Patient-handling Tasks Research Articles

Effectiveness of Safe Patient Handling Equipment and Techniques: A Review of Biomechanical Studies.

This review aimed to evaluate all studies that have evaluated the biomechanical effects when using assistive devices. The physical demands of patient handling activities are well known. One safety strategy for the reduction of the physical risks is use of assistive devices. The search process identified articles published in English-speaking journals through Google Scholar, Medline, and ISI Web of Science. The included 56 studies contained a biomechanical assessment of a patient handling activity with assistive devices. The biomechanical effects included four groups: changes in body posture (spinal, other joints), subjective assessment (force, effort, discomfort), measured force (hand force, ground reaction force, spine force, joint torque), and physiological measures. The evidence showed caregivers benefited from using lift hoists, air-assisted devices, and to a lesser extent friction reducing devices for lateral transfers and repositioning, while floor and ceiling lifts were most effective for patient transfers. Some gaps were noted in the evidence and other handling tasks such as sit-to-stand, turning patient in bed, limb lifting, and repositioning and some more high hazard activities like supporting people with limited balance and those that fall need to be investigated with respect to biomechanical outcomes. There is a growing level of biomechanical evidence to support the use of assistive devices for many patient-handling tasks, but the benefits of equipment use in some transfers remain uninvestigated. Evidence indicates the best way to lift patients safely is with floor or ceiling lifts, and air-assisted devices for lateral and repositioning tasks.

Patient Handling Tasks And Muscle Fatigue Among Health Professionals In A Ghanaian Teaching Hospital

Patient Handling Tasks And Muscle Fatigue Among Health Professionals In A Ghanaian Teaching Hospital

Risk Assessment of Musculoskeletal Disorders in Patient Handling Tasks Using MAPO and 3DSSPP Methods

Risk Assessment of Musculoskeletal Disorders in Patient Handling Tasks Using MAPO and 3DSSPP Methods

A pilot study of biomechanical and ergonomic analyses of risky manual tasks in physical therapy

The objective of this pilot study was to identify risk factors in physical therapy by performing quantitative ergonomic postural and biomechanical analyses of representative manual tasks. A total of 23 physical therapy students were recruited to perform six patient handling and joint mobilization tasks. Movement data were collected by a motion capture system. Biomechanical and ergonomic analyses were performed, including estimate of lumbar spine compression force, Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA). It was found that the low back compression forces of different transfer tasks were greater than the safety threshold. The ergonomic analysis showed that the three transfer tasks had high risk and the mobilization tasks had low to medium risk. Changes should be implemented to modify these body postures.

High-risk patient handling and movement tasks.

High-risk patient handling and movement tasks.

Medical Cost of Workers' Compensation Claims Related to Patient Handling and Mobility Tasks Within Skilled Nursing Facilities, Continuing Care Retirement Communities and Assisted Living Facilities: An Exploratory Analysis.

Objective:Evaluate the medical costs related to patient handling & mobility (PH&M) claims.Methods:Closed medical only and indemnity workers’ compensation claims were utilized for this exploratory study. In addition to the PH&M tasks, the claimants’ gender, age, tenure, and the claim lag time were also analyzed.Results:Generalized linear models indicated that variables related to tasks, claims’ number of open days and age of the claimants had meaningful effects on the adjusted medical costs for medical only claims. For indemnity claims, the number of open days of claims, age and tenure had meaningful effects. Gender had meaningful effects only for indemnity claims when classifying the claims by patient handling tasks versus non-patient handling tasks.Conclusions:Results showed that factors, other than the type of injury; meaningfully influenced the adjusted medical costs of indemnity claims.

