Evaluating repeated patient handling injuries following the implementation of a multi-factor ergonomic intervention program among health care workers

Comparing risk assessment methods for work-related musculoskeletal disorders with in vivo joint loads during manual materials handling

The validity of observational methods in ergonomics is still challenging research. Criterion validity in terms of concurrent validity is the most commonly studied. However, studies comparing observational methods with biomechanical values are rare. Thus, the aim of this study is to compare the Ovako Working Posture Analysing System (OWAS) and the Rapid Entire Body Assessment (REBA) with in vivo load measurements at hip, spine, and knee during stoop and squat lifting of 14 participants. The results reveal that OWAS and REBA action levels (AL) can distinguish between different in vivo load measurements during manual lifting. However, the results also reveal that the same OWAS- and REBA-AL do not necessarily provide equal mean values of in vivo load measurements. For example, resultant contact force in the vertebral body replacement for squat lifting ranged from 57% body weight (%BW) in OWAS-AL1 to 138%BW in OWAS-AL3 compared to 46%BW in REBA-AL0 and 173%BW in REBA-AL3. Furthermore, the results suggest that the performed squat lifting techniques had a higher risk for work-related musculoskeletal disorders than the performed stoop lifting techniques.

Patient handling training interventions and musculoskeletal injuries in healthcare workers: Systematic review and meta-analysis

Workplace injuries are a serious issue for the health and social care industry, with the sector accounting for 20 % of all serious claims reported. The aim of this systematic review was to determine whether patient handling training interventions that included instruction on patient transfer techniques are effective in preventing musculoskeletal injuries in healthcare workers. Methods: Electronic databases MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and Health and Safety Science Abstracts (ProQuest) were searched for controlled trials from January 1996-August 2022. Risk of bias was evaluated using the PEDro scale and overall certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluation for each meta-analysis. Results: A total of nine studies (3903 participants) were included. There is moderate certainty evidence that could not conclude whether patient handling training affects the 12-month incidence of lower back pain (OR = 0.83, 95 % CI [0.59, 1.16]). There is low certainty evidence that patient handing training does not prevent lower back pain in health professionals without pre-existing pain (MD = -0.06, 95 % CI [-0.63, 0.52]) but may reduce lower back pain in those with pre-existing pain (MD = -2.92, 95 % CI [-5.44, -0.41]). The results also suggest that there may be a positive effect of training incorporating risk assessment on musculoskeletal injury rates; however the evidence is of very low certainty. There is low certainty evidence from a single study that training may have a short-term effect on sickness absences.) Conclusions: There is a lack of evidence to support patient handling training when delivered to all healthcare staff. Training in its current form may be an ineffective strategy for reducing musculoskeletal injuries and pain. High quality disinvestment studies or trials incorporating risk assessment strategies are warranted. Practical Applications: This review suggests health service managers question the effectiveness of current patient handling training practices and consider evaluating current practices before allocating resources to meet employee risk reduction obligations.

Efficacy of Interventions in Reducing the Risks of Work-Related Musculoskeletal Disorders Among Healthcare Workers: A Systematic Review and Meta-Analysis

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) are prevalent among healthcare professionals, including nurses, therapists, doctors, and paramedics, due to the potential injuries incurred during patient transfer and handling. This review aimed to assess the effectiveness of existing interventions in reducing the risks of WMSDs in this population.

METHODS

Four databases including PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect were searched to identify randomized and nonrandomized controlled trials, as well as studies with pre-post design. Two reviewers independently extracted data and assessed the quality of the included studies using the Effective Public Health Practice Project criteria. A meta-analysis was performed to obtain quantitative results.

RESULTS

A total of 40 studies were included in the review. Among the interventions, motorized assistive devices showed the most significant relative reduction in WMSD risks (p < .0000; standardized mean difference [SMD] = -3.32, 95% confidence interval [CI] = [-4.53, -2.12]), followed by combined interventions of cognitive and exercise (p < .0001; SMD = -0.62, 95% CI = [-0.91, -0.33]), combined intervention of cognitive and assistive device intervention (p = .02; SMD = -0.77, 95% CI = [-1.42, -0.12]), nonmotorized assistive device (p = .02; SMD = -0.63, 95% CI = [-1.15, -0.12]), cognitive intervention (p < .0001; SMD = -0.62, 95% CI = [-0.91, -0.33]), and physical exercise (p = .06; SMD = -0.16, 95% CI = [-0.32, 0.00]) intervention.

