Back pain in nurses: epidemiology and risk assessment

Evaluation of the Efficacy of a Lift-Assist Device Regarding Caregiver Posture and Muscle Load for Transferring Tasks

The aim of this study was to confirm the effect of a lift-assist device when performing a patient-lifting task. Ten working caregivers participated in this experiment, and lifting patients from bed to wheelchair (B2C) and wheelchair to bed (C2B) was performed for manual care (MC) and lift-assist device (robot) care (RC). EMG sensors and IMU motion sensors were attached as indicators of the assistive device's effectiveness. EMG was attached to the right side of eight muscles (UT, MD, TB, BB, ES, RF, VA, and TA), and flexion/extension angles of the neck, shoulder, back, and knee were collected using motion sensors. As a result of the analysis, both B2C and C2B showed higher muscle activities in MC than RC. When using a lift-assist device to lift patients, the RC method showed reductions in muscle activities compared to MC. As a result of the work-posture analysis, both the task type and the task phase exhibited pronounced reductions in shoulder, back, and knee ROM (range of motion) compared to those of MC. Therefore, based on the findings of this study, a lift-assist device is recommended for reducing the physical workloads of caregivers while performing patient-lifting tasks.

The impact of the work environment on the health-related quality of life of Licensed Practical Nurses: a cross-sectional survey in four work environments

Background

Nurses are known to have negative health outcomes related to their work. While it is acknowledged that nursing work is associated with things like back injuries and burnout, there is limited evidence as to what factors in the work environment contribute to these issues.

Purpose

The aims of this study were to assess how Licensed Practical Nurses (LPNs) report their Health-related quality of life (HRQoL), and how nurses’ health is impacted by their work environment.

Methods

These data used for analysis comes from a cross-sectional survey administered online to all LPNs in Alberta (2018). The survey collected data on the following variables: participant’s demographics, the SF-36 HRQoL, Practice Environment Scale of the Nursing Work Index (PES-NW) and the CD-RISC measure of resilience. The beta distribution was used to model HRQoL outcomes. In instances where optimal health (score of ‘1’) was observed then an extended version of beta distribution (called one—inflated beta) was applied.

Results

4,425 LPNs responded to the survey. LPNs (mean age: 40) report lower scores on each SF-36 subscale than the general Canadian population aged 35–44. LPNs who work ‘causal’ had better physical health, (OR 1.21, CI 1.11–1.32, p = 0.000), and mental health (OR 1.22, CI 1.12–1.30, p = 0.000) than LPNs who work full time, even after controlling for resilience. LPNs’ views on the adequacy of staffing and resources in their workplaces have an influence across all dimensions of health.

Conclusion

This study suggests that improvements in the work environment could positively impact health outcomes and that adequate resourcing could support the nursing workforce.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-01951-9.

The prevalence of low back pain among female hospital staff at childbearing age

Background

Low back pain (LBP) is considered the most common work-related musculoskeletal disorder among female healthcare workers. The aim of this study is to compare the prevalence of LBP and non-ergonomic risk factors between female nurses, office workers, and patient transporters, and the effect of pain on job performance.

Methods

Based on semi-structured interviews, we conducted a cross-sectional study on Jordanian female hospital workers between January and July, 2017.

Results

We included 209 participants with a mean age of 35.57 ± 8 years from four Jordanian medical centers. Nurses have significantly higher frequency of LBP (82.5%; p = 0.05) compared to both office workers (67.5%) and patient transporters (68.6%). The mean difference in pain score using Visual Analogue Scale (VAS) after treatment varied significantly (p = 0.003), since it was 28.2 (±35.4) for office workers, compared to 22.8 (±26.5) for nurses and 6.5 (±33.7) for patient transporters. A higher frequency of nurses reported that LBP affected their job performance (64.9%; p = 0.013), and 43.3% of them reported having previous sick leaves due to LBP (p = 0.008).

Conclusions

LBP is common among female hospital workers, with significantly higher prevalence among female nurses when compared to other female hospital staff.

Ergonomics in apiculture: A case study based on inspecting movable frame hives for healthy bee activities

The agricultural sector suffers from high risk of injury and damage to human health. There is considerable research not only identifying these risks but also finding ways to mitigate them. Beekeeping or apiculture, recognised as part of this sector, has many risk factors such as heavy lifting, high degree of manual materials handling, twisting, and awkward positioning common to all agriculture areas. It also has some unique risks such as those resulting from bee stings and smokers. However, there is much less attention focused on the health and safety of apiculture to the human beekeepers, and much more attention focused on bee health and safety. An ergonomics case study on beekeeping inspection tasks involving three independent, local beekeepers showed that many tasks involve awkward positions of the body, arms and hands, excessive lifting well beyond recommended weight limits, eye strain, and chemical and sting exposure. In addition, beekeepers are more interested in bee and hive health rather than reducing human-centred risk factors such as those due to excessive lifting. Standard ergonomics interventions such as a magnifier inspection and lift assist systems as well as interventions unique to beekeeping such as a smokeless method of calming bees are recommended. The beekeeping industry seems to have been forgotten in the modernisation of technology and agricultural practices. This paper offers some initial insights into possible points for research, development and improvements.

Low back pain prevalence in healthcare professionals and identification of factors affecting low back pain

BACKGROUND

Work-related musculoskeletal system diseases are commonly observed among nurses, physiotherapists, dentists, and dieticians.

OBJECTIVE

To assess working postures of nurses, physiotherapists, dentists and dieticians, to identify whether low back pain (LBP) is present, and to put forth the correlation between LBP, working posture, and other factors.

METHODS

Twenty seven physiotherapists, 34 nurses, 30 dentists, and 16 dieticians were included. Impairment ratings of cases with LBP were analysed with Quebec Back Pain Disability Scale (Quebec). Working postures were analysed with Owako Working Posture Analysis System.

RESULTS

LBP was observed in 70.09% of healthcare professionals. Of the individuals suffering from LBP, 57.2% were working with a risky posture. 40.63% of individuals without LBP were using risky working postures. Trunk and head posture distribution of individuals with and without LBP was found as different from each other (p < 0.05). LBP prevalence of dentists and nurses were higher compared to other groups (p < 0.05). Quebec scores of professionals with LBP were not different among occupations (p > 0.05). Quebec scores were observed as correlated with various factors in various occupation groups.

CONCLUSIONS

Considering that head-neck and trunk postures are changeable factors that are among the factors affecting LBP, correcting the working posture gains importance.

Proper Positioning of Clients: A Risk for Caregivers

The primary objective of this study was to learn more about the occupational risk of client repositioning by caregivers. This study also included information on frequency demands and factors contributing to the need to reposition clients and future risk-reduction solutions and interventions. A questionnaire was administered to caregivers at 12 hospitals. Targeted groups were client care units with caregivers who are required to reposition clients in bed. The task of client repositioning presents a high frequency demand to caregivers. Some characteristics such as size and health condition made it more likely clients would require repositioning. Researchers need to study client repositioning further and look for methods that will reduce the caregiver occupational risk factors. Caregivers are seeking new devices and techniques that facilitate client repositioning and benefit both the caregiver and the client.

Spine loading during the application and removal of lifting slings: the effects of patient weight, bed height and work method

The biomechanical loading on the lumbar spine was assessed as 12 female nurses applied and removed slings under two patients of differing weights (54 and 100 kg), using two work methods, and while working at three bed heights (56, 71, 93 cm). Three-dimensional spine loads at the L2/L3, L3/L4, L4/L5 and L5/S1 disc levels were measured using a validated EMG-assisted biomechanical model. Anterior/posterior (A/P) shear loading at the L5/S1 level consistently exceeded the tolerance threshold limit for disc failure. The peak compression values exceeded the 3400 N tolerance threshold for several participants when placing the sling under the 100-kg patient. In general, working from both sides of the bed generated slightly higher A/P shear loading than the one-sided method. Raising the bed significantly decreased compression and A/P shear forces. Therefore, raising the bed to at least the nurse's knuckle height is recommended when applying and removing patient slings. Practitioners Summary: We investigated the spine loading associated with placing and removing slings used for the mechanised lifting of patients. Peak compression and anterior shear forces exceeded recognised thresholds when placing slings underneath heavier patients. Raising the bed to at least knuckle level helps mitigate these spinal loads.

Caring for the Caregivers: Results of an Extended, Five-component Stress-reduction Intervention for Hospital Staff

The health-related consequences of stress in hospital workers and associated costs of absenteeism and high turnover have increased the need for programs targeting stress in this population. "Caring for the Caregivers," a multimodal approach to stress-reduction designed to address the multidimensional nature of stress in hospital staff, integrates five components: cognitive, somatic, dynamic, emotive and hands-on, in a flexible eight-month format. Significant improvements were demonstrated for 97 participants compared to 67 controls in pre-post scores for the Maslach Burnout Inventory, Job-Related Tension Index, Perceived Stress Scale, Productivity Scale, General Health Questionnaire, Positive and Negative Affect Schedule, and Visual Analogue Scales of 12 stress-associated symptoms. Together with significant reduction in upper respiratory infections and family doctor visits, these results suggest that providing hospital staff with multiple techniques addressing commonly encountered work stressors impacts positively on health and well-being and significantly reduces stress and burnout in this population.

Friction-Reducing Devices for Lateral Patient Transfers

The purpose of this study was to evaluate the efficacy of friction-reducing devices used for lateral patient transfers. A mannequin used to represent a dependent patient was transferred laterally from bed to stretcher. One male investigator repeated this task using 11 comparable lateral transfer aids or techniques. Applied force was measured using a dynamometer; postural analysis was prepared from still photography. Mean applied force, spinal forces, and population strength capabilities were calculated. The most efficacious mechanism for lateral patient transfers had extendable pull straps, low-friction material, and optimally located handles. Findings of this study will aid occupational health and safety clinicians and hospital-based caregivers in the selection of appropriate technologies to be used during lateral patient transfers. These devices improve patient safety and reduce the risk of back injury to caregivers.