Posture Coaching and Feedback during Patient Handling in a Student Nurse Population

OCCUPATIONAL APPLICATIONS Physically demanding nurse activities, such as patient handling, are leading contributors to an occupation with a historically high prevalence of musculoskeletal injury. Numerous strategies have been investigated to reduce injury rates associated with patient handling activities, including mechanical lifts and ergonomic educational programs. Despite such interventions, injury rates remain high in the profession. We implemented a posture coaching and verbal feedback intervention to evaluate patient handling activities in a student nurse population. Our aim was to provide a feedback intervention that could be implemented in student curriculum to educate student trainees. Results indicate that feedback during patient handling tasks can have an effect on lifting behaviors. The feedback intervention session led to changes in spine postures and more efficient movement strategies. This work, if implemented correctly, could translate to improved patient handling activities. Future work, however, is needed to evaluate both the long-term retention of the training and impact on actual injury rates.TECHNICAL ABSTRACT Background: Nurses who routinely perform patient handling and transfer activities are at a high risk for the development of musculoskeletal injury. Despite biomechanical quantification of spine loads, ergonomic education programs, and other intervention strategies, injury rates remain high for the profession, in particular to the low back. Purpose: The purpose of this work was to evaluate a combined feedback and posture coaching session to improve patient handling techniques (trunk kinematics) in a student nurse population. Methods: Ten student nurses performed three patient-handling tasks: 1) Placing a sling under the patient; 2) transferring a patient from bed-to-chair; and 3) repositioning a patient in bed. Trunk kinematics were measured throughout all tasks. Participants performed a pre-feedback session (four repetitions of each task), followed by a feedback (eight repetitions of each task) session and a final post-feedback session (four repetitions of each task). Feedback included verbal instructions on safe lifting techniques and real-time auditory feedback based on the participant's trunk flexion (using a set threshold of 45º). Results: The largest changes due to the feedback intervention were observed during the bed-to-chair task. There was a significant decrease in the mean time to complete the bed-to-chair task (∼6 sec.) following feedback, along with a mean reduction of ∼7.5º in peak trunk flexion. Peak trunk flexion and rotation, along with triaxial trunk rotational velocity and acceleration, were all reduced for the bed-to-chair task following feedback. Conclusions: Despite the use of a relatively minimalist feedback training protocol (i.e., eight repetitions of a movement), kinematic changes in patient handling tasks were demonstrated. A combination of auditory feedback and coaching appears to be a promising method to lead to beneficial changes in spine postures (closer to neutral) and more efficient movement strategies. The largest changes in trunk kinematics were found for the most complex task (bed-to-chair), and these changes could help reduce cumulative loading and injury risk during patient transfers.

Biomechanical evaluation and perceived exertion of a lateral patient-handling task

BACKGROUND: Slide sheets (SS) are friction-reducing devices used during patient-handling tasks. A modified SS position (modSS), with the slider placed beneath the regular bedsheet, may decrease a caregiver’s workload and reduce low back injuries, as the SS could remain in place for longer periods of time, thus reducing patient re-positioning frequency. OBJECTIVE: To investigate the efficacy of modSS use on back muscle activity, pulling force, and perceived effort during lateral patient-handling tasks, and determine whether lumbar electromyography (EMG) correlates with perceived effort (RPE) during such tasks. METHODS: Ten females completed 9 lateral patient-handling tasks with 3 simulated patients (45 kg, 68 kg and 91 kg) and 3 SS conditions (absent, normal, modSS). Outcomes included peak pulling force, back muscle EMG, RPE and subjective reports of low-back discomfort and preference. RESULTS: ModSS use was as effective as or better than normal SS use at reducing back muscle EMG, pulling force, RPE and perceived discomfort in all 9 conditions, when compared to no SS ( p< 0.05). The relationship between RPE and EMG was moderately strong (r = 0.75). CONCLUSION: ModSS use may reduce caregiver injury rates, as it reduces biomechanical and perceived demands associated with lateral patient-handling tasks at least as well as normal SS use, if not better.

