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Sabbath EL, Pan Y, McTernan ML, Peters SE, Lovett SM, Stelson EA, Wagner GR, Hopcia K, Boden LI. Adding injury to insult: Unfair treatment at work and occupational injury among hospital patient-care workers. Am J Ind Med 2024; 67:667-676. [PMID: 38738969 DOI: 10.1002/ajim.23616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Hospital patient-care workers have high occupational injury rates. While physical hazards within hospital work environments are established determinants of injury, social exposures may also contribute. This study examined how reports of unfair treatment at work, a dimension of work-related experiences of discrimination, were associated with injury among hospital-based patient-care workers. METHODS We used data from the Boston Hospital Workers Health Study, a longitudinal cohort of nurses and nursing assistants at two Boston-area hospitals. In 2018, we conducted a worker survey asking about three types of unfair treatment at work and occupational injuries during the past year. We used mixed-effects logistic regression models to evaluate associations between specific types, total load, and high-frequency exposure of unfair treatment with injury, adjusting for age, gender, race and ethnicity, job title, and unit type. RESULTS Among 1001 respondents, 21% reported being humiliated in front of others at work, 28% reported being watched more closely than other workers, and 47% reported having to work twice as hard as others for the same treatment. For each type of unfair treatment, we observed a monotonic relationship with occupational injury wherein increasing frequency of exposure was associated with increased odds of injury. We also observed monotonic relationships between total load and high-frequency exposure to unfair treatment and odds of injury. CONCLUSIONS Work-related unfair treatment is associated with injury among hospital workers. Programs and policies that focus on preventing unfair treatment may lessen injury burden in hospital workers.
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Affiliation(s)
- Erika L Sabbath
- Boston College School of Social Work, Chestnut Hill, Massachusetts, USA
| | - Yixin Pan
- Academic Research Services, Boston College, Chestnut Hill, Massachusetts, USA
| | - Melissa L McTernan
- Academic Research Services, Boston College, Chestnut Hill, Massachusetts, USA
| | - Susan E Peters
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sharonda M Lovett
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elisabeth A Stelson
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gregory R Wagner
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Karen Hopcia
- Occupational Health Services, Mass General Brigham, Somerville, Massachusetts, USA
| | - Leslie I Boden
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
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2
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Kugler HL, Taylor NF, Brusco NK. Patient handling training interventions and musculoskeletal injuries in healthcare workers: Systematic review and meta-analysis. Heliyon 2024; 10:e24937. [PMID: 38371982 PMCID: PMC10873653 DOI: 10.1016/j.heliyon.2024.e24937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
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.
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Affiliation(s)
- Helen L. Kugler
- Clinical Education and Research Institute, Cabrini Health, Australia
- School of Allied health, Human Services and Sport, La Trobe University, Australia
| | - Nicholas F. Taylor
- School of Allied health, Human Services and Sport, La Trobe University, Australia
- Allied Health Clinical Research Office, Eastern Health, Australia
| | - Natasha K. Brusco
- Clinical Education and Research Institute, Cabrini Health, Australia
- School of Allied health, Human Services and Sport, La Trobe University, Australia
- Rehabilitation, Aging and Independent Living (RAIL) Research Centre, Monash University, Australia
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3
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Abdul Halim NSS, Mohd Ripin Z, Ridzwan MIZ. Efficacy of Interventions in Reducing the Risks of Work-Related Musculoskeletal Disorders Among Healthcare Workers: A Systematic Review and Meta-Analysis. Workplace Health Saf 2023; 71:557-576. [PMID: 37539959 DOI: 10.1177/21650799231185335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
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.
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Affiliation(s)
- Nur Shuhaidatul Sarmiza Abdul Halim
- Neurorehabilitation Engineering and Assistance Systems Research (NEAR), School of Mechanical Engineering, Engineering Campus, Universiti Sains Malaysia
| | - Zaidi Mohd Ripin
- Neurorehabilitation Engineering and Assistance Systems Research (NEAR), School of Mechanical Engineering, Engineering Campus, Universiti Sains Malaysia
| | - Mohamad Ikhwan Zaini Ridzwan
- Neurorehabilitation Engineering and Assistance Systems Research (NEAR), School of Mechanical Engineering, Engineering Campus, Universiti Sains Malaysia
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Wåhlin C, Buck S, Sandqvist J, Enthoven P, Fock J, Andreassen M, Strid EN. Evaluation of the implementation and effectiveness of a multifactorial intervention strategy for safe patient handling and movement in the healthcare sector: a study protocol of a cluster randomised controlled trial. BMJ Open 2023; 13:e067693. [PMID: 36737081 PMCID: PMC9900050 DOI: 10.1136/bmjopen-2022-067693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Healthcare workers with physically demanding work tasks, such as patient handling and movement (PHM), are at high risk of musculoskeletal disorders. To facilitate safe PHM and prevent musculoskeletal disorders, a combination of workplace interventions, including risk assessments, is needed. The aim of this study is to implement and evaluate a multifactorial intervention strategy for safe PHM and compare it with a single intervention strategy. METHODS AND ANALYSIS This cluster randomised controlled trial will compare a multifactorial intervention strategy with a single intervention strategy for safe PHM in workplaces in the Swedish regional and municipal healthcare systems. At least twelve healthcare units will be recruited. Care units belonging to arm A will receive: (1) guidelines for PHM, (2) training modules, (3) risk assessment with TilThermometer, (4) risk assessment with Downtown Fall Risk Index and (5) work environment mapping. Care units belonging to Arm B will receive interventions (1) and (5). The two strategies will be evaluated with regards to (1) the primary outcome of the applied strategies' intervention effectiveness (safety climate in relation to aspects of PHM) and (2) the primary implementation outcome (acceptability, appropriateness and feasibility). This study will also explore the implementation process and intervention fidelity, examine the influence of contextual factors and investigate participants' experiences of working with strategies for safe PHM. A mix of quantitative and qualitative methods will be used. The data collection is based on questionnaires, interviews and field notes of contextual factors. ETHICS AND DISSEMINATION The study is approved by the Swedish national ethical board (Dnr 2021-00578). Study results will be published in peer-reviewed journals, presented at conferences and distributed on social media. A lay summary and dissemination strategy will be codesigned with a reference group and participating healthcare units. TRIAL REGISTRATION NUMBER NCT05276180.