A systematic review of prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups

AIM

To investigate the prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups.

BACKGROUND

Productivity of workforce groups is a concern for ageing societies. Symptoms of pelvic floor dysfunction are associated with ageing and negatively influence psychosocial health. In the general population, lower urinary tract symptoms negatively influence work productivity.

DESIGN

A systematic review of observational studies.

DATA SOURCES

Electronic searches of four academic databases. Reference lists were scanned for relevant articles. The search was limited to English language publications 1990-2014.

REVIEW METHODS

The Centre for Reviews and Dissemination procedure guided the review method. Data extraction and synthesis was conducted on studies where the workforce group was identified and the type of pelvic floor dysfunction defined according to accepted terminology. Quality appraisal of studies was performed using a Joanna Briggs Institute critical appraisal tool.

RESULTS

Twelve studies were identified of variable quality, all on female workers. Nurses were the most frequently investigated workforce group and urinary incontinence was the most common subtype of pelvic floor dysfunction examined. Lower urinary tract symptoms were more prevalent in the studied nurses than related general populations. No included study investigated pelvic organ prolapse, anorectal or male symptoms or the influence of symptoms on work productivity.

CONCLUSION

Lower urinary tract symptoms are a significant issue among the female nursing workforce. Knowledge of the influence of symptoms on work productivity remains unknown. Further studies are warranted on the impact of pelvic floor dysfunction subtypes in workforce groups.

Improving the safety of patient turning and repositioning tasks for caregivers

Current evidence demonstrates why turning and positioning patients in bed presents a serious occupational risk of musculoskeletal disorders for caregivers. Results of the laboratory study investigating a new method of turning and positioning patients in bed are presented. The study was designed to evaluate how this new method reduced the risk of occupational musculoskeletal disorders to caregivers and may improve outcomes for patients.

Sixty-four-slice computed tomographic scanner to clear traumatic cervical spine injury: systematic review of the literature

PURPOSE

Cervical spine (CS) injury in blunt trauma is a prevalent and devastating complication. Clearing CS injuries in obtunded patients is fraught with challenges, and no single imaging modality or algorithm is both safe and effective. Increased time in c-spine precautions is associated with greater patient morbidity including increased ventilator associated pneumonia, delirium and ulceration. We systemically reviewed the literature to assess the effectiveness of 64-slice computed tomographic (CT) scanners in clearing traumatic CS injuries.

MATERIALS AND METHODS

Studies were identified using MEDLINE and Embase, the references of identified studies, international experts on CS clearance and authors of primary studies. Three reviewers independently selected and extracted data from studies that reported on both CT and MRI in traumatic CS injury.

RESULTS

We included five studies involving a total of 3443 patients; however, heterogeneity and lack of sample size precluded quantitative summation of the results. Qualitative assessment showed that 64-Slice CT scan, when applied within a set protocol, performed favourably in clearing injury.

CONCLUSIONS

Data suggests that using 64-slice CT scans on obtunded trauma patients with grossly intact motor function, in the context of a defined clearance protocol with interpretation by an experienced radiologist, may be sufficient to safely clear significant CS injury. A prospective study comparing MRI and 64-slice CT scan clearance in this population is necessary to corroborate these conclusions.

Work-relatedness of low back pain in nursing personnel: a systematic review

BACKGROUND

Although non-specific low back pain (LBP) is known to be multifactorial, studies from across the globe have documented their higher prevalence in nurses. This systematic review was conducted to ascertain whether this much-documented association constitutes a causal relationship, and whether there is a discernible threshold of exposures associated with this elevated risk.

METHODS

PRISMA guidelines were followed and standard critical appraisal tools were applied. The outcome of interest was non-specific LBP or back injury; exposure was "performing nursing duties." Applicable studies, published in English during 1980-2012, were identified through database searches, screened against preset inclusion/exclusion criteria. Ergonomic assessments of nursing tasks were included along with epidemiological studies. Bradford Hill considerations for causation were utilized as a framework for discussing findings.

FINDINGS

Of 987 studies identified, 89 qualified for inclusion, comprising 21 longitudinal, 36 cross-sectional analytic, 23 descriptive biomechanical/ergonomic, and 9 review studies. Overall studies showed that nursing activities conferred increased risk for, and were associated with back disorders regardless of nursing technique, personal characteristics, and non-work-related factors. Patient handling appears to confer the highest risk, but other nursing duties are also associated with elevated risk, and confound dose-response assessments related to patient handling alone. Associations were strong, consistent, temporally possible, plausible, coherent, and analogous to other exposure-outcomes, with risk estimates ranging from 1·2 to 5·5 depending on definitions. A threshold of nursing activities below which the risk of back disorders is not elevated has not been established.