2G2-1 Low-back Joint Moment and Tissue Oxygenation Level During Patient-handling Task Using Kinematics Inverse Dynamic Technique and Near-infrared spectroscopy

2G2-1 Low-back Joint Moment and Tissue Oxygenation Level During Patient-handling Task Using Kinematics Inverse Dynamic Technique and Near-infrared spectroscopy

Assessing the Interplay Between the Shoulders and Low Back During Manual Patient Handling Techniques in a Nursing Setting

The purpose of this research was to quantify shoulder demands during freestyle manual patient handling (MPH) tasks and determine whether approaches intended to prevent low back injury increased shoulder demands. Twenty females completed 5 MPH tasks found commonly in hospital settings before and after a training session using current workplace MPH guidelines. Most normalized muscle activity indices and ratings of perceived exertion decreased following training at both the low back and shoulders, but were more pronounced at the low back. There was little evidence to suggest that mechanical demands were transferred from the low back to the shoulders following the training session. The study generally supports continued use of the recommended MPH techniques, but indicates that several tasks generate high muscular demands and should be avoided if possible.

Efficacy of 'Tailored Physical Activity’ in reducing sickness absence among health care workers: design of a randomised controlled trial

BackgroundHealth care workers have high physical work demands, involving patient handling and manual work tasks. A strategy for prevention of work-related musculoskeletal disorders can enhance the physical capacity of the health care worker. The aim of this study is to evaluate the efficacy of 'Tailored Physical Activity’ for health care workers in the Sonderborg Municipality.Methods/DesignThis protocol describes the design of a randomised controlled trial to assess the efficacy of 'Tailored Physical Activity’ versus a reference group for health care workers in the Sonderborg Municipality. Inclusion criteria to be fulfilled: health care workers with daily work that includes manual work and with the experience of work-related musculoskeletal pain in the back or upper body.All participants will receive 'Health Guidance’, a (90-minute) individualised dialogue focusing on improving life style, based on assessments of risk behaviour, on motivation for change and on personal resources. In addition, the experimental groups will receive 'Tailored Physical Activity’ (three 50-minute sessions per week over 10 weeks). The reference group will receive only 'Health Guidance’.The primary outcome measure is the participants’ self-reported sickness absence during the last three months due to musculoskeletal troubles, measured 3 and 12 months after baseline.In addition, secondary outcomes include anthropometric measurements, functional capacity and self-reported number of sick days, musculoskeletal symptoms, self-reported health, work ability, work productivity, physical capacity, kinesiophobia and physical functional status.DiscussionThe results from this study will contribute to the knowledge about evidence-based interventions for prevention of sickness absence among health care workers.Trial registrationClinicalTrials.gov: NCT01543984.

A structural equation modelling approach to predicting adoption of a patient-handling intervention developed for EMS providers

Patient-handling tasks are integral to Emergency Medical Service (EMS) work as are the musculoskeletal injuries associated with these tasks. The aim of this study was to develop and test a structural equation model that describes the interactions between previously identified factors that contribute to the adoption of a specific ergonomics intervention designed for EMS work. EMS responders (n = 187), from six different organisations, participated in a 2-month longitudinal study following the introduction of a foldable patient transfer-board (slide-board) designed to assist with lateral patient transfers. Surveys administered at baseline, after 1 month and after 2 months sampled factors potentially influencing EMS responders' adoption decisions. Perceived ergonomics advantage, which was influenced by access and storage concerns and prior tool experience, contributed most strongly to intention to use at the end of the first month and to the emergence of champions, which contributed to the intention to use at the end of the second month.

Advantages of Using Ceiling Mounted Lifts in Acute Stroke Rehabilitation

Background and Purpose: Physical therapists are involved in high-risk patient-handling tasks on a daily basis, which include patient transfers, repositioning, and gait training. The primary purpose of this risk management case report was to describe a therapeutic approach to the treatment of a patient after sustaining a cerebrovascular accident (CVA) while using ceiling mounted lifts (CMLs) to lessen the fatigue of the therapist. Case Description: The patient was a 40-year-old man admitted to an acute care hospital for medical management of an extensive CVA. Progressive mobilization was performed using both standard methods of patient-handling and ceiling mounted lifts. During all treatment sessions, with and without the use of the CML, the patient's and the physical therapist's rates of perceived exertion (RPEs) were measured. Outcome: The patient was treated by a physical therapist or physical therapy assistant for a total of 52 visits over the course of his 97-day hospital stays. The patient continued to ambulate with a slightly hemiparetic gait pattern but advanced each leg independently in a reciprocal fashion. The RPE for the patient ranged from 5 to 9 during sessions and averaged 6 overall. For the physical therapist, the RPE averaged 2 when the CML was used, and averaged 5 when it was not. Discussion: This case report has highlighted the potential benefit of incorporating overhead lifts into physical therapy treatment for patients recovering from a CVA. The RPEs measured during transfer and gait training demonstrated a reduced fatigue level for the therapist when using the CML. Future research studies will benefit from clinical trials that incorporate outcome measures and the treatment of patients recovering from a CVA with mechanical lifts versus conventional care.