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Affiliation(s)
- Charlotte Wåhlin
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Clinical Medicine, Linköping University, Linkoping, Sweden
- Unit of Intervention and Implementation Research for worker health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Buck
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Clinical Medicine, Linköping University, Linkoping, Sweden
| | - Jan Sandqvist
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Occupational Therapy, Linköping University, Norrköping, Sweden
| | - Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Jenni Fock
- Unit of Stratgic Development, Linköping University Hospital, Region Östergötland, Linkoping, Sweden
| | - Maria Andreassen
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Occupational Therapy, Linköping University, Norrköping, Sweden
| | - Emma Nilsing Strid
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Albanesi B, Piredda M, Bravi M, Bressi F, Gualandi R, Marchetti A, Facchinetti G, Ianni A, Cordella F, Zollo L, De Marinis MG. Interventions to prevent and reduce work-related musculoskeletal injuries and pain among healthcare professionals. A comprehensive systematic review of the literature. JOURNAL OF SAFETY RESEARCH 2022; 82:124-143. [PMID: 36031239 DOI: 10.1016/j.jsr.2022.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/26/2021] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Beatrice Albanesi
- Research Unit Nursing Science, Campus Bio-Medico University, Rome, Italy; Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico University, Rome, Italy.
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Rome, Italy
| | - Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Rome, Italy
| | - Raffaella Gualandi
- Research Unit Nursing Science, Campus Bio-Medico University, Rome, Italy
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico University, Rome, Italy
| | | | - Andrea Ianni
- Research Unit in Hygiene, Statistics and Public Health, Campus Bio-Medico University, Rome, Italy
| | - Francesca Cordella
- CREO Lab - Advanced Robotics and Human Centred Technologies, Campus Bio-Medico University, Rome, Italy
| | - Loredana Zollo
- CREO Lab - Advanced Robotics and Human Centred Technologies, Campus Bio-Medico University, Rome, Italy
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McCrory B, Ma J, Irons SL, Burnfield JM. Occupational injuries and patient lift usage among physical rehabilitation therapists. J Back Musculoskelet Rehabil 2022; 35:195-205. [PMID: 34397400 DOI: 10.3233/bmr-200354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Physical therapists (PTs) and physical therapist assistants (PTAs) are at high risk for work-related musculoskeletal pain and discomfort. OBJECTIVE Determine the prevalence and exposure risk factors for work-related injuries (WRIs) among rehabilitation PTs and PTAs. METHODS A cross-sectional research survey was conducted among 170 PTs and 67 PTAs at 51 free-standing rehabilitation hospitals and rehabilitation units embedded in general hospitals in the Midwestern states of Iowa, Kansas, Missouri and Nebraska. The prevalence of WRIs and significant risk factors for developing WRIs were determined for PTs and PTAs. RESULTS The 1-year prevalence of WRIs among PTs and PTAs working in physical rehabilitation was 29.5%. Multifaceted causes were identified including frequently bending/twisting, over-exerting force during patient handling activities, inadequate lifting devices, and lack of ongoing training for mechanical lifting device usage. CONCLUSIONS Equipment usage barriers point to a critical need for technology creation, research, and education to advance worker safety while simultaneously enhancing patient outcomes.
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Affiliation(s)
- Bernadette McCrory
- Mechanical and Industrial Engineering Department, Montana State University, Bozeman, MT, USA
| | - Jiahui Ma
- Mechanical and Industrial Engineering Department, Montana State University, Bozeman, MT, USA
| | | | - Judith M Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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7
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Wåhlin C, Stigmar K, Strid EN. A systematic review of work interventions to promote safe patient handling and movement in the healthcare sector. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2021; 28:2520-2532. [PMID: 34789085 DOI: 10.1080/10803548.2021.2007660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Charlotte Wåhlin
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden.,Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Kjerstin Stigmar
- Department of Health Sciences, Lund University, Lund, Sweden.,Skåne University Hospital, Region Skåne, Lund, Sweden
| | - Emma Nilsing Strid
- University Health Care Research Center, Region Örebro County, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Komashie A, Ward J, Bashford T, Dickerson T, Kaya GK, Liu Y, Kuhn I, Günay A, Kohler K, Boddy N, O'Kelly E, Masters J, Dean J, Meads C, Clarkson PJ. Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis. BMJ Open 2021; 11:e037667. [PMID: 33468455 PMCID: PMC7817809 DOI: 10.1136/bmjopen-2020-037667] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/02/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To systematically review the evidence base for a systems approach to healthcare design, delivery or improvement. DESIGN Systematic review with meta-analyses. METHODS Included were studies in any patients, in any healthcare setting where a systems approach was compared with usual care which reported quantitative results for any outcomes for both groups. We searched Medline, Embase, HMIC, Health Business Elite, Web of Science, Scopus, PsycINFO and CINAHL from inception to 28 May 2019 for relevant studies. These were screened, and data extracted independently and in duplicate. Study outcomes were stratified by study design and whether they reported patient and/or service outcomes. Meta-analysis was conducted with Revman software V.5.3 using ORs-heterogeneity was assessed using I2 statistics. RESULTS Of 11 405 records 35 studies were included, of which 28 (80%) were before-and-after design only, five were both before-and-after and concurrent design, and two were randomised controlled trials (RCTs). There was heterogeneity of interventions and wide variation in reported outcome types. Almost all results showed health improvement where systems approaches were used. Study quality varied widely. Exploratory meta-analysis of these suggested favourable effects on both patient outcomes (n=14, OR=0.52 (95% CI 0.38 to 0.71) I2=91%), and service outcomes (n=18, OR=0.40 (95% CI 0.31 to 0.52) I2=97%). CONCLUSIONS This study suggests that a systems approaches to healthcare design and delivery results in a statistically significant improvement to both patient and service outcomes. However, better quality studies, particularly RCTs are needed.PROSPERO registration numberCRD42017065920.