INTERPRETATION

Notwithstanding the bio-psycho-social nature of LBP, and complexities of studying this area, sufficient evidence exists of a causal relationship between nursing tasks and back disorders to warrant new policies.

Repositioning patients in chairs-an improved method

Proper seated posture is important in health care settings because immobilized patients may be sitting for extended periods. In many situations, a caregiver is required to assist a slouching patient to a proper, more comfortable upright posture. The caregiver is at risk from exposure to the physical demands of this task. This study evaluated exertion and risk to the caregiver using three methods of repositioning patients in chairs in the health care setting. Through application of a new method employing an ergonomically designed device, exertion and risk were reduced. Results from this study indicate that the high-risk occupational activity of repositioning a slouching patient in a chair can be made safer for caregivers.

Repositioning Patients in Chairs—An Improved Method

Proper seated posture is important in health care settings because immobilized patients may be sitting for extended periods. In many situations, a caregiver is required to assist a slouching patient to a proper, more comfortable upright posture. The caregiver is at risk from exposure to the physical demands of this task. This study evaluated exertion and risk to the caregiver using three methods of repositioning patients in chairs in the health care setting. Through application of a new method employing an ergonomically designed device, exertion and risk were reduced. Results from this study indicate that the high-risk occupational activity of repositioning a slouching patient in a chair can be made safer for caregivers.

Facilitating Repositioning in Bed

Repositioning patients in bed presents an occupational hazard to direct care nursing staff. Much research has been conducted in the area of safe patient handling and movement. However, little progress has been made in reducing risks associated with patient repositioning, especially pulling patients toward the head of the bed. This laboratory study investigated risk reduction achieved by introducing the gravity assist feature into bed system design for post-acute health care. Through the application of gravity assist, the amount of work required to reposition a simulated 200-pound patient was reduced by 67%. This reduction in work should reduce some of the occupational risk for nurses.

Effects of general principles of person transfer techniques on low back joint extension moment

The purpose of this study was to examine the effects of general principles of person transfer techniques specifically on the low back joint extension moment. These effects were examined by the following measurable quantitative parameters: 1) trunk bending angle, 2) knee flexion angle, 3) distance between the centers of gravity (COGs) of the caregiver and patient, representing the distance between the caregiver and patient, and 4) the vertical component of the ground reaction force representing the amount of the weight-bearing load on the caregiver's low back during transfers with and without assistive devices. Twenty students each took the role of caregiver, and one healthy adult simulated a patient. The participants performed three different transfer tasks: without any assistive device, with the patient wearing a low back belt, and with the caregiver using a transfer board. We found that the distance between the COGs and the vertical component of the ground reaction force, but not the trunk bending and knee flexion angles, were the variables that affected the low back joint extension moment. Our results suggest that the general principle of decreasing the distance between COGs is most effective for decreasing the low back joint extension moment during transfers under all conditions.

Effects of educational intervention on joint angles of the trunk and lower extremity and on muscle activities during patient-handling tasks

OBJECTIVE

The objective of this study was to examine the effects of educational intervention on joint angles of the trunk and lower extremity and on muscle activities during patient-handling task.

METHODS

Thirty-two subjects (17 males and 15 females) volunteered for the study. They were classified into three groups: intervention group 1, comprised of first grade physical therapist students; control group, which included first grade occupational therapist students; intervention group 2, which comprised third grade physical therapist students. The educational intervention during the experimental period consisted of: (1) 12 regular classes and short-term clinical practice for the students of intervention group 1; (2) long-term clinical practice, relating to patient-handling task, for the students of intervention group 2. The following experiments were repeated before and after the educational intervention. Each subject was asked to transfer a male (55 kg) from one chair to a second chair (left to right) and then back again to the original chair (right to left). The flexion angles of the trunk, hip and knee joints were quantified by means of the dynamic three-dimensional biomechanical analysis. Muscle activities (% maximum voluntary contraction, %MVC) of biceps brachii, trapezius, rectus femoris and erector spinae muscles were measured using surface electromyography (EMG). The effects of group, gender, measurement time and side on joint angles of trunk and lower extremity, %MVC of four muscle activities and transfer time were assessed.

RESULTS

Although the EMG analysis could not clearly demonstrate any reduction of physical load to the low back, the flexion angles of the hip and knee joints of student subjects during the patient-handling task became larger and that of the trunk became smaller in the group given the educational intervention.

CONCLUSION

The finding of this study suggests that the posture of the study subjects changed to the squat lifting method, which is preferable for reducing the physical load to the lower back, as a result of the educational intervention.

