Evaluation of the implementation fidelity of an ergonomic training program designed to prevent back pain

Prevalence of musculoskeletal low back pain among registered nurses: Results of an online survey

AIMS AND OBJECTIVES

The aim of this study was to describe the prevalence of low back pain (LBP) and the use of lifting aids and ergonomics among Czech registered nurses.

BACKGROUND

Low back pain is the most common occupational health problem affecting nurses. Frequent manual lifting of heavy loads, including patients, is one of the main duties of nursing staff, which causes compressive and shear forces on the vertebrae of the lower spine. Training in manual handling and lifting aids reduce the physical burden on the musculoskeletal system, thus decreasing work-related back injuries and further back problems.

DESIGN

A cross-sectional survey.

METHODS

The online survey was distributed to 1460 randomly selected nurses involved in caring for patients. The survey comprised the extended version of the Nordic Musculoskeletal Questionnaire and a self-structured questionnaire. Data were analysed using STATA 15 at a significance level of 0.05.

RESULTS

Of the 569 respondents, 84.7% reported high occurrence of LBP over the previous 12-month period. The lower back was the most commonly reported body region for pain, followed by the neck, shoulders and upper back. LBP was found to occur significantly less among nursing staff who used mechanical lifting aids. Nurses with a higher level of education were found significantly more likely to use mechanical patient-lifting equipment in their clinical practice.

CONCLUSIONS

The study findings show that LBP is a frequent problem among nurses and has highlighted a lack of organisational safety practices and culture in clinical nursing practice.

RELEVANCE TO CLINICAL PRACTICE

This study provides valuable information about the extent of LBP among nurses with insufficient preventive measures or health and safety practices at work. The results provide useful baseline data for the Czech Republic, that may lead to increased awareness and therefore implementation of preventative strategies, and thus enable a reduction in the risk of back injuries among nursing professionals.

To what extent do paramedics apply safe handling principles when transferring patients from stair chairs to stretchers?

The efficiency of training programmes in handling designed to prevent injuries has rarely been demonstrated by studies in the workplace. This study aimed to identify factors that may favour or inhibit the application of safe handling principles by paramedics performing full-body transfers of patients from a stair chair to a stretcher. In an observational field study, handling methods used in 45 patient transfers from a stair chair to stretcher were characterised. Principles concerning the physical environment seem to be applied frequently, but those applicable during the transfer are neglected. Principles taught during training may not be applied due to the physical constraints of the workplace and the underestimation of risk exposure. The results suggest that training should be enhanced, not by focussing on handling techniques but by focussing on compromise and the capacity to adapt work techniques based on the working context and the team-mate.

Development of a device to reduce the risk of injury in handling unstable loads

BACKGROUND

Manual material handling (MMH) task is the most common cause of work-related musculoskeletal disorders (MSDs). Operators carrying unstable loads were recently shown to be at greater risk of back injury compared to workers carrying stable loads.

OBJECTIVE

This study focused on developing a device to minimize trunk muscle activity and cardiovascular demand while handling a 19-liter bottle.

METHOD

After evaluating several designs, one was selected to be developed, manufactured and tested through an experimental study. Healthy participants (n = 42) manually carried a 19-liter bottle. The carrying technique (i.e., carrying a lateral load while holding the load using the dominant hand, pulling the load using the developed device, carrying the load on the back using the developing device) was the independent variable. The muscular activities (e.g., neck extensor, upper trapezius, pectoralis major, deltoid medial, rectus abdominis, and erector spinae muscles of the dominant side), cardiac costs, plantar pressures, walking speeds, and subjective measures were the dependent variables.

RESULTS

Results show that carrying the developed device like a backpack significantly reduced trunk muscle activity, cardiovascular demand, and plantar pressure compared to the usual practice. The present results suggest that carrying a 19-liter water bottle using the developed device is likely to contribute to lower MSDs.

CONCLUSION

Implementation of the develop device recommended to lessen the risk of injury when handling unstable loads such as liquids.