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Affiliation(s)
- Alexander Komashie
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Global Health Research Group on Neurotrauma, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - James Ward
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Tom Bashford
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Global Health Research Group on Neurotrauma, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
- Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Terry Dickerson
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Gulsum Kubra Kaya
- Faculty of Engineering and Natural Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Yuanyuan Liu
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Isla Kuhn
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aslι Günay
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
- Media and Visual Arts, Koc University, Istanbul, Turkey
| | - Katharina Kohler
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
- Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Nicholas Boddy
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Eugenia O'Kelly
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Joseph Masters
- Major Trauma Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - John Dean
- Department of Care Quality Improvement, Royal College of Physicians, London, London, UK
| | - Catherine Meads
- School of Nursing and Midwifery, Anglia Ruskin University - Cambridge Campus, Cambridge, Cambridgeshire, UK
| | - P John Clarkson
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
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Lee SJ, Kang KJ, Lee JH. Safe patient handling legislation and changes in programs, practices, perceptions, and experience of musculoskeletal disorders by hospital characteristics: A repeated cross-sectional survey study. Int J Nurs Stud 2020; 113:103791. [PMID: 33152606 DOI: 10.1016/j.ijnurstu.2020.103791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Safe patient handling legislation has been enacted in 11 states in the United States to protect healthcare workers from patient handing injuries. Implementations and outcomes may vary across hospitals by the characteristics of the institution. OBJECTIVES This study was to investigate the changes in safe patient handling programs in hospitals, and nurses' perceptions, work practices, and musculoskeletal symptoms by hospital characteristics after the passage of California's safe patient handling legislation. DESIGN Repeated cross-sectional surveys. SETTINGS Two statewide surveys of registered nurses were conducted in California, where a safe patient handling law became effective in 2012. Random samples were selected from the lists of the California Board of Registered Nurses (2000 nurses in 2013 and 3000 nurses in 2016). PARTICIPANTS Among survey respondents (26% in 2013 and 20% in 2016), the study sample included 254 nurses in 2013 and 281 nurses in 2016, who met the eligibility for this study: nurses employed in a hospital and had direct patient care or patient handling duties. METHODS Data were collected by postal and on-line surveys. Data were compared by hospital size, geographic area, hospital teaching status, and ownership (for-profit, non-profit, government). RESULTS Between 2013 and 2016, nurses' reports showed improvements in safe patient handling policies and programs across the different characteristics of hospitals. In 2016, nurses in large, teaching, non-profit, and rural hospitals reported slightly better scores for safe patient handling program variables than their counterparts; however, changes in the use of mechanical lifting devices and experiences of musculoskeletal symptoms and injury were not significantly different by hospital characteristics. Overall, teaching hospitals consistently showed greater improvements than non-teaching hospitals for both hospital-level (safe patient handling programs and organizational practices) and individual-level (perceptions and symptoms) variables. CONCLUSIONS Our findings indicate overall improvements of safe patient handling programs in California hospitals after the passage of safe patient handling legislation. Positive changes appear to be greater among teaching, non-profit, and rural hospitals. However, greater positive changes in safe patient handling programs shown in certain hospital characteristics were not necessarily linked to more improvements in nurses' safe work practices and experiences of musculoskeletal symptoms or injuries.
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Affiliation(s)
- Soo Jeong Lee
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, Suite N-505, Box 0608, San Francisco, CA 94143-0608, USA.
| | - Kyung Ja Kang
- College of Nursing, Jeju National University, 102 Jeju-daehakno, Jeju-city, Jeju 63243, South Korea.
| | - Joung Hee Lee
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, Suite N-505, Box 0608, San Francisco, CA 94143-0608, USA; Department of Nursing, Chodang University, 380 Muanro, Muaneup, Muangun, Jeollanamdo 58530, South Korea.
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10
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Dennerlein JT, Burke L, Sabbath EL, Williams JAR, Peters SE, Wallace L, Karapanos M, Sorensen G. An Integrative Total Worker Health Framework for Keeping Workers Safe and Healthy During the COVID-19 Pandemic. HUMAN FACTORS 2020; 62:689-696. [PMID: 32515231 PMCID: PMC7346710 DOI: 10.1177/0018720820932699] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/18/2020] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The aim was to recommend an integrated Total Worker Health (TWH) approach which embraces core human factors and ergonomic principles, supporting worker safety, health, and well-being during the COVID-19 pandemic. BACKGROUND COVID-19 has resulted in unprecedented challenges to workplace safety and health for workers and managers in essential businesses, including healthcare workers, grocery stores, delivery services, warehouses, and distribution centers. Essential workers need protection, accurate information, and a supportive work environment with an unwavering focus on effective infection control. METHOD The investigators reviewed emerging workplace recommendations for reducing workers' exposures to the novel coronavirus and the challenges to workers in protecting their health. Using a theoretical framework and guidelines for integrating safety and health management systems into an organization for TWH, the investigators adapted the framework's key characteristics to meet the specific worker safety and health issues for effective infection control, providing supports for increasing psychological demands while ensuring a safe work environment. RESULTS The recommended approach includes six key characteristics: focusing on working conditions for infection control and supportive environments for increased psychological demands; utilizing participatory approaches involving workers in identifying daily challenges and unique solutions; employing comprehensive and collaborative efforts to increase system efficiencies; committing as leaders to supporting workers through action and communications; adhering to ethical and legal standards; and using data to guide actions and evaluate progress. CONCLUSION Applying an integrative TWH approach for worker safety, health, and well-being provides a framework to help managers systematically organize and protect themselves, essential workers, and the public during the COVID-19 pandemic. APPLICATION By using the systems approach provided by the six implementation characteristics, employers of essential workers can organize their own efforts to improve system performance and worker well-being during these unprecedented times.
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Affiliation(s)
- Jack T. Dennerlein
- Northeastern University, Boston, MA, USA
- Jack T. Dennerlein, Northeastern University, Robinson Hall, Room 301, 360 Huntington Ave, Boston, MA, USA;
| | - Lisa Burke
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | | | - Glorian Sorensen
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Poor Sleep Is a Risk Factor for Low-Back Pain among Healthcare Workers: Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030996. [PMID: 32033339 PMCID: PMC7036951 DOI: 10.3390/ijerph17030996] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/13/2022]
Abstract
This study aimed to investigate the association between poor sleep and risk of low-back pain (LBP) in healthcare workers. Using a prospective cohort design with 1-year follow-up, a total of 1955 healthcare workers (60% nurses) from 389 departments at 19 hospitals responded to questionnaires containing items related to lifestyle, health, and working environment. Associations between sleep scores (0-100) at baseline and LBP intensity (0-10) at follow-up were modelled using cumulative logistic regression accounting for clustering at the department level and adjusted for lifestyle and psychosocial confounders. In the full population of healthcare workers, 43.9% and 24.4% experienced moderate and poor sleep, respectively. In the fully adjusted model with good sleep as reference, moderate, and poor sleep increased the risk of LBP at follow-up, with odds ratios (OR's) of 1.66 (95% confidence interval (CI) 1.35-2.04) and 2.05 (95% CI 1.57-2.69), respectively. Three sensitivity analyses including healthcare workers free from LBP, nurses, and nurses free from LBP at baseline, respectively, yielded similar results. In conclusion, poor sleep constitutes a potent risk factor for LBP among healthcare workers. The presented results provide strong incentives to evaluate and weigh current prevention policies against an updated biopsychosocial framework.
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The Current State of Surgical Ergonomics Education in U.S. Surgical Training: A Survey Study. Ann Surg 2020; 269:778-784. [PMID: 29381528 DOI: 10.1097/sla.0000000000002592] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to characterize the current state of surgical ergonomics education in the United States. BACKGROUND The burden of work-related musculoskeletal disorders (MSDs) in surgeons is high and no overarching strategy for redress exists. Twelve distinct specialties describe an unmet need for surgical ergonomics education (SEE). This study aimed to define the current state of SEE in U.S. surgical training programs. METHODS We performed a descriptive analysis of a 20-item questionnaire of ACGME-certified program directors from 14 surgical and interventional medical specialties. Formal SEE was defined as any organized education module that reviewed the occupation-specific burden of common work-related MSDs and described a framework for prevention via occupation-specific applied ergonomics. Program directors were queried regarding SEE provision, characteristics, and perceived trainee attitude toward the education. RESULTS Questionnaires were received from 130 of 441 (29.5%) program directors. Two (1.5%) provided formal SEE and 33 (25.4%) provided informal SEE, which consisted of unstructured intraoperative directives and isolated lectures. Two programs previously provided SEE but discontinued the effort due to lack of an evidence-based framework and instructors. Trainees appeared to think that learning surgical ergonomics skills was a worthwhile time investment in 100% and 76.7% of current formal and informal SEE, respectively. CONCLUSION SEE is rarely provided in any capacity (25.4%), let alone in a consistent or evaluable fashion (1.5%). Impediments to sustainable SEE include lack of an evidence-based framework for education and instructors. An evidence-based, reproducible, and accreditation council-compliant SEE module would be a valuable resource for the surgical and interventional medical communities.
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Kayser SA, Wiggermann NE, Kumpar D. Factors associated with safe patient handling practice in acute care and its relationship with patient mobilization: A cross-sectional study. Int J Nurs Stud 2019; 104:103508. [PMID: 32105973 DOI: 10.1016/j.ijnurstu.2019.103508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Mobilizing hospital patients is associated with improved outcomes and shorter length of stay. Safe patient handling and mobility programs that include mechanical lift use facilitate mobilizing patients and reduce the likelihood of musculoskeletal disorders in staff. However, there is little information on the prevalence of lift use or why some patients are more likely to have a lift used than others. Such information is needed to inform public policy, benchmark lift use over time, and contextualize barriers for lift use. OBJECTIVE To determine the percentage of patients that had a lift used during care in US acute care facilities, identify attributes related to the patient and their hospital stay that affect the lift use, examine whether state legislation increased lift use, and determine whether lift use was correlated with more frequent mobilization out of bed. DESIGN Retrospective analysis of the 2018 International Pressure Ulcer Prevalence ™ data. PARTICIPANTS 40,856 patients in 642 US acute care hospitals over the age of 18 with complete data. METHODS Lift use prevalence was calculated as the percentage of patients that met inclusion criteria that had a lift used for care. Prevalence was then analyzed by patient mobility level. A logistic regression examined the influence of patient and facility related attributes. For patients with limited mobility (that could not stand or turn themselves), a t-test of proportions evaluated whether lift use during a patient's stay was correlated with an increased likelihood of being out of bed at the time of the survey. RESULTS 3.7% of patients had a lift used during their care. 11.1% of limited mobility patients had a lift used. Lift use was associated with higher body mass, longer length of stay, lower Braden score, pressure injury prevention methods in place, being in an intensive care unit, being in a smaller hospital, and being in a state with safe patient handling and mobility legislation. Limited mobility patients moved with lifts during their stay were more likely to be observed in a bedside chair and less likely to be observed in bed, as compared to patients that never had a lift used. CONCLUSIONS Despite the benefits to patients and caregivers, US acute care facilities are largely not using lifts to safely mobilize patients. Results suggested that safe patient handling and mobility legislation has increased the rate of lift use. Finally, lift use was correlated with patients being mobilized out of bed.