Lumbar spine forces during manoeuvring of ceiling-based and floor-based patient transfer devices

Patient handling continues to represent a high risk task for low back pain (LBP) among health caregivers. Previous studies indicated that manual transfers of patients impose unacceptable loads on the spine even when two caregivers perform the transfer. Patient lift devices are considered a potential intervention; however, few biomechanical analyses have investigated the spine loads and LBP risk associated with these transfer devices. This study analysed the 3-D spine forces imposed upon the lumbar spine when 10 subjects manipulated ceiling-based and floor-based patient lifts through various patient handling conditions and manoeuvres. The results indicated that ceiling-mounted patient lift systems imposed spine forces upon the lumbar spine that would be considered safe, whereas floor-based patient handling systems had the potential to increase anterior/posterior shear forces to unacceptable levels during patient handling manoeuvres. Given these findings, ceiling-based lifts are preferable to floor-based patient transfer systems.

Little effect of transfer technique instruction and physical fitness training in reducing low back pain among nurses: a cluster randomised intervention study

The aim of this study was to evaluate the effect of a transfer technique education programme (TT) alone or in combination with physical fitness training (TTPT) compared with a control group, who followed their usual routine. Eleven clinical hospital wards were cluster randomised to either intervention (six wards) or to control (five wards). The intervention cluster was individually randomised to TT (55 nurses) and TTPT (50 nurses), control (76 nurses). The transfer technique programme was a 4-d course of train-the-trainers to teach transfer technique to their colleagues. The physical training consisted of supervised physical fitness training 1 h twice per week for 8 weeks. Implementing transfer technique alone or in combination with physical fitness training among a hospital nursing staff did not, when compared to a control group, show any statistical differences according to self-reported low back pain (LBP), pain level, disability and sick leave at a 12-month follow-up. However, the individual randomised intervention subgroup (transfer technique/physical training) significantly improved the LBP-disability (p = 0.001). Although weakened by a high withdrawal rate, teaching transfer technique to nurses in a hospital setting needs to be thoroughly considered. Other priorities such as physical training may be taken into consideration. The current study supports the findings of other studies that introducing transfer technique alone has no effect in targeting LBP. However, physical training seems to have an influence in minimising the LBP consequences and may be important in the discussion of how to prevent LBP or the recurrence of LBP among nursing personnel.

Comparison of low back joint moment using a dynamic 3D biomechanical model in different transferring tasks wearing low back belt

The purpose of this study was to construct a 3D dynamic model to quantify low back load during single person dependent transfer, and to compare the effects of wearing style of a low back belt on low back loading. Of the nine subjects participating in this study, eight adopted the role of caregiver and one was a simulated patient. Tasks were general transfer without either subject wearing a low back belt (WB), transfer with the patient wearing a low back belt (BP), transfer with both subjects wearing low back belts (BB), and transfer with the caregiver wearing a low back belt (BC). Low back lateral and extension moments in BB and BC transfers showed the significantly smaller values than those in WB transfers (p<0.01). The results suggest that the wearing of a low back belt by caregivers would reduce low back joint moment during transfers.

Justification for a minimal lift program in critical care

This chapter reviews literature pertaining to patient-handling tasks spanning the areas of epidemiology, biomechanics, perceived stresses, education and training programs, and introduction of mechanical patient lifting devices. All findings agree that patient handling is inherently dangerous and has been attributed to the majority of injuries incurred by nursing personnel; however, most studies have been performed in hospitals or long term care settings, but have not been specific to the area of critical care. The critical care environment poses unique challenges for nursing personnel and therefore, to ergonomists.

Association of low back pain, impairment, disability & work limitations in nurses

INTRODUCTION

Health care professionals use measures of pain and impairment to identify potential disability and subsequently to predict workers' ability to do their work. However, there is little evidence that measures used are associated with ability to do one's job.

METHODS

A cross-sectional study was conducted. Nurses (n = 100) were classified into either off/modified work (due to LBP) or regular work groups. Trunk ROM, trunk muscular endurance, pain and disability were measured relative to the outcomes work status and Work Limitations Questionnaire (WLQ) score.

RESULTS

Regression analyses which included Roland Morris Questionnaire (RMQ, disability) and Sørenson (back extensor endurance) in the final models correctly classified the work status of 87% of the participants and accounted for 60% of variance in the WLQ score.

CONCLUSIONS

Use of the RMQ and Sørenson test as diagnostic and prognostic tools should be considered in assisting return to work and treatment decision-making in female nurses with LBP.

Competency-based training for patient handling

A technique-training approach has traditionally been used to address the problem of back pain associated with patient handling. This project aimed to investigate whether different levels of safety culture, based on competency-based training, resulted in different behaviour (physical and cognitive) for patient handling tasks. Sixteen healthcare organisations in the UK participated from the acute and primary healthcare sectors. Archival data for each organisation were benchmarked against the Royal College of Nursing competencies for manual handling. Behavioural data were collected on two patient handling tasks: (1) sitting-to-standing and (2) repositioning-in-sitting using observations (postural analysis) and interviews (verbal protocol analysis). The data were analysed for each organisation and then grouped by task and method into larger data sets. These data sets were triangulated using the key decision-making points (from the interview data) as the framework. The results showed that in organisations with a more positive safety culture the nursing staff demonstrated more complex decision-making about the patient handling tasks and had lower levels of associated postural risk.