Associação do diagnóstico clínico com a situação ocupacional de usuários de um serviço de fisioterapia

RESUMO A multicausalidade nas lesões relacionadas ao trabalho (LER) é pouco explorada na fisioterapia e sua compreensão baseada no Nexo Técnico Epidemiológico Previdenciário (NTEP) pode fornecer ao fisioterapeuta condição de atuar nos processos do trabalho. O objetivo foi analisar a associação entre diagnóstico clínico e situação ocupacional de usuários de serviço de fisioterapia. Em estudo descritivo transversal, com 656 usuários atendidos de janeiro de 2013 a julho de 2014, foram coletadas de prontuários informações sobre sexo, idade, cor da pele, diagnóstico clínico e situação ocupacional. Testes qui-quadrado e regressão logística foram utilizados para análise da associação entre diagnósticos e situações ocupacionais em população com idade média de 49,4 anos, maioria mulheres, cor branca e predominância de lesões não traumáticas. A regressão múltipla mostrou associação entre serviços domésticos e síndrome do túnel do carpo (odds ratio ou OR=2,54) e lesões no ombro (OR=1,82); entre trabalho na construção civil e algias na coluna (OR=5,78) e fraturas distais de membros inferiores (OR=3,53); e entre aposentados e gonartrose (OR=3,76), artrose na coluna (OR=2,24), acidente vascular encefálico (AVE) (OR=2,03), lesões no ombro (OR=0,27) e fraturas distais de membros inferiores (OR=0,15). O estudo mostrou risco para lesões de membros superiores em serviços domésticos; para lesões na coluna vertebral e fraturas distais de membro inferior na construção civil; e para artroses e AVE em aposentados. Estes apresentaram fator de proteção para lesões de ombro e fraturas de membros inferiores. A atuação fisioterapêutica pode ser ampliada com conhecimento do nexo causal. O fisioterapeuta pode atuar em seleção de indicadores epidemiológicos, formulação de orientações ergonômicas e elaboração de conduta terapêutica.

Promoting a Shared Representation of Workers' Activities to Improve Integrated Prevention of Work-Related Musculoskeletal Disorders

Effective and sustainable prevention of work-related musculoskeletal disorders (WR-MSDs) remains a challenge for preventers and policy makers. Coordination of stakeholders involved in the prevention of WR-MSDs is a key factor that requires greater reflection on common knowledge and shared representation of workers' activities among stakeholders. Information on workers' strategies and operational leeway should be the core of common representations, because it places workers at the center of the "work situation system" considered by the intervention models. Participatory ergonomics permitting debates among stakeholders about workers' activity and strategies to cope with the work constraints in practice could help them to share representations of the "work situation system" and cooperate. Sharing representation therefore represents a useful tool for prevention, and preventers should provide sufficient space and time for dialogue and discussion of workers' activities among stakeholders during the conception, implementation, and management of integrated prevention programs.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Interventions to reduce injuries when transferring patients: a critical appraisal of reviews and a realist synthesis

OBJECTIVES

There has been extensive investment in programmes to reduce injuries among health care staff caused by moving and handling patients or residents. Given conflicting evidence regarding the effectiveness of such programmes, the present paper conducted a critical appraisal of systematic reviews assessing the effectiveness of interventions in reducing back pain and injuries among healthcare staff. A realist synthesis was conducted on a second set of reports to identify best practices for moving and handling programmes.

DESIGN

A critical appraisal of systematic reviews and a realist synthesis to identify best practices for moving and handling programmes.

DATA SOURCES

A literature search of five databases (Medline, EMBASE, CINAHL, PsycINFO and ScienceDirect) located 150 reports assessing programme outcomes published in refereed journals between 2000 and 2013.

REVIEW METHODS

The critical appraisal included six systematic reviews. The realist synthesis included 47 studies that provided descriptive information about programme mechanisms.

RESULTS

Five of the six systematic reviews covered interventions involving either staff training or training and equipment supply. One review covered multi-component interventions. All concluded that training staff by itself was ineffective. There were differing conclusions regarding the effectