The Effects of Direction of Exertion, Path, and Load Placement in Nursing Cart Pushing and Pulling Tasks: An Electromyographical Study

Comparing different scoping and mapping review methodologies: A practical example using the nursing mobile workstation

AIMS

To provide (1) an overview of core characteristics of scoping and mapping review methodologies and (2) to illustrate the differences and similarities of these methodologies using literature on nursing mobile workstations.

DESIGN

Systematic review.

METHODS

Systematic searches were conducted to identify (1) scoping and mapping review methodologies used in the field of nursing and (2) literature on nursing mobile workstations. For each systematic search, two reviewers independently screened all titles, abstracts, and full texts. We conducted narrative syntheses for both review questions. Publications on scoping and mapping review methodologies in the field of nursing were searched in MEDLINE (PubMed), Web of Science, Scopus, and CINAHL (September 2022). Publications on nursing mobile workstations were searched in MEDLINE (PubMed), CINAHL, and Web of Science (April 2022).

RESULTS

We identified six scoping and mapping review methodologies (aim 1): bibliometric analysis, evidence mapping, focused mapping review and synthesis, and scoping review. The methodologies aim to provide a graphical, tabular, or narrative overview without a formal critical assessment of the literature. We provide an overview of key variables that reflect the different focus of these methodologies. We also included 26 publications on nursing mobile workstations (aim 2). Nineteen different terms were used to describe the workstations. An overall definition of the nursing mobile workstation was not found.

CONCLUSION

Scoping and mapping methodologies are regularly applied in nursing research. Although there is overlap between the different methodologies, we found some unique characteristics. Despite the regular use of nursing mobile workstations, little is known about their impact in care processes and important features. Future studies on nursing mobile workstations could explore the impact of the workstations in the care process and the current functions of the workstations. A universal definition of the workstations is warranted.

CLINICAL RELEVANCE

Most publications address aspects of practicability of nursing mobile workstations, but we found no universal definition. Little knowledge is available on the impact of the workstations in clinical practice.

Fatigue and Recovery of Muscles for Pulling Tasks

Manual materials handling (MMH) contributes to musculoskeletal disorders (MSDs) in the workplace. The development and recovery of muscle fatigue are essential in work/rest arrangements for MMH tasks. A pulling experiment, including a muscle fatigue test and a muscle fatigue recovery test, was conducted. In the muscle fatigue test, the participant performed a pulling task on a treadmill with a walking velocity of 1 km/h until they could no longer do so. The load was either 30 or 45 kg. The maximum endurance time (MET) was recorded. The pull strength (PS) of the participant both before and after the pulling task was measured. The subjective ratings of muscle fatigue after the pulling task were recorded. In the muscle fatigue recovery test, the participant took a rest after performing the pulling task. The participants reported their subjective ratings of muscle fatigue on the CR-10 scale after taking a rest for a time period t, where t = 1, 2,…, 6 min. The PS of the participant was then measured again. It was found that the load significantly affected the MET for pulling tasks. The load was insignificant to the decrease of the PS, but was significant to the decrease rate (PS decrease per min) of the PS. The PS decrease rate for the 45 kg condition (30.8 ± 16.5 N/min) was significantly higher (p < 0.05) than that of the 30 kg condition (15.4 ± 5.5 N/min). The recovery time significantly affected the PS and CR-10. Two MET models were established to explore the development of muscle fatigue in pulling tasks. A PS model was constructed to describe the recovery of muscle force. A CR-10 model was proposed to show the subjective ratings of recovery. These models are beneficial for determining the work/rest allowance for pulling tasks.

A Systematic Review of EMG Applications for the Characterization of Forearm and Hand Muscle Activity during Activities of Daily Living: Results, Challenges, and Open Issues

The role of the hand is crucial for the performance of activities of daily living, thereby ensuring a full and autonomous life. Its motion is controlled by a complex musculoskeletal system of approximately 38 muscles. Therefore, measuring and interpreting the muscle activation signals that drive hand motion is of great importance in many scientific domains, such as neuroscience, rehabilitation, physiotherapy, robotics, prosthetics, and biomechanics. Electromyography (EMG) can be used to carry out the neuromuscular characterization, but it is cumbersome because of the complexity of the musculoskeletal system of the forearm and hand. This paper reviews the main studies in which EMG has been applied to characterize the muscle activity of the forearm and hand during activities of daily living, with special attention to muscle synergies, which are thought to be used by the nervous system to simplify the control of the numerous muscles by actuating them in task-relevant subgroups. The state of the art of the current results are presented, which may help to guide and foster progress in many scientific domains. Furthermore, the most important challenges and open issues are identified in order to achieve a better understanding of human hand behavior, improve rehabilitation protocols, more intuitive control of prostheses, and more realistic biomechanical models.

Characterization of hand forces exerted during non-powered hospital bed pushing and pulling tasks

Accurate assessment of biomechanical risk associated with pushing/pulling tasks represents a challenging issue, especially in the health system where personnel are often required to maneuver beds and carts. Most studies in this field have been carried out in the laboratory, while few data have been collected under actual working conditions. This study aims to characterize the forces exerted during non-powered hospital bed maneuvering. Twenty participants were required to move a bed (equipped with a customized handlebar to measure exerted forces) along an actual hospital path including straight, turn and maneuver phases. The results show that higher forces are associated with the initial phase (peak and mean values 222 and 68 N) while the straight, turn and maneuvering phases required similar (lower) efforts. The combined effect of left, right and transversal forces suggests that the trunk of the operator might experience axial rotation, thus calling for further investigations of this aspect.