Occupational back pain in Iranian nurses: an epidemiological study

The aim of this study was to identify the prevalence and risk factors for low back pain (LBP) in nursing personnel and to analyze how individual and occupational characteristics contribute to the risk of LBP. Following ethical approval, 1226 nurses were randomly recruited from 13 general hospitals in northern Iran. Different questionnaires were designed to cover personal and professional data, the prevalence, and associations of risk factors with LBP. Results indicated that prevalence of LBP in nurses was over 50%. Lifting was the most common mechanism for LBP (30.4%). Prolonged standing and rest were found to be the significant aggravating and relieving factors (57.6% and 59.2%, respectively). Absence from work because of LBP in the month before the questionnaire was completed was reported by 33.7% of the sample. The results demonstrate that the magnitude of LBP among nursing personnel appears to be high and therefore more resources should be allocated to prevent such an injury occurring in the nursing profession.

Evaluation of the effectiveness of portable ceiling lifts in a new long-term care facility

Researchers and health and safety practitioners have advocated replacing manual patient handling techniques with ceiling lifts in long-term care. The majority of these studies have only evaluated the impact of fixed ceiling lifts on extended care residents where the ratio of ceiling lifts to resident beds is one to one. This pre-post intervention study assesses the effectiveness of portable ceiling lifts in a new multi-level care facility on risk of patient handling injuries where the ratio of ceiling lifts to resident beds is one to six. Results indicated that staff perceived they were at significantly (p<0.05) less risk of injury when using ceiling lifts compared to manual methods. Seventy-five percent of staff preferred to use the ceiling lifts over any other method for lifting and transferring residents. Compensation costs due to patient handling decreased in the intervention facility, with a 241% increase in the comparison facility. This study demonstrates that incorporating ceiling lifts into the design of a new multi-level care facility reduced patient handling injuries and decreased perceived risk of injury among care staff.

Social-cognitive determinants of hoist usage among health care workers

Injuries caused by unsafe manual handling of patients are a major source of ill health in health care workers. The present study evaluated the ability of 4 classes of variable to predict use of a hoist when moving a heavily dependent patient. Variables examined were occupational role characteristics, such as hours of work and type of shift worked; biographics, including age and height; aspects of occupational context, such as number of hoists available and number of patients; and motivational variables specified by the theory of planned behavior (Ajzen, 1985) and protection motivation theory (Rogers, 1983). Regression analyses showed that background and social-cognitive variables were able to account for 59% of variance in intention to use a hoist and 41% of variance in use of the hoist assessed 6 weeks later. Height, hoist availability, coworker injunctive norm, perceived behavioral control, response cost, response benefits, and social and physical costs of not using the hoist each explained independent variance in motivation to use a hoist at work.

Trends in injuries, illnesses, and policies in Canadian healthcare workplaces

Background

Analysis of workers’ compensation data and occupational health and safety trends in healthcare across Canada was conducted to provide insight concerning workplace injuries and prevention measures undertaken in the healthcare sector.

Methods

Timeloss claims data were collected for 1992–2002 from the Association of Workers’ Compensation Boards of Canada. Labour Force data from Statistics Canada were used to calculate injury rates. The Occupational Health and Safety Agency for Healthcare in British Columbia coordinated with provincial occupational health and safety agencies in Ontario, Quebec and Nova Scotia to analyze injury data and collate prevention measures in their regions.

Results

The national timeloss injury rate declined from 4.3 to 3.7 injuries per 100 personyears since 1998. Musculoskeletal injuries consistently comprised the majority of timeloss claims. Needlestick injuries, infectious diseases and stress-related claims infrequently resulted in timeloss claims although they are known to cause great concern in the workplace. Prevention measures taken in the various provinces related to safer equipment (lifts and electric beds), return-to-work programs, and violence prevention initiatives. Different eligibility criteria as well as adjudication policies confounded the comparison of injury rates across provinces.

Discussion

Since 2000, all provinces experienced healthcare restructuring and increased workload in an aging workforce. Despite these increased risks, injury rates have decreased. Attribution for these trends is complex, but there is reason to believe that focus on prevention can further decrease injuries. While occupational health is a provincial jurisdiction, harmonizing data in addition to sharing data on successful prevention measures and best practices may improve workplace conditions and thereby further reduce injury rates for higher risk healthcare sector occupations.

Trends in injuries, illnesses, and policies in Canadian healthcare workplaces

BACKGROUND

Analysis of workers' compensation data and occupational health and safety trends in healthcare across Canada was conducted to provide insight concerning workplace injuries and prevention measures undertaken in the healthcare sector.