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Affiliation(s)
- Susan A Kayser
- Hill-Rom Holdings, Inc., 1069 State Road 46 East, Batesville, IN 47006, United States.
| | - Neal E Wiggermann
- Hill-Rom Holdings, Inc., 1069 State Road 46 East, Batesville, IN 47006, United States.
| | - Dee Kumpar
- Hill-Rom Holdings, Inc., 1069 State Road 46 East, Batesville, IN 47006, United States.
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Literature Review of Policy Implications From Findings of the Center for Work, Health, and Well-being. J Occup Environ Med 2019; 61:868-876. [PMID: 31453894 DOI: 10.1097/jom.0000000000001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the publications of a Total Worker Health Center of Excellence, the Harvard T.H. Chan School of Public Health Center for Work, Health, and Well-being, in order to identify research findings relevant to either organizational or public policies. METHODS Two researchers independently reviewed 57 publications from 2011 to 2019 to identify cross-cutting themes that focus on working conditions or related health outcomes and their organizational and public policy implications. RESULTS Twelve cross-cutting themes were identified with their respective organizational and public policy implications. Several policy implications cut across work-related themes. CONCLUSIONS Policy implications of TWH research will aid in setting priorities to translate this from research into practice in future studies and help identify gaps that we and others can use to plan future TWH research.
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CE: Original Research: Patient Handling and Mobility Course Content: A National Survey of Nursing Programs. Am J Nurs 2019; 118:22-31. [PMID: 30325746 DOI: 10.1097/01.naj.0000547636.03211.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Purpose: Despite the evidence supporting safe patient handling and mobility (SPHM) practices, anecdotal evidence suggests that such practices are not universally taught in academic nursing programs. The primary goal of this cross-sectional descriptive study was to understand what nursing programs teach students about lifting, turning, transferring, repositioning, and mobilizing patients. METHODS Faculty from baccalaureate and associate's degree nursing programs in the United States were invited via e-mail to complete a 64-item survey questionnaire, which was accessible through an online link. Participants were also invited to send documents related to SPHM course content to the research team. RESULTS Faculty from 228 baccalaureate and associate's degree nursing programs completed the questionnaire. Most curricula included outdated manual techniques, taught reliance on body mechanics to reduce the risk of musculoskeletal injuries, and made use of nonergonomic aids such as draw sheets. Elements of SPHM in the curricula were less common, and nearly half of the respondents didn't know whether their affiliated clinical facilities had an SPHM program. CONCLUSIONS The survey results suggest many possibilities for improvement-such as partnering with faculty in physical and occupational therapy departments, clinical partnering, and working with equipment vendors-to better incorporate evidence-based SPHM principles and practices into nursing curricula.
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Kusma B, Pietsch A, Riepenhof H, Haß S, Kuhn D, Fischer K, Nienhaus A. The Back College for nurses - an evaluation of intermediate effects. J Occup Med Toxicol 2019; 14:19. [PMID: 31249605 PMCID: PMC6584993 DOI: 10.1186/s12995-019-0239-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/10/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Nursing staff and care workers run an increased risk of work related musculoskeletal disorders such as low back pain. The Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW) offers its insured persons the opportunity to participate in a three-week Back College with the aim of preventing them having to abandon their profession due to back problems. The aim of the study was to record the effectiveness and sustainability of the Back College on an intermediate basis (6 months). METHODS As part of a single-group pre-post measurement on three survey dates - at the start (T0) and end (T1) of rehabilitation and 6 months later (T2) - in 2013 all participants in the Back College at three locations were surveyed using a standard questionnaire. Wilcoxon signed-rank tests were performed to evaluate statistically significant changes. RESULTS For measurement dates T0 to T2 we had 570 complete datasets (response rate 70.81%). There was a significant decrease in reported back pain and the general state of health and quality of life index improved. Participants' emotional strain decreased and they showed an improved understanding of illness as well as of having acquired knowledge-based abilities and skills for dealing with the disease. After training, they recorded back-friendly behaviour in everyday life and opportunities to relieve strain on the spinal column were utilised at work more often. Participants' subjective assessment of their ability to work (Work Ability Index) improved. CONCLUSION The present study proved the intermediate effectiveness of the Back College curriculum. Whether these effects remain stable in the long term will be tested on the subsequent measurement date (T3, after 24 months).