Establishing a physical therapist-driven model of safe patient handling and movement programs in a general hospital

Healthcare workers are at great risk for musculoskeletal injuries related to ergonomic risk work factors. Patient handling tasks such as transfers and bed positioning pose the highest risk. This report describes the implementation of a physical therapist-driven model of ergonomic intervention in a general hospital in Israel. A group of senior physical therapists undertook the lead role in implementing an ergonomics program on four hospital wards. After participating in an extensive ergonomics training program, the therapists were guided through the process of risk analysis and program formation tailored to four pilot wards. Four interdisciplinary ergonomic teams were established. The teams will define their ongoing role in coordinating and implementing ergonomics activities in the future. Short-term outcomes include the advancement of ergonomics knowledge and awareness among therapy and nursing staffs, and recognition of therapists' role in healthcare ergonomics, as well as the establishment of four interdisciplinary ergonomics teams. The long-term outcome will be the maintenance of team activities over time, including repeated surveys of staff attitudes and practices, which have been positively correlated with reductions in musculoskeletal injury rates. This model of intensive involvement of therapists within multidisciplinary ergonomics programs may serve as a protocol for further projects in healthcare settings.

A biomechanical and subjective assessment and comparison of three ambulance cot design configurations

Effects of ambulance cot design features (handle design and leg folding mechanism) were evaluated. Experienced ambulance workers performed tasks simulating loading and unloading a cot to and from an ambulance, and a cot raising task. Muscle activity, ratings of perceived exertion, and performance style were significantly affected by cot condition (p < 0.05). Erector Spinae activity was significantly less when using Cot-2's stretcher-style handles. Shoulder muscle activity was significantly less when using Cot-2's loop handle. During loading and unloading, operators allowed the cot to support its own weight most often with Cot-2's stretcher-style handles. Preference for Cot-2 (either handles) over Cot-1 (with loop handle) was consistent across tasks. Handle effects were influenced by operator stature; taller participants received more benefit from Cot-2's stretcher-style handles; shoulder muscles’ demands were greater for shorter participants due to handle location. Providing handle options and automatic leg folding/unfolding operation can reduce cot operator's effort and physical strain. Practitioner Summary: Paramedics frequently incur musculoskeletal injuries associated with patient-handling tasks. A controlled experiment was conducted to assess effects of ambulance cot design features on physical stress of operators, as seen through muscle activity and operator's perceptions. Differences between cots were found, signalling that intentional design can reduce operator's physical stress.

Identification of physically demanding patient-handling tasks in an acute care hospital

Work-related musculoskeletal disorders are prevalent among nurses and other healthcare workers worldwide, and patient-handling tasks are a common precipitating event. Existing research has focused on patient-handling within long-term care facilities and has identified physically demanding patient-handling tasks within this context. It is not known, however, whether nurses in acute care facilities have similar exposures. Using on-site work sampling procedures and a subsequent survey, the primary aim of the present study was to identify, describe, and rank the physically demanding patient-handling tasks performed by nursing staff in an acute care facility. The 10 most physically demanding patient-handling tasks were identified and contrasted with earlier results. Compared to long-term care facilities, in which the majority of tasks have been shown to be associated with performance of activities of daily living, the most frequently observed tasks in the acute care facility were repositioning tasks. Differences in the types of transfers being performed across types of healthcare facilities, as well as across units within acute care facilities, highlight the importance of determining the patient-handling demands and needs that are unique to each type of healthcare facility. Generalizing across facilities or units may lead to incorrect assumptions and conclusions about physical demands being placed on nurses. Relevance to industryKnowledge of the most physically demanding tasks can facilitate future intervention efforts to control exposures and injury risks. Differences in physically demanding tasks likely exist between types of healthcare facilities and suggest distinct approaches are needed.