CONCLUSION

The overall evidence indicates that interventions have a significant effect in reducing the risk of WMSDs among healthcare workers, with motorized assistive devices showing the most promising results. The findings from this review can provide valuable guidance for hospital administrators, policymakers, and other experts in implementing effective strategies to prevent WMSDs among healthcare professionals.

The impact of mechanical devices for lifting and transferring of patients on low back pain and musculoskeletal injuries in health care personnel-A systematic review and meta-analysis

OBJECTIVES

Heavy lifting in nursing is highly associated with low back pain (LBP) and musculoskeletal injuries (MSI). We aimed to evaluate the impact of mechanical devices used for patient lifting and transferring on risk of LBP and MSI of health care personnel.

METHODS

We conducted a systematic review and meta-analysis. The literature search was performed during 1st and 12th September 2021 using 17 electronic databases and handsearching of bibliographies of included studies. Twenty studies were included in the qualitative synthesis and eight studies with in total 2087 participants in the meta-analysis. Dependent on the study design, risk of bias was assessed by Cochrane RoB 2.0, EPOC, and MINORS. We conducted random-effects meta-analyses assessing Hedges's g and 95% CI of MSI rate, perceived LBP, and peak compressive spinal load. We calculated prediction intervals and conducted a cost-benefit analysis (CBA).

RESULTS

All outcomes showed significant, adjusted pooled effect sizes (MSI rate: g = 1.11, 95% CI 0.914-1.299; perceived LBP: g = 1.54, 95% CI -0.016-3.088; peak compressive spinal load: g = 1.04, 95% CI -0.315 to 2.391). True effect sizes in 95% of all comparable populations fell in the following prediction intervals: MSI rate = -1.07-3.28, perceived LBP = -0.522-3.594, and peak compressive spinal load = -15.49 to 17.57. CBA revealed cost-benefit ratios of 1.2 and 3.29 between cumulative total savings and investment costs of intervention.

CONCLUSIONS

Prediction intervals confirmed strong true effect sizes for MSI rate and perceived LBP in 95% of all comparable populations but not for peak compressive spinal load. Mechanical lifting and transferring devices displayed a favorable cost-benefit ratio and should be considered for clinical implementation.

Interventions to prevent and reduce work-related musculoskeletal injuries and pain among healthcare professionals. A comprehensive systematic review of the literature

INTRODUCTION

Work-related musculoskeletal disorders (WMSDs) are among the main causes of injury and pain in healthcare professionals. Previous reviews provided a fragmented view of the interventions available for WMSDs. This review aims to provide a comprehensive description of interventions for preventing and reducing work-related musculoskeletal injuries and/or pain among healthcare professionals, and to assess the methodological quality of studies.

METHODS

A systematic literature review was performed, based on the Effective Public Health Practice Project process. A comprehensive search was conducted on six peer-reviewed databases and manually. The methodological quality of the studies included was rated as weak, moderate, or strong. The studies were organized based on the 2019 classification of the interventions by Oakman and colleagues.

RESULTS

Twenty-seven articles were included reporting individual (n = 4), task-specific (n = 4), work organization and job design (n = 2), work environment (n = 1), and multifactorial (n = 16) interventions. Overall quality rating was strong for 6 studies, moderate for 16, and weak for 5. Individual interventions such as neuromuscular and physical exercise were effective in reducing pain. Task-specific and work organization interventions could prevent certain injuries. Significant reduction of both injuries and pain resulted from multifactorial interventions, which were reported by the majority of strong (n = 5) and moderate (n = 10) quality articles.

CONCLUSIONS

This review provides healthcare professionals with evidence-based information to plan interventions targeted towards reducing WMSDs. In particular, more efforts are needed to implement and extend effective multifactorial interventions. Moreover, studies about each professional healthcare target group are needed.

PRACTICAL APPLICATION

Our results can guide policy-makers, healthcare managers and professionals to choose the best strategies to prevent and reduce WMSDs and to shape continuous education programs. This study prompts clinicians to develop inter-professional collaborations and to practice physical activities in order to reduce WMSDs.

Safe patient handling legislation and musculoskeletal disorders among California healthcare workers: Analysis of workers' compensation data, 2007-2016

BACKGROUND

California requires general acute care hospitals to have a comprehensive plan to prevent patient handling injuries (PHIs) among employees. The California safe patient handling (SPH) law took effect in 2012. This study assessed the impact of the SPH law on workers' compensation claims for musculoskeletal disorders (MSDs) in California hospital workers.

METHODS

We used California Workers' Compensation Information System data from 2007 to 2016 and analyzed claims for MSDs that occurred in acute care hospitals compared with nursing and residential care facilities. MSD claims were classified into PHI and non-PHI claims.

RESULTS

We identified 199,547 MSD claims that occurred during 2007-2016 in acute care hospitals (62.8%) and nursing and residential care facilities (37.2%). MSDs accounted for 42.8% of all claims. Of the MSD claims, 81.0% were strains or sprains and 33.5% of MSDs were related to patient handling activities. From 2011 to 2016, MSD claim rates showed significant reductions among both hospital and nursing/residential care workers. However, the MSD-PHI claim rate showed a significant reduction only among hospital workers (7.3% per year, incidence rate ratio [IRR] = 0.927, 95% confidence interval [CI] 0.903-0.952). There was no significant change among nursing/residential care workers (IRR = 0.990, 95% CI 0.976-1.005). The non-PHI claim rate showed no significant change among hospital workers (IRR = 0.982, 95% CI 0.956-1.009).

CONCLUSIONS

Our study identified significant reductions of PHI claims among California hospital workers after the passage of the SPH legislation, suggesting that SPH legislation played a crucial role in reducing the risk of injury among healthcare workers.

A systematic review of work interventions to promote safe patient handling and movement in the healthcare sector

PURPUSE

The aim of this systematic review was to describe interventions which promote safe patient handling and movement (PHM) among workers in healthcare by reviewing the literature of their effectiveness for work and health-related outcomes.

METHODS

Data bases were searched for studies published 1997‒2018. Measures was operationalised broadly, capturing outcomes of work and health. Only Randomized controlled trials (RCTs) and cohort studies with control group were included. Quality was assessed using evidence-based checklists by Swedish Agency for Health Technology Assessment and Assessment of Social Services.

RESULTS

The systematic review included 10 RCTs and 19 cohort. Providing work equipment and training workers is effective: it can increase usage. Training workers to be peer coaches is associated with fewer injuries. Other effective strategies are participatory ergonomics and management engagement in collaboration with workers, facilitating safe PHM.

CONCLUSIONS

This systematic review suggests interventions for safe PHM with an impact of health-related outcomes should include access to work equipment, training as well as employer and employee engagement. The additional impact of multifaceted interventions is inconclusive.

PRACTITIONER SUMMARY

In clinical practice, there is a need for employers in healthcare to; 1) provide healthcare workers access to suitable work equipment. 2) provide training on how to use work equipment to prevent work-related injuries. Furthermore, the study also indicates that 3) training and appointing peer coaches can facilitate safe manual handling and movement (PHM) and, 4) It can be beneficial to involve workers in a participatory approach.

Development and testing of a new electronic foot health promotion programme on nurses' foot self-care

Background

Nurses form the largest professional group in health care, and they spend most of their working day on their feet. From the perspective of work well-being, healthy feet are important to tolerate the physical demands of nursing work. However, little is known about how nurses’ foot self-care practices can be promoted with computerised interventions. The aim of this study was two-fold: to explore the preliminary effects of the electronic Foot Health Promotion Programme (FHPP) on foot self-care in nurses and to examine the usability of the programme.

Methods

A single group pretest-posttest design was used. The FHPP was targeted at nurses working in the operating theatre. The FHPP lasted for 4 weeks and focused on improving nurses’ knowledge and awareness of foot self-care through self-directed learning tasks. The primary outcome was knowledge of foot self-care. The secondary outcomes were foot health and work ability. Thirty-seven participants completed the study. The outcomes were assessed at baseline (April–June 2017) and 4 weeks (August–September 2017) after the intervention ended. The data were analysed statistically.

Results

Participants’ knowledge of foot self-care and foot health improved; however, the changes were not statistically significant. The FHPP was considered to be usable and has potential as a tool to increase knowledge of foot self-care among nurses.

Conclusions

The FHPP developed in this study is a newly developed potential tool to increase nurses’ knowledge of foot self-care. Application of the FHPP as part of occupational health care may enhance nursing personnel’s foot self-care and lower extremity health.

Trial registration

ClinicalTrials.gov NCT03116451, 17.4.2017.

Do Technical Aids for Patient Handling Prevent Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies

The physical load ensuing from the repositioning and moving of patients puts health care workers at risk of musculoskeletal complaints. Technical equipment developed to aid with patient handling should reduce physical strain and workload; however, the efficacy of these aids in preventing musculoskeletal disorders and complaints is still unclear. A systematic review of controlled intervention studies was conducted to examine if the risk of musculoskeletal complaints and disorders is reduced by technical patient handling equipment. MEDLINE®/PubMed®, EMBASE®, Allied and Complementary Medicine Database (AMED), and Cumulative Index of Nursing and Allied Health Literature (CINAHL®) were searched using terms for nursing, caregiving, technical aids, musculoskeletal injuries, and complaints. Randomized controlled trials and controlled before-after studies of interventions including technical patient handling equipment were included. The titles and abstracts of 9554 publications and 97 full-texts were screened by two reviewers. The qualitative synthesis included one randomized controlled trial (RCT) and ten controlled before-after studies. A meta-analysis of four studies resulted in a pooled risk ratio for musculoskeletal injury claims (post-intervention) of 0.78 (95% confidence interval 0.68-0.90). Overall, the methodological quality of the studies was poor and the results often based on administrative injury claim data, introducing potential selection bias. Interventions with technical patient handling aids appear to prevent musculoskeletal complaints, but the certainty of the evidence according to GRADE approach ranged from low to very low.

A Review of Patient Lifting Interventions to Reduce Health Care Worker Injuries

Health care workers suffer from musculoskeletal disorders at a significantly higher rate than workers in other industries. Consequently, a growing demand for patient handling devices to reduce worker injury has evolved. This article reviews the literature regarding interventions designed to reduce injuries among health care workers. A PubMed search was conducted using the terms "occupational health [Mesh Terms] patient lifting." Fourteen articles were identified that assessed interventions to improve worker safety. Of the 14 articles, 7 discussed technological interventions, 4 educational approaches, and 3 policy change. All three types of interventions were generally effective at improving worker safety, with the ideal intervention consisting of elements of all three types. Although adopting a new intervention may be expensive, the reduction in workers' compensation costs associated with injured nurses can easily outweigh the costs of interventions.

Designing, prototype making and evaluating a mechanical aid device for patient transfer between bed and stretcher

INTRODUCTION

The present study aimed at designing, prototype making and evaluating a new assistive device to improve patient transfer conditions.

METHODS

A new aid device for patient transfer was designed and its prototype was made. Comfort and perceived physical exertion of users and stability and applicability of the device were examined. The test subjects included 37 healthcare workers from a hospital with patient transfer experience. The data collection tools consisted of visual analog scales (VAS) and Borg's rating physical effort scale. The rapid entire body assessment (REBA) method was applied to evaluate working posture.

RESULTS

The results showed that in 70% of the wards, patient transfer was performed manually more than five times per shift. While using the newly designed device, the mean (SD) of the users' comfort, and the clients' comfort and safety, was measured as 8.59 (0.87), 8.46 (0.92) and 8.67 (0.71), respectively, as reported by VAS. The results revealed a significant reduction in the users' rating of perceived exertion (p < 0.001). Additionally, the REBA score was lower in mechanical transfer.

CONCLUSION

The new assistive device increased the users' and the clients' comfort, reduced the users' physical exertion and improved working postures.

An Evaluation of the Effects of Human Factors and Ergonomics on Health Care and Patient Safety Practices: A Systematic Review

Background

From the viewpoint of human factors and ergonomics (HFE), errors often occur because of the mismatch between the system, technique and characteristics of the human body. HFE is a scientific discipline concerned with understanding interactions between human behavior, system design and safety.

Objective

To evaluate the effectiveness of HFE interventions in improving health care workers’ outcomes and patient safety and to assess the quality of the available evidence.

Methods

We searched databases, including MEDLINE, EMBASE, BIOSIS Previews and the CBM (Chinese BioMedical Literature Database), for articles published from 1996 to Mar.2015. The quality assessment tool was based on the risk of bias criteria developed by the Cochrane Effective Practice and Organization of Care (EPOC) Group. The interventions of the included studies were categorized into four relevant domains, as defined by the International Ergonomics Association.

Results

For this descriptive study, we identified 8, 949 studies based on our initial search. Finally, 28 studies with 3,227 participants were included. Among the 28 included studies, 20 studies were controlled studies, two of which were randomized controlled trials. The other eight studies were before/after surveys, without controls. Most of the studies were of moderate or low quality. Five broad categories of outcomes were identified in this study: 1) medical errors or patient safety, 2) health care workers’ quality of working life (e.g. reduced fatigue, discomfort, workload, pain and injury), 3) user performance (e.g., efficiency or accuracy), 4) health care workers’ attitudes towards the interventions(e.g., satisfaction and preference), and 5) economic evaluations.

Conclusion

The results showed that the interventions positively affected the outcomes of health care workers. Few studies considered the financial merits of these interventions. Most of the included studies were of moderate quality. This review highlights the need for scientific and standardized guidelines regarding how HFE should be implemented in health care.