METHODS

Timeloss claims data were collected for 1992-2002 from the Association of Workers' Compensation Boards of Canada. Labour Force data from Statistics Canada were used to calculate injury rates. The Occupational Health and Safety Agency for Healthcare in British Columbia coordinated with provincial occupational health and safety agencies in Ontario, Quebec and Nova Scotia to analyze injury data and collate prevention measures in their regions.

RESULTS

The national timeloss injury rate declined from 4.3 to 3.7 injuries per 100 person-years since 1998. Musculoskeletal injuries consistently comprised the majority of timeloss claims. Needlestick injuries, infectious diseases and stress-related claims infrequently resulted in timeloss claims although they are known to cause great concern in the workplace. Prevention measures taken in the various provinces related to safer equipment (lifts and electric beds), return-to-work programs, and violence prevention initiatives. Different eligibility criteria as well as adjudication policies confounded the comparison of injury rates across provinces.

DISCUSSION

Since 2000, all provinces experienced healthcare restructuring and increased workload in an aging workforce. Despite these increased risks, injury rates have decreased. Attribution for these trends is complex, but there is reason to believe that focus on prevention can further decrease injuries. While occupational health is a provincial jurisdiction, harmonizing data in addition to sharing data on successful prevention measures and best practices may improve workplace conditions and thereby further reduce injury rates for higher risk healthcare sector occupations.

The three-year economic benefits of a ceiling lift intervention aimed to reduce healthcare worker injuries

Ceiling lifts are frequently advocated to mitigate risk of injury to healthcare workers when lifting, transferring, or repositioning patients. A longitudinal case-study was conducted in an extended care facility to evaluate the efficacy of overhead lifts in reducing the risk of injury beyond that previously reported for the first year post-intervention (Am. Assoc. Occup. 50 (3) (2002) 120-127, 128-134). Analysis of injury trends spanning 3 years pre-intervention and 3 years post-intervention, found a significant and sustained decrease in days lost, workers' compensation claims, and direct costs associated with patient handling injuries. The payback period was estimated assuming that pre-intervention injury costs would either continue to increase (0.82 years) or plateau (2.50 years) in the year immediately preceding intervention. The rapid economic gains and sustained reduction in the frequency and cost of patient handling injuries beyond the first year strongly advocate for ceiling lift programs as an intervention strategy.

Schoolbag weight and musculoskeletal symptoms in New Zealand secondary schools

The weight of schoolbags and the prevalence of musculoskeletal symptoms amongst 140 students (70 third form students comprising 35 females and 35 males, and 70 sixth form students comprising 35 females and 35 males) from five New Zealand secondary schools was investigated. Schoolbag weight for third form students (mean age 13.6 years) was 13.2% of their body weight, while for sixth form students (mean age 17.1 years) it was 10.3% of their body weight. These weights may exceed the recommended guideline load limits for adult industrial workers. Musculoskeletal symptoms were reported by 77.1% of the students. Symptoms were most prevalent in the neck, shoulders, upper back and lower back. Although musculoskeletal symptoms are believed to be multifactorial in origin, the carriage of heavy schoolbags is a suspected contributory factor and may represent an overlooked daily physical stress for New Zealand secondary school students.

An observation instrument for the description and evaluation of patient transfer technique

The aim of the present study was to evaluate the reliability and validity of an observation instrument for patient transfer. The instrument, which consisted of 23 items, was evaluated on five different patient transfer tasks. A weighted score was included to evaluate the performed transfer technique. Four observers were selected for the assessment of instrument intra- and inter-observer reliability. Instrument validity was evaluated by testing whether the instrument could detect a difference between use of a self-chosen and a recommended transfer technique. Furthermore, calculated compression values at L4-L5 were compared with the weighted score for the different transfer technique situations. Eleven items were reliable. Nine items deserve further attention and three items were not reliable. The weighted score was significantly higher for the recommended transfer technique situations (p < 0.01) and an association between the weighted score and the calculated compression values was observed (r = -0.589).

New low back pain in nurses: work activities, work stress and sedentary lifestyle

BACKGROUND

Low back pain is common among nurses. Previous studies have shown that the risk of low back pain increases rapidly with greater amounts of physical work and psychological stress, but is inversely related to leisure activities. However, these previous studies were predominantly retrospective in design and not many took account of three factors simultaneously.

AIMS

This 12-month prospective study examined the relationships between work activities, work stress, sedentary lifestyle and new low back pain.

METHODS

A total of 144 nurses from six Hong Kong district hospitals completed a face-to-face baseline interview, which was followed-up by a telephone interview. The main study measures were demographic characteristics, work activities, work stress, physical leisure activities and the nature of new low back pain during the 12-month follow-up period. Level of work stress, quality of relationships at work, level of enjoyment experienced at work, and work satisfaction were self-reported.