A Lift Assist Team in an Acute Care Hospital—Prevention of Injury or Transfer of Risk During Patient-Handling Tasks?

A Lift Assist Team (LAT) was created on three units at a medical center where nursing staff were at high risk for patient-handling injuries. LAT members were drawn from the hospital's pool of patient transporters. Using qualitative and quantitative data, this case study summarizes the development, implementation, and experiences of the LAT. Nursing staff valued the LAT, reporting increased staff safety and improved patient care. LAT members reported greater job satisfaction and a newfound sense of assimilation into the nursing group compared to when their role was patient transport only. However, over time, their job responsibilities expanded beyond those officially designated for LAT members. Active, ongoing surveillance of the LAT's exposures and outcomes is warranted to understand whether patient-handling injury risk is shifting from nursing personnel to LAT members.

A Lift Assist Team in an Acute Care Hospital— Prevention of Injury or Transfer of Risk during Patient-Handling Tasks?

A Lift Assist Team (LAT) was created on three units at a medical center where nursing staff were at high risk for patient-handling injuries. LAT members were drawn from the hospital's pool of patient transporters. Using qualitative and quantitative data, this case study summarizes the development, implementation, and experiences of the LAT. Nursing staff valued the LAT, reporting increased staff safety and improved patient care. LAT members reported greater job satisfaction and a newfound sense of assimilation into the nursing group compared to when their role was patient transport only. However, over time, their job responsibilities expanded beyond those officially designated for LAT members. Active, ongoing surveillance of the LAT's exposures and outcomes is warranted to understand whether patient-handling injury risk is shifting from nursing personnel to LAT members.

Manual handling incident claims in the healthcare sector: Factors and outcomes

Manual handling (MH) incidents may result in injury, absenteeism and/or compensation claim. This study investigated the factors associated with MH incidents among healthcare workers who had made a claim, and the management and outcome of those workers. A national sample of healthcare sector MH incident claim files (n=247) were accessed and 35~files met the inclusion criteria. Data were collected and presented graphically or descriptively using percentages (and 95% Confidence intervals, CI). Chi-square (χ2) tests were used for comparing proportions between groups. SPSS (v14.0) was used for analysis. Significance at p<0.05 is assumed. Attendants accounted for the highest number of claimants. The majority of claims (74%, 95% CI 68%, 81%) were for back injury; 11% (8%, 15%) for neck injury. Fifty-one percent (43%, 60%) involved patient-handling tasks at the time of incident; 46% (37%, 54%) involved inanimate handling. Ninety-one percent (89%, 94%) took sick leave, with 52% (43%, 60%) taking > 52 weeks. Only 58% (49%, 65%) returned to work. Claimants who had been in communication with employers were significantly more likely to return to work than those who did not (χ2 test, p=0.017). Improved management of MH incidents and injured workers are recommended.

Safe Patient Handling for Rehabilitation Professionals

Every day, thousands of physical therapists and rehabilitation nurses are required to perform physically demanding therapeutic patient handling tasks that are stressful to the caregiver and increase his or her risk of developing work-related musculoskeletal disorders (MSDs). In rehabilitation, patient handling tasks might be classified as"traditional" or "therapeutic."Traditional tasks have a practical goal, such as transferring a patient from bed to a wheelchair, and therapeutic tasks have more targeted goals such as facilitating patient function and independence. Therapeutic patient handling tasks present a greater risk for caregivers to sustain work-related MSDs than typical patient handling tasks do because caregivers are exposed to high mechanical loads on the spinal tissues for longer amounts of time. The Veterans Health Administration, Association of Rehabilitation Nurses, and the American Physical Therapy Association endorse the use of modern patient handling technology as part of a comprehensive safe patient handling program for providing therapy in rehabilitation settings. Information about patient handling technology that is effective in reducing the risk of work-related MSDs from performing therapeutic patient handling and movement tasks is also presented and discussed in this article.