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Affiliation(s)
- Bianca Kusma
- Institution for Statutory Accident Insurance in the Health and Welfare Services, Pappelallee 35/37, 22089 Hamburg, Germany
| | - Aki Pietsch
- BG Hospital Hamburg, Bergedorfer Straße 10, 21033 Hamburg, Germany
| | - Helge Riepenhof
- BG Hospital Hamburg, Bergedorfer Straße 10, 21033 Hamburg, Germany
| | - Sören Haß
- BG Nordsee Reha-Klinik, Wohldweg 7, 25826 St. Peter-Ording, Germany
| | - Daniel Kuhn
- BG Hospital Bergmannstrost Halle, Merseburger Straße 165, 06112 Halle (Saale), Germany
| | - Klaus Fischer
- BG Hospital Bergmannstrost Halle, Merseburger Straße 165, 06112 Halle (Saale), Germany
| | - Albert Nienhaus
- Institution for Statutory Accident Insurance in the Health and Welfare Services, Pappelallee 35/37, 22089 Hamburg, Germany
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246 Hamburg, Germany
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Sabbath EL, Hashimoto D, Boden LI, Dennerlein JT, Williams JAR, Hopcia K, Orechia T, Tripodis Y, Stoddard A, Sorensen G. Cohort profile: The Boston Hospital Workers Health Study (BHWHS). Int J Epidemiol 2019; 47:1739-1740g. [PMID: 30107500 DOI: 10.1093/ije/dyy164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Erika L Sabbath
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Dean Hashimoto
- Partners HealthCare, Boston, MA, USA.,School of Law, Boston College, Newton, MA, USA
| | - Leslie I Boden
- School of Public Health, Boston University, Boston, MA, USA
| | - Jack T Dennerlein
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | | | | | | | - Anne Stoddard
- Centre for Community-based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Glorian Sorensen
- Centre for Community-based Research, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Social and Behavioural Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Sabbath EL, Yang J, Dennerlein JT, Boden LI, Hashimoto D, Sorensen G. Paradoxical Impact of a Patient-Handling Intervention on Injury Rate Disparity Among Hospital Workers. Am J Public Health 2019; 109:618-625. [PMID: 30789763 DOI: 10.2105/ajph.2018.304929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To test whether a comprehensive safe patient-handling intervention, which successfully reduced overall injury rates among hospital workers in a prior study, was differentially effective for higher-wage workers (nurses) versus low-wage workers (patient care associates [PCAs]). METHODS Data were from a cohort of nurses and PCAs at 2 large hospitals in Boston, Massachusetts. One hospital received the intervention in 2013; the other did not. Using longitudinal survey data from 2012 and 2014 plus longitudinal administrative injury and payroll data, we tested for socioeconomic differences in changes in self-reported safe patient-handling practices, and for socioeconomic differences in changes in injury rates using administrative data. RESULTS After the intervention, improvements in self-reported patient-handling practices were equivalent for PCAs and for nurses. However, in administrative data, lifting and exertion injuries decreased among nurses (rate ratio [RR] = 0.64; 95% confidence interval [CI] = 0.41, 1.00) but not PCAs (RR = 1.10; 95% CI = 0.74,1.63; P for occupation × intervention interaction = 0.02). CONCLUSIONS Although the population-level injury rate decreased after the intervention, most improvements were among higher-wage workers, widening the socioeconomic gap in injury and exemplifying the inequality paradox. Results have implications for public health intervention development, implementation, and analysis.
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Affiliation(s)
- Erika L Sabbath
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
| | - Jie Yang
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
| | - Jack T Dennerlein
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
| | - Leslie I Boden
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
| | - Dean Hashimoto
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
| | - Glorian Sorensen
- Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA. At the time of the study, Jie Yang was with the School of Social Work, Boston College, and is also with the School of Social Work, East Carolina University, Greenville. Jack T. Dennerlein is with the Bouve College of Health Sciences, Northeastern University, Boston, MA. Leslie I. Boden is with the Department of Environmental Health, School of Public Health, Boston University, Boston. Dean Hashimoto is with Partners HealthCare, Somerville, MA. Glorian Sorensen is with the Center for Community-Based Research, Dana-Farber Cancer Institute, Boston
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Lee SJ, Lee JH, Harrison R. Impact of California's safe patient handling legislation on musculoskeletal injury prevention among nurses. Am J Ind Med 2019; 62:50-58. [PMID: 30474130 DOI: 10.1002/ajim.22923] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study evaluated the impact of California's safe patient handling (SPH) legislation on musculoskeletal injury prevention among hospital nurses. METHODS Two serial cross-sectional surveys were conducted using postal and online questionnaires in statewide random samples of California registered nurses in 2013 and 2016. Analysis included hospital nurses who performed patient handling (n = 254 and n = 281, respectively). RESULTS In 2016, there were significant improvements in nurses' knowledge of a SPH policy in their hospital (87%), receipt of annual SPH training (73%), and availability of lift equipment (80%); 33% perceived their hospital's SPH programs as excellent or very good. Significant prevalence reduction was observed for work-related musculoskeletal symptoms (61% vs 52%; Adjusted Prevalence Ratio = 0.78, 95% CI 0.66-0.91). CONCLUSIONS Our findings indicate the significant role of SPH legislation with positive impacts on SPH policies and programs at the hospital level and on musculoskeletal health outcomes at the worker level.
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Affiliation(s)
- Soo-Jeong Lee
- School of Nursing, University of California, San Francisco, California
| | - Joung Hee Lee
- School of Nursing, University of California, San Francisco, California
| | - Robert Harrison
- School of Medicine, University of California, San Francisco, California
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20
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Tamers SL, Goetzel R, Kelly KM, Luckhaupt S, Nigam J, Pronk NP, Rohlman DS, Baron S, Brosseau LM, Bushnell T, Campo S, Chang CC, Childress A, Chosewood LC, Cunningham T, Goldenhar LM, Huang TTK, Hudson H, Linnan L, Newman LS, Olson R, Ozminkowski RJ, Punnett L, Schill A, Scholl J, Sorensen G. Research Methodologies for Total Worker Health®: Proceedings From a Workshop. J Occup Environ Med 2018; 60:968-978. [PMID: 30407366 PMCID: PMC6221402 DOI: 10.1097/jom.0000000000001404] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE There is growing interest in the NIOSH Total Worker Health program, specifically in the process of designing and implementing safer, health-promoting work and workplaces. A Total Worker Health (TWH) Research Methodology Workshop was convened to discuss research methods and future needs. METHODS Twenty-six experts in occupational safety and health and related fields reviewed and discussed current methodological and measurement issues and those showing promise. RESULTS TWH intervention studies face the same challenges as other workplace intervention studies and some unique ones. Examples are provided of different approaches and their applications to TWH intervention studies, and desired developments in the TWH literature. CONCLUSIONS This report discusses and outlines principles important to building the TWH intervention research base. Rigorous, valid methodologic, and measurement approaches are needed for TWH intervention as well as for basic/etiologic, translational, and surveillance research.