The Effects of Ramp Gradients and Pushing-Pulling Techniques on Lumbar Spinal Load in Healthy Workers

Background

Many tasks in industrial and health care setting are involved with pushing and pulling tasks up or down on a ramp. An efficient method of moving cart which reduces the risk of low back pain should be concerned. This study aimed to investigate the effects of handling types (HTs) and slope on lumbar spinal load during moving a cart on a ramp. We conducted a 2 × 2 × 4 factorial design with three main factors: 2 HTs, 2 handling directions of moving a cart and 4 degrees of ramp slope.

Methods

Thirty healthy male workers performed 14 tasks consist of moving a cart up and down on the ramp of 0°, 10°, 15°, and 20° degrees with pushing and pulling methods. Joint angles from a 3D motion capture system combined with subject height, body weight, and hand forces were used to calculate the spinal load by the 3DSSPP program.

Results

Our results showed significant effect of HT, handling directions and slope on compression and shear force of the lumbar spine (p < 0.001). When the ramp gradient increased, the L4/5 compression forces increased in both pushing and pulling (p < 0.001) Shear forces increased in pulling and decreased in pushing in all tasks. At high slopes, pulling generated more compression and shear forces than that of pushing (p < 0.01).

Conclusion

Using the appropriate technique of moving a cart on the ramp can reduce the risk of high spinal load, and the pushing is therefore recommended for moving a cart up/down on ramp gradients.

Whole body biomechanical burden of healthcare workers: proposal for a complementary risk assessment and management tool (HOARA)

Introduction:

We have developed a new tool, named Holistic Approach Risk Assessment (HOARA), to support occupational safety and health professionals (OSH) in risk assessment and management when evaluating the biomechanical load of healthcare workers.

Objectives:

The primary aim of the HOARA is to support OSH in risk assessment and management of biomechanical hazards in healthcare facilities. This tool ensures a superior level of analysis by targeting independently various body compartments during all activities completed throughout the work shift. These include: head, neck, back and upper and lower limbs.

Methods:

For each body segment, ergonomic determinants were defined on the basis of previous literature, according to which task and job analyses were performed. Upon direct observation, ergonomic factors were given a score based on their temporal extent. Subsequently, action-body segment raw indices and weighted indices were calculated.

Results:

Results of the application of the method are shown. Of note, a relational database was set up to improve its usability.

Conclusions:

From an occupational health perspective, the HOARA, integrated with other methods, is expected to allow a more effective management of human resources, especially when assigning workers to specific jobs or tasks. Overall, the HOARA will be instrumental in assessing the impact of fitness for work judgments on work organization and its resources, in compliance with the guidelines from the Società Italiana di Medicina del Lavoro (SIML).

Spatial dependency of shoulder muscle demand during dynamic unimanual and bimanual pushing and pulling

Work involving extensive pushing and pulling is associated with higher frequency of shoulder complaints. While reports of shoulder muscle demand during submaximal isometric tasks are abundant, dynamic submaximal push-pull exertions are not well understood. We evaluated how muscle demand (weighted EMG average) of surface glenohumeral muscles varies with task type and target. Seventeen healthy young adults performed seated unimanual and bimanual pushes and pulls to 3 thoracohumeral elevations (20°, 90°, 170°) and 4 elevation planes (0°, 45°, 90°, 135°) with loading at 15% of isometric push-pull capacity. Pulling required less demand than pushing (p < 0.0001). Muscle demand varied more with elevation than elevation plane. The lowest target had highest demand for pulling (p < 0.01), and the most elevated target had highest demand for pushing (p < 0.0001). Working above the shoulder is known to increase demand during isometric tasks, however, these results suggest that for dynamic tasks working against gravity has a larger effect on demand than task target.

Human Body Mechanics of Pushing and Pulling: Analyzing the Factors of Task-related Strain on the Musculoskeletal System

The purpose of this review is to name and describe the important factors of musculoskeletal strain originating from pushing and pulling tasks such as cart handling that are commonly found in industrial contexts. A literature database search was performed using the research platform Web of Science. For a study to be included in this review differences in measured or calculated strain had to be investigated with regard to: (1) cart weight/ load; (2) handle position and design; (3) exerted forces; (4) handling task (push and pull); or (5) task experience. Thirteen studies met the inclusion criteria and proved to be of adequate methodological quality by the standards of the Alberta Heritage Foundation for Medical Research. External load or cart weight proved to be the most influential factor of strain. The ideal handle positions ranged from hip to shoulder height and were dependent on the strain factor that was focused on as well as the handling task. Furthermore, task experience and subsequently handling technique were also key to reducing strain. Workplace settings that regularly involve pushing and pulling should be checked for potential improvements with regards to lower weight of the loaded handling device, handle design, and good practice guidelines to further reduce musculoskeletal disease prevalence.