Effects of a national safe patient handling program on nursing injury incidence rates

OBJECTIVE

The objective of the study was to identify which components of a system-wide safe patient handling (SPH) program reduced musculoskeletal injury (MSI) due to patient handling among nurses.

METHODS

The 3-year longitudinal study from 2008 to 2011 used a pretest-posttest design. The study was conducted in the Veterans Health Administration, and all medical centers participated. The outcome was 2011 MSI incidence rates due to patient-related handling for nurses, expressed as injuries per 10 000 full-time employees.

RESULTS

Three organizational risk factors, bed days of care, facility complexity level, and baseline MSI incidence rate, were significantly associated with MSI incidence rate and explained 21% of its variation. Five SPH components, including deployment of ceiling lifts and other new technologies, peer leader effectiveness, competency in SPH equipment use, facility coordinator link with safety committee, and peer leader training, uniquely accounted for an additional 23% of the total variation.

CONCLUSIONS

Findings provide evidence to support the effectiveness of a multicomponent approach to SPH programs given contextual considerations.

TROPHI: development of a tool to measure complex, multi-factorial patient handling interventions

Patient handling interventions are complex and multi-factorial. It has been difficult to make comparisons across different strategies due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes and comparing performance across interventions. Focus groups were held with expert patient handling practitioners (n = 36) in four European countries (Finland, Italy, Portugal and the UK) to identify preferred outcomes to be measured for interventions. A systematic literature review identified 598 outcome measures; these were critically appraised and the most appropriate measurement tool was selected for each outcome. TROPHI was evaluated in the four EU countries (eight sites) and by an expert panel (n = 16) from the European Panel of Patient Handling Ergonomics for usability and practical application. This final stage added external validity to the research by exploring transferability potential and presenting the data and analysis to allow respondent (participant) validation.

PRACTITIONER SUMMARY

Patient handling interventions are complex and multi-factorial and it has been difficult to make comparisons due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes to compare performance across interventions.

Impacto de uma metodologia interativa de ergonomia de conscientização

A ergonomia tem demonstrado avanços ao ser pró-ativa com a concepção de ambientes ergonomicamente adequados e com a conscientização do uso correto dos postos de trabalho. Nesse contexto, destaca-se o papel da ergonomia de conscientização, que confere ao indivíduo papel central no processo de educação em saúde. O presente estudo teve como objetivo avaliar o impacto de uma metodologia interativa de ergonomia de conscientização no conhecimento de trabalhadores de uma indústria têxtil. A amostra foi selecionada a partir do parecer do comitê de ergonomia da empresa. Participaram do estudo 328 trabalhadores (idade: 33,94±9,15 anos). Foram aplicadas intervenções interativas nos temas: Corpo Humano, Visão, Audição, Coluna vertebral, Membros Superiores e Membros Inferiores. O impacto da metodologia foi mensurado com a aplicação de um questionário criado e validado para o estudo. Para a comparação da pontuação antes e após as intervenções foi utilizado o teste t de Student (pareado), analisado no pacote estatístico SPSS 19.0 para Windows com significância de p<0,05. As questões qualitativas foram categorizadas, e a frequência das informações constatada. Observou-se aumento na pontuação total do questionário (8,07±1,03 para 8,76±0,50; p<0,001), o que demostra que o programa teve impacto na aquisição de conhecimento por parte dos trabalhadores em relação a segurança e saúde.

It’s not about the hoist: A narrative literature review of manual handling in healthcare

The manual handling of people and objects is integral to the provision of nursing care to patients globally. Despite over 30 years of research intended to guide improvements for nurses’ safety, substantial rates of manual handling injuries persist internationally within the nursing profession. This paper reviews the contemporary international literature regarding manual handling interventions noting the unique context for injury prevention strategies within healthcare. The review includes the recognition of underlying assumptions inherent in the conceptualisation of manual handling and its management, and the preponderance of the post-positivist paradigm in this field.

The complexity of manual handling in healthcare has resulted in a theoretical shift from single factor interventions based on technique training towards an emerging multidimensional approach. However the key elements for sustainable solutions to reduce nurses’ manual handling injuries have not yet been identified and consensus is lacking regarding the implementation and appropriate evaluation of injury prevention programmes. Furthermore, whilst the literature is replete with data derived from surveys or insurance industry records of compensation claims, there is a dearth of literature exploring nurses’ manual handling experiences. The in-depth investigation of nurses’ perspectives on manual handling may uncover new knowledge critical to improvement of the manual handling issues.