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Affiliation(s)
- Sara L Tamers
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC (Dr Tamers, Ms Chang, Dr Childress, Dr Schill); Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Atlanta, GA (Dr Chosewood); Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH (Dr Luckhaupt, Ms Hudson, Dr Cunningham, Dr Bushnell, Dr Scholl, Ms Nigam); Johns Hopkins University, Baltimore, Maryland (Dr Goetzel); IBM Watson Health, Bethesda, Maryland (Dr Goetzel, Dr Ozminkowski); University of Iowa, Iowa City, Iowa (Dr Kelly, Dr Rohlman, Dr Campo); HealthPartners Institute, Minneapolis, Minnesota (Dr Pronk); City University of New York, New York City, New York (Dr Baron, Dr Huang); University of Illinois at Chicago, Chicago, Illinois (Dr Brosseau); Center for Construction Research and Training, Silver Spring, Maryland (Dr Goldenhar); University of North Carolina-Chapel Hill, Chapel Hill, North Carolina (Dr Linnan); Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Colorado (Dr Newman); Oregon Health and Science University, Portland, Oregon (Dr Olson); University of Massachusetts Lowell, Lowell, Massachusetts (Dr Punnett); Harvard University, Cambridge, Massachusetts (Dr Pronk, Dr Sorensen)
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Peters SE, Grant MP, Rodgers J, Manjourides J, Okechukwu CA, Dennerlein JT. A Cluster Randomized Controlled Trial of a Total Worker Health ® Intervention on Commercial Construction Sites. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112354. [PMID: 30366387 PMCID: PMC6265748 DOI: 10.3390/ijerph15112354] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 01/17/2023]
Abstract
This study evaluated the efficacy of an integrated Total Worker Health® program, “All the Right Moves”, designed to target the conditions of work and workers’ health behaviors through an ergonomics program combined with a worksite-based health promotion Health Week intervention. A matched-pair cluster randomized controlled trial was conducted on ten worksites (five intervention (n = 324); five control sites (n = 283)). Worker surveys were collected at all sites pre- and post- exposure at one- and six-months. Linear and logistic regression models evaluated the effect of the intervention on pain and injury, dietary and physical activity behaviors, smoking, ergonomic practices, and work limitations. Worker focus groups and manager interviews supplemented the evaluation. After controlling for matched intervention and control pairs as well as covariates, at one-month following the ergonomics program we observed a significant improvement in ergonomic practices (B = 0.20, p = 0.002), and a reduction in incidences of pain and injury (OR = 0.58, p = 0.012) in the intervention group. At six months, we observed differences in favor of the intervention group for a reduction in physically demanding work (B = −0.25, p = 0.008), increased recreational physical activity (B = 35.2, p = 0.026) and higher consumption of fruits and vegetables (B = 0.87, p = 0.008). Process evaluation revealed barriers to intervention implementation fidelity and uptake, including a fissured multiemployer worksite, the itinerant nature of workers, competing production pressures, management support, and inclement weather. The All the Right Moves program had a positive impact at the individual level on the worksites with the program. For the longer term, the multi-organizational structure in the construction work environment needs to be considered to facilitate more upstream, long-term changes.
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Affiliation(s)
- Susan E Peters
- Harvard Center for Work, Health and Wellbeing, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Michael P Grant
- Harvard Center for Work, Health and Wellbeing, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Justin Rodgers
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115, USA.
| | - Justin Manjourides
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115, USA.
| | - Cassandra A Okechukwu
- Harvard Center for Work, Health and Wellbeing, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Jack T Dennerlein
- Harvard Center for Work, Health and Wellbeing, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Department of Physical Therapy, Movement and Rehabilitation Science, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115, USA.
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Reducing Intensive Care Unit Staff Musculoskeletal Injuries With Implementation of a Safe Patient Handling and Mobility Program. Crit Care Nurs Q 2018; 41:264-271. [PMID: 29851675 DOI: 10.1097/cnq.0000000000000205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this safety initiative was to reduce work-related injuries through the implementation of a safe patient handling and mobility (SPHM) program in a medical intensive care unit. An SPHM program was implemented on a critical care medicine unit in February of 2017. Nursing and assistive personnel completed education via hands-on and online educational modules regarding SPHM equipment and techniques and an SPHM policy. All staff were expected to follow SPHM practices. Critical care medicine unit nursing leadership and unit-based SPHM peer coaches rounded to ensure staff compliance with the program. A 1-year evaluation demonstrated a reduction of 86% in work-related injuries. In 2016, there were 7 injuries while in 2017, only 1 injury occurred. Lost and restricted days away from work were reduced by 54% or from a total of 112 days in 2016 to 52 days in 2017. The implementation of an SPHM program in a medical intensive care unit appears to be highly effective at reducing health care worker injuries. More research is needed to identify the best and most effective ways to provide care to our most critical patients. Positive behaviors from the staff regarding the SPHM program have helped reduce injuries and lost workdays.
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Sabbath EL, Sparer EH, Boden LI, Wagner GR, Hashimoto DM, Hopcia K, Sorensen G. Preventive care utilization: Association with individual- and workgroup-level policy and practice perceptions. Prev Med 2018; 111:235-240. [PMID: 29567439 PMCID: PMC6028933 DOI: 10.1016/j.ypmed.2018.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/05/2018] [Accepted: 03/14/2018] [Indexed: 01/13/2023]
Abstract
Preventive medical care may reduce downstream medical costs and reduce population burden of disease. However, although social, demographic, and geographic determinants of preventive care have been studied, there is little information about how the workplace affects preventive care utilization. This study examines how four types of organizational policies and practices (OPPs) are associated with individual workers' preventive care utilization. We used data collected in 2012 from 838 hospital patient care workers, grouped in 84 patient care units at two hospitals in Boston. Via survey, we assessed individuals' perceptions of four types of OPPs on their work units. We linked the survey data to a database containing detailed information on medical expenditures. Using multilevel models, we tested whether individual-level perceptions, workgroup-average perceptions, and their combination were associated with individual workers' preventive care utilization (measured by number of preventive care encounters over a two-year period). Adjusting for worker characteristics, higher individual-level perceptions of workplace flexibility were associated with greater preventive care utilization. Higher average unit-level perceptions of people-oriented culture, ergonomic practices, and flexibility were associated with greater preventive care utilization. Overall, we find that workplace policies and practices supporting flexibility, ergonomics, and people-oriented culture are associated with positive preventive care-seeking behavior among workers, with some policies and practices operating at the individual level and some at the group level. Improving the work environment could impact employers' health-related expenditures and improve workers' health-related quality of life.
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Affiliation(s)
- Erika L Sabbath
- Boston College, School of Social Work, Chestnut Hill, MA, United States.
| | - Emily H Sparer
- Center for Community-based Research, Dana-Farber Cancer Institute, Boston, MA, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Leslie I Boden
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Gregory R Wagner
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Dean M Hashimoto
- Workplace Health and Wellbeing, Partners HealthCare System, Boston, MA, United States; Boston College Law School, Chestnut Hill, MA, United States
| | - Karen Hopcia
- Workplace Health and Wellbeing, Partners HealthCare System, Boston, MA, United States
| | - Glorian Sorensen
- Center for Community-based Research, Dana-Farber Cancer Institute, Boston, MA, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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24
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Hegewald J, Berge W, Heinrich P, Staudte R, Freiberg A, Scharfe J, Girbig M, Nienhaus A, Seidler A. Do Technical Aids for Patient Handling Prevent Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E476. [PMID: 29522440 PMCID: PMC5877021 DOI: 10.3390/ijerph15030476] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Wera Berge
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Philipp Heinrich
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Ronny Staudte
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Julia Scharfe
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Maria Girbig
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Albert Nienhaus
- Institute for Health Service Research in Dermatology and Nursing, University Clinics Hamburg Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Department of Occupational Health Research, German Social Accident Insurance Institution for the Health and Welfare Service, Pappelallee 33-37, 22089 Hamburg, Germany.
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
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25
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Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D, Lee BT. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg 2018; 153:e174947. [PMID: 29282463 DOI: 10.1001/jamasurg.2017.4947] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Physicians in procedural specialties are at high risk for work-related musculoskeletal disorders (MSDs). This has been called "an impending epidemic" in the context of the looming workforce shortage; however, prevalence estimates vary by study. Objectives To estimate the prevalence of work-related MSDs among at-risk physicians and to evaluate the scope of preventive efforts. Data Sources and Study Selection Systematic search in MEDLINE (Ovid), Embase (Elsevier), Web of Science, PubMed (National Center for Biotechnology Information), and 2 clinical trial registries, without language restriction, for studies reporting on the prevalence and prevention of work-related MSDs among at-risk physicians published until December 2016. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for meta-analyses and systematic reviews of observational studies were used. At-risk physicians were defined as surgeons and medical interventionalists. Studies reporting on specific disorders or pain assessed with validated instruments were included. Data Extraction and Synthesis Study characteristics; disease prevalence for the neck, shoulder, back, and upper extremity; and measures of resulting disability were recorded. Study estimates were pooled using random-effects meta-analytic models. Main Outcomes and Measures Career prevalence of injuries and 12-month prevalence of pain. Results Among 21 articles (5828 physicians [mean age, 46.0 years; 78.5% male; 12.8 years in practice; 14.4 hours performing procedures per week]) included in this systematic review and meta-analysis, pooled crude prevalence estimates of the most common work-related MSDs were degenerative cervical spine disease in 17% (457 of 2406 physicians) (95% CI, 12%-25%), rotator cuff pathology in 18% (300 of 1513 physicians) (95% CI, 13%-25%), degenerative lumbar spine disease in 19% (544 of 2449 physicians) (95% CI, 5%-16%), and carpal tunnel syndrome in 9% (256 of 2449 physicians) (95% CI, 5%-16%). From 1997 to 2015, the prevalence of degenerative cervical spine disease and degenerative lumbar spine disease increased by 18.3% and 27%, respectively. Pooled prevalence estimates for pain ranged from 35% to 60% and differed by assessment instrument. Of those with a work-related MSD, 12% (277 of 2319 physicians) (95% CI, 7%-18%) required a leave of absence, practice restriction or modification, or early retirement. Heterogeneity was considerable for all crude analyses (mean I2 = 93.5%) but was lower for sensitivity analyses (mean I2 = 72.3%). Interventions focused on products and behaviors. Twelve at-risk specialties described a gross lack of awareness and an unmet need for ergonomics education. Conclusions and Relevance Prevalence estimates of work-related MSDs among at-risk physicians appear to be high. Further research is needed to develop and validate an evidence-based applied ergonomics program aimed at preventing these disorders in this population.
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Affiliation(s)
- Sherise Epstein
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Emily H Sparer
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Bao N Tran
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Qing Z Ruan
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jack T Dennerlein
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Dhruv Singhal
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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