged in CAs from 11.7 to 22.8 MNs with a mean of 16.4 MNs. Average compression was significantly different during different periods of the day (p < 0.001) with highest compression during pre-breakfast when CAs assist most with activities of daily living. Significant differences were found in average compression between low and high injury facilities for 3 of 5 periods of the day (p < 0.010). Peak compressions exceeding 3400 N occurred for very little of the workday (e.g. 11.25s during the 75 min period pre-breakfast). Peak neck/shoulder muscle activity is low (99% APDF ranged from 8.33% to 28% MVC). Peak and cumulative spinal compression were significantly correlated with lost-time and musculoskeletal injury rates as well as with total tasks observed in the CAs (p < 0.01). Perceived exertion was only correlated with peak compressions (p < 0.01). Facilities with low injury rates provided significantly more CAs (p < 0.01) to meet resident needs, and subsequently CAs performed fewer tasks, resulting in less peak and cumulative spinal loading over the day.
Although Musculoskeletal Disorders (MSD) represent a common occupational problem, few epidemiological studies have investigated MSD risk factors among Asian nurses, particularly those in Japan.
We administered a modified Japanese-language version of the Standardized Nordic Questionnaire to 1,162 nurses from a large teaching hospital. MSD categories focused on the neck, shoulder, upper back, and lower back regions.
A total of 844 completed questionnaires were analyzed (response rate: 72.6%). The 12-month period-prevalence of MSD at any body site was 85.5%. MSD was most commonly reported at the shoulder (71.9%), followed by the lower back (71.3%), neck (54.7%), and upper back (33.9%). Alcohol consumption, tobacco smoking, and having children were shown to be significant risk factors, with adjusted Odds Ratios of 1.87 (95%CI: 1.17-2.96), 2.45 (95%CI: 1.43-4.35), and 2.53 (95%CI: 1.32-4.91), respectively. Workplace risk factors included manually handling patients (OR: 2.07 to 11.97) and undertaking physically laborious work (OR: 2.09 to 2.76). Nurses reporting pre-menstrual tension were 1.66 and 1.94 times more likely to suffer from lower back and upper back MSD, respectively. High mental pressure was also identified as a significant risk factor for MSD of the neck (OR: 1.53) and shoulder (OR: 2.07).
The complex nature of MSD risk factors identified during this study suggests that remediation strategies which focus only on manual handling tasks would probably be suboptimal in reducing MSD among nurses. Therefore, to help alleviate their considerable MSD burden, a greater emphasis will need to be placed on job satisfaction, work organization, and occupational stress, as well as the more traditional hazard reduction strategies such as manual handling, work tasks, and other occupational factors.
The objective of the review was to gain more insight into the effects of occupational interventions for primary prevention of musculoskeletal symptoms in healthcare workers. The Cochrane Collaboration methodological guidelines for systematic reviews functioned as a starting point. Thirteen studies meeting the inclusion criteria were analysed for methodological quality and effects. Eight outcome effect areas were established and defined as areas in which an effect had been determined in at least two studies. A method based on levels of scientific evidence was then used to synthesize the information available. Strong scientific evidence for the beneficial effect of occupational interventions was found for the outcome effect areas physical discomfort, technical performance of transfers and frequency of manual lifting. Insufficient evidence was found for the effect areas absenteeism due to musculoskeletal problems, musculoskeletal symptoms, fatigue, perceived physical load and knowledge of risk factors at work and ergonomic principles. Training and education combined with an ergonomic intervention were found to be effective.
1. The problem of work related musculoskeletal disorders of the low back in nursing personnel has been well documented in the literature by cross sectional studies showing high prevalence rates in licensed nurses and nursing aides. However, it is difficult to compare findings among these studies because of the use of nonstandardized symptom surveys, variations in case definitions, and other methodological inconsistencies. 2. Measuring the change in current back pain prevalence yields more timely information about the effectiveness of an ergonomic intervention than assessing injury incidence rates, because of the high percent of nursing staff members who work in pain but delay filing workers' compensation claims. 3. As employers attempt to reduce manual handling injuries, occupational health nurses may be called upon to survey workers for musculoskeletal symptom prevalence and document the effectiveness of ergonomic interventions. Before using or developing any musculoskeletal disorder symptom survey for workplace surveillance or research, occupational health nurses should determine whether the survey has adequate reliability, validity, responsiveness, and practicality.