The effect of working position on trunk posture and exertion for routine nursing tasks: an experimental study

Effects of Sensor Types and Angular Velocity Computational Methods in Field Measurements of Occupational Upper Arm and Trunk Postures and Movements

Accelerometer-based inclinometers have dominated kinematic measurements in previous field studies, while the use of inertial measurement units that additionally include gyroscopes is rapidly increasing. Recent laboratory studies suggest that these two sensor types and the two commonly used angular velocity computational methods may produce substantially different results. The aim of this study was, therefore, to evaluate the effects of sensor types and angular velocity computational methods on the measures of work postures and movements in a real occupational setting. Half-workday recordings of arm and trunk postures, and movements from 38 warehouse workers were compared using two sensor types: accelerometers versus accelerometers with gyroscopes-and using two angular velocity computational methods, i.e., inclination velocity versus generalized velocity. The results showed an overall small difference (<2° and value independent) for posture percentiles between the two sensor types, but substantial differences in movement percentiles both between the sensor types and between the angular computational methods. For example, the group mean of the 50th percentiles were for accelerometers: 71°/s (generalized velocity) and 33°/s (inclination velocity)-and for accelerometers with gyroscopes: 31°/s (generalized velocity) and 16°/s (inclination velocity). The significant effects of sensor types and angular computational methods on angular velocity measures in field work are important in inter-study comparisons and in comparisons to recommended threshold limit values.

A kinematic posture analysis of neurological assistants in their daily working practice-a pilot study

Background

The aim of this pilot study was to analyze postures during the work of neurologists with respect to their occupational activities.

Methods

A total data material of 64.8 h (3885.74 min) of nine (three m/six f) neurologists (assistant physicians) was collected. Kinematic data were collected using the CUELA system (electro-goniometry). In addition, the occupational tasks performed on-site were subject to a detailed objective activity analysis. All activities were assigned to the categories “Office activities” (I), “Measures on patients” (II) and “Other activities” (III). The angle values of each body region (evaluation parameters) were evaluated according to ergonomic ISO standards.

Results

Only 3.4% of the working hours were spent with (II), while 50.8% of time was spent with (I) and 45.8% with (III). All tasks of category (II) revealed an increased ergonomic risk to the head, neck, trunk and back areas. During category (I) especially neck and back movements in the sagittal plane showed higher ergonomic risk levels.

Conclusion

Despite frequently performed awkward body positions in (II), the ergonomic risk is considered as rather low, since the percentage time share totaled only 3.4%. As a result, “Office activities” have been detected as high predictor to cause stress load on the musculoskeletal system in the daily work of neurologists.

Evaluation of the occurrence of work-related musculoskeletal pain among anesthesiology, intensive care, and surgical nurses: An observational and descriptive study

Clinical nurses can encounter musculoskeletal pain episodes stemming from regular exposure to workplace risk factors that contribute to overloads. This study aimed to evaluate the occurrence and location of work-related musculoskeletal pain among Polish nurses. An observational and descriptive survey study was conducted among 136 nurses working in the anesthesiology, intensive care, and surgery units. An extended version of the Nordic Musculoskeletal Questionnaire was used to investigate musculoskeletal pain. Only 8% of the participating nurses experienced no musculoskeletal pain, while 85% suffered from pain in more than one location. The lower back (67%), upper back (59%), and neck (66%) were the most common pain locations. In summary, nurses experienced multiple musculoskeletal pain episodes, occurring most frequently in the spinal region (lower and upper back and neck). It is crucial to determine the real causes of musculoskeletal pain and to take appropriate preventive measures to improve workplace ergonomics.

Assessment of pressure pain threshold at the cervical and lumbar spine region in the group of professionally active nurses: A cross-sectional study

OBJECTIVES

The problem of spinal pain among nurses and lack of compliance with workplace ergonomy is increasing. The study aimed to assess the pressure pain threshold (PPT) at the cervical and lumbar spine in nursing staff.

METHODS

The sample of this prospective and observational study consisted of 30 female nurses with a mean age of 38.6 ± 11.1 years. The standardized Oswestry (ODI) and the Neck Disability Index (NDI) were used, as well as the Authors' Designed Questionnaire (ADQ) was used to assess compliance with ergonomic principles. The PPT analysis using a computerized pressure algometer (CPA) was performed to examine the level of PPT.

RESULTS

A mild disability was found in 56% of nurses (NDI and ODI). A value of <4 kg/cm2 (CPA), indicating musculoskeletal overload was observed in 57% of subjects. Also, 60% of nurses work with a lying patient; 73.4% grabs the patient's armpits while transferring in bed; 16.7% never adjusts the height of the bed, and only 13.4% choose specialist footwear for work. There is a correlation between PPT values for trapezius and erector spinae muscles on the same side of the body in nurses with mild and moderate disability (P < .05).

CONCLUSIONS

Pain complaints are associated with lower PPT of trapezius and erector spinae muscles and asymmetry of muscle tension. Also, it was noted that the lack of implementation of ergonomic principles by nursing staff affects their degree of disability.

Baropodometric evaluation of foot load distribution during gait in the group of professionally active nurses

OBJECTIVES

Nurses are extremely exposed to musculoskeletal overloads. Prolonged standing postural balance distributions, functional deficits and pain may affect the symmetry of the load on the feet. The study aimed to assess the distribution of foot load during gait among nurses.

METHODS

The sample of this prospective and observational study consisted of 37 female nurses with mean age of 39 years. The Nordic Musculoskeletal Questionnaire (NMQ) was used to evaluate musculoskeletal disturbances and baropodometric gait analysis (BGA) was performed to register distribution of foot load during gait.

RESULTS

We showed that 68% of nurses declare that they know the principles of workplace ergonomics, but only 14% comply with them. NMQ results indicate that as many as 73% of the respondents feel ailments in the "lower back" area. An asymmetry was observed in the load of IV-V of the metatarsal head between the left and right foot (P = .000) and in the load of the left and right lateral part of the heel (P = .028) in the BGA test. Correlations between ailments occurring in the neck area and loading of the lateral arch of the right foot (P = .032) were found. Moreover, the load in this area correlated positively with the occurrence of "lower back" pain (P = .045).

CONCLUSIONS

Nurses have asymmetric distribution of foot load during gait, which results in a discrepancy between the loads on the three main support points of the foot and which may affect nurses' work productivity.

Associations between trunk flexion and physical activity of patient care workers for a single shift: A pilot study

BACKGROUND

Trunk flexion and occupational physical activity are parameters that have been used to assess and characterize jobs with high physical demands.

OBJECTIVE

Characterize the physical load of trunk flexion and physical activity of patient care unit (PCU) workers during a single work shift.

METHODS

Participants wore an accelerometer to measure physical activity and an inclinometer to assess trunk flexion during a single work shift, which was compared using correlation and linear regression analyses.

RESULTS

Participants spent 74% of their work time upright between - 10° to 20° and 19% of their time flexed between 20° to 45°. On average workers spent 3% and 5% of their time, in the extreme postures of less than - 10° and greater than 45°, respectively. Participants spent 99% of their shift below moderate and vigorous activity. The largest correlation found was between the number of forward trunk flexions to 20° degrees per shift and minutes in lifestyle activity (r = 0.6, p < 0.001). No correlations between minutes of moderate or vigorous physical activity and trunk flexion were observed.

CONCLUSIONS

This study suggests that the physical demands of patient care unit workers as measured through trunk flexion are associated with lifestyle and light levels of physical activity.

Evaluation of a Training Program to Reduce Stressful Trunk Postures in the Nursing Professions: A Pilot Study

Objectives

The aim of this pilot study was to evaluate metrologically the effectiveness of a training program on the reduction of stressful trunk postures in geriatric nursing professions.

Methods

A training program, consisting of instruction on body postures in nursing, practical ergonomic work methods at the bedside or in the bathroom, reorganization of work equipment, and physical exercises, was conducted in 12 wards of 6 nursing homes in Germany. The Computer-Assisted Recording and Long-Term Analysis of Musculoskeletal Loads (CUELA) measurement system was used to evaluate all movements and trunk postures adopted during work before and 6 months after the training program. In total, 23 shifts were measured. All measurements were supported by video recordings. A specific software program (WIDAAN 2.75) was used to synchronize the measurement data and video footage.

Results

The median proportion of time spent in sagittal inclinations at an angle of >20° was significantly reduced (by 29%) 6 months after the intervention [from 35.4% interquartile range (27.6-43.1) to 25.3% (20.7-34.1); P < 0.001]. Very pronounced inclinations exceeding 60° [2.5% (1.1-4.6) to 1.0% (0.8-1.7); P = 0.002] and static inclinations of over 20° for >4 s [4.4% (3.0-6.7) to 3.6% (2.5-4.5); P < 0.001] were significantly reduced, by 60% and 22%, respectively. Video analysis showed that in 49% of care situations, ergonomic measures were implemented properly, either at the bedside or in the bathroom.

Conclusions

Stressful trunk postures could be significantly reduced by raising awareness of the physical strains that frequently occur during a shift, by changes in work practices and by redesigning the work environment. Workplace interventions aimed at preventing or reducing low back pain in nursing personnel would probably benefit from sensitizing employees to their postures during work.

Working postures and physical activity among registered nurses

Nurses report a high prevalence of musculoskeletal discomfort, particularly of the low back and neck/shoulder. This study characterized the full-shift upper arm and trunk postures and movement velocities of registered nurses using inertial measurement units (IMUs). Intensity of occupational physical activity (PA) was also ascertained using a waist-worn PA monitor and using the raw acceleration data from each IMU. Results indicated that nurses spent a relatively small proportion of their work time with the arms or trunk in extreme postures, but had few opportunities for rest and recovery in comparison to several other occupational groups. Comparisons between nurses in different PA groups suggested that using a combination of accelerometers secured to several body locations may provide more representative estimates of physical demands than a single, waist-worn PA monitor. The findings indicate a need for continued field-based research with larger sample sizes to facilitate the development of maximally effective intervention strategies.

What do healthcare workers in elderly care know about occupational health and safety? An explorative survey

BACKGROUND

Demographic changes will lead to a growing demand for healthy, motivated healthcare workers (HCW) in the years ahead. Along with well-targeted prevention, knowledge of occupational health and safety and infection precaution is essential for a healthy working life. In this context back-friendly working methods and protection from infectious diseases are necessary in elderly care.

METHODS

In 2012, a survey was conducted in nine residential and two semi-residential nursing homes, as well as in one home care service in the Schwerin area of northeast Germany. Four hundred and seventy three HCWs were asked to fill in a questionnaire on what they knew about aspects of occupational health and safety such as vaccinations and preventative measures administered by occupational physicians, hygiene, back-friendly working methods and infection prevention. The statistical evaluation was descriptive, with a comparison between job title. Differences were examined with chi square or Fisher's exact test.

RESULTS

The response rate was 28 % (n = 132). The largest group of respondents (36 %) were qualified geriatric HCWs. More than 74 % of employees felt well informed about opportunities for precautionary checks and vaccination by occupational physician, and 93 % utilized these opportunities. When it came to assigning modes of transmission to specific infectious diseases, only 23 % of participants were well informed, and one in three (31 %) care assistants was inadequately informed. Fewer than half of participants could correctly name the indications for hand disinfection. Only 66 % of the HCWs said they were aware of training offers for the management of multidrug-resistant organisms in their institution. They did know about possible aids to back-friendly working, although gaps in knowledge were apparent. Only 59 % of respondents knew that care utensils should preferably be stored at working height so as to reduce awkward body postures.

CONCLUSIONS

Employees in elderly care are well informed about the range of precautionary occupational medical examinations and take advantage of this offering. Questions in the survey regarding hygiene management were answered in a competent manner. On the other hand some gaps in the knowledge about infection prevention and occupational safety became apparent. Differences between qualified and unqualified participating professionals occurred only in the knowledge of infectious diseases and pathogens and the associated path of infection. The extent to which training can help to improve infection prevention and occupational health and safety should be investigated.

Medical work assessment in German hospitals: a study protocol of a movement sequence analysis (MAGRO-MSA)

Background

Medical doctors are essential for the German public and occupational health system. They ensure the productivity of German society by enabling people to regain and recover their health. That is why the physicians’ health and hence their productivity require special attention. Musculoskeletal disorders have a high prevalence in this work area. As a consequence, movement sequences, range of motions, and body postures of physicians in the course of the working day are in focus of this research project.

Methods

For this investigation 21 male or female junior physicians of various conservative medical disciplines will be covered. Data will be collected over one working day (approx. 9 hours). The CUELA system attached to the test person’s body detects body posture and/or movements. This biomechanical measurement system ensures a locomotor and posture analysis that includes movement sequences, movement intensity, and range of motions to qualify the work tasks. For data analysis intra- and inter-professional comparisons are chosen.

Conclusions

Working movement sequence analysis of physicians by means of the CUELA system is exclusive and novel in its focus. Up to now, knowledge of the working tasks of medical doctors has only been acquired by real-time observation approaches to work activity. In addition to this method of analysis, the CUELA system is able to record quantified biomechanical data about musculoskeletal loads of ordinary working tasks. Workloads and activities of physicians can be improved by ergonomic work design to reduce musculoskeletal disorders by utilizing the data collected. The healthcare system in Germany will thus be optimized by improving medical doctors’ health. Consequently, MAGRO-MSA will also be used for other healthcare professions such as nurses and physicians assistants.