RESULTS

Fifty-six (38.9%) nurses reported experiencing new low back pain. Sedentary leisure time activity was not associated with new low back pain. Being comparatively new on a ward (adjusted relative risk 2.90), working in bending postures (adjusted relative risk 2.76) and poor work relationships with colleagues (adjusted relative risk 2.52) were independent predictors of new low back pain.

CONCLUSION

The findings of this study suggest that low back pain is a common problem in the population of nurses in Hong Kong. Being comparatively new on a ward, bending frequently during work and having poor work relationships with colleagues are independent predictors of new low back pain. Training for high-risk work activities and ergonomic assessment of awkward work postures are essential. Moreover, relaxation and team-building workshops for nurses, especially those who are less experienced in the type of work on their current ward, are recommended.

Muscle activity during patient transfers: a preliminary study on the influence of lift assists and experience

The purpose of this study was to examine muscle activity patterns during patient handling during manual transfers, and transfers using floor and ceiling lifts. EMG patterns during transfers from bed to wheelchair and wheelchair to bed as well as patient repositioning in novices and experienced participants were examined. Surface EMG was recorded from the upper and lower erector spinae, latissimus dorsi and trapezius muscles bilaterally. Overall, normalized mean and peak muscle activity were lowest using the ceiling lift, increasing with the floor lift, which were lower than manual transfers (novices: all p < 0.01). Experienced patient handlers demonstrated approximately two times greater trapezius and latissimus dorsi activity than novices, combined with lower mean erector spinae activity (p < 0.05, for most tasks). Integrated EMG for all muscles was directly proportional to the transfer time and was lowest during the manual transfer followed by the ceiling lift, with the floor lift being highest. The difference between the muscle activity patterns between the experienced and novice patient handlers may suggest a learned behaviour to protect the spine by distributing load to the shoulder. Further examination of the muscle activation patterns differences between experience levels could improve training techniques to develop better patient handling strategies.

Biomechanical analysis of the effect of changing patient-handling technique

The objective of the study was to assess the changes in the mechanical load on the low-back when shifting from a self-chosen to a recommended patient-handling technique. Nine female health care workers without formal education in patient-handling carried out 8 different tasks involving moving, turning and lifting situations. By means of a dynamic 3D biomechanical model of the lower part of the body, peak torque, compression and shear forces at the L4/L5 joint were compared using the two different patient-handling techniques. In 5 of the 8 tasks, a significant reduction was observed in spinal loading. Application of the recommended technique decreased the compression value significantly for all tasks with a mean value above 3000 N. For the two tasks with the highest compression values when using the self-chosen technique (4223, 4446 N), the loading was reduced with 36% and 25%, respectively. If the principles behind the recommended technique are implemented and maintained, a decrease in the risk of low-back disorders during patient-handling should thus be expected.

Manual handling injury in a disability services setting

Approximately 2700 manual handling injuries recorded among disability services workers in an Australian state government agency between 1997 and 2000 were analysed to identify high-risk groups and leading causes to be targeted for prevention. Client support, including assisting clients into and out of bed and holding clients during epileptic seizures, had the highest cause-specific injury rate per 100 full-time equivalents (12.2, 95% confidence interval (CI) 6.2-20.2). Women had significantly higher rates than men, an average of 29.8 (95% CI 19.9-41.7) compared with 16.6 (95% CI 9.5-25.7). Gender (being female) and low job classification significantly increased the odds of an injury resulting in time off work. Only gender significantly predicted the likelihood of high compensation payments. Together with the surveillance data, responses to the questionnaire survey of 120 workers indicate a need for effective ergonomics intervention.

A dynamic 3D biomechanical evaluation of the load on the low back during different patient-handling tasks

The objective of this study was to investigate the low-back loading during common patient-handling tasks. Ten female health care workers without formal training in patient handling performed nine patient-handling tasks including turning, lifting and repositioning a male stroke patient. The low-back loading was quantified by net moment, compression, and shear forces at the L4/L5 joint, measured muscle activity (EMG) in erector spinae muscles and rate of perceived exertion (RPE; Borg scale). The experiments were videotaped with a 50Hz video system using five cameras, and the ground and bedside reaction forces of the health care worker were recorded by means of force platforms and force transducers on the bed. The biomechanical load was calculated using a dynamic 3D seven-segment model of the lower part of the body, and the forces at the L4/L5 joint were estimated by a 14 muscles cross-sectional model of the low back (optimisation procedure). Compression force and torque showed high task dependency whereas the EMG data and the RPE values were more dependent on the subject. The peak compression during two tasks involving lifting the patient (4132/4433N) was significantly higher than all other tasks. Four tasks involving repositioning the patient in the bed (3179/3091/2932/3094N) did not differ, but showed higher peak compression than two tasks turning the patient in the bed (1618/2197N). Thus, in this study the patient-handling tasks could be classified into three groups-characterised by lifting, repositioning or turning-with different levels of peak net torque and compression at the L4/L5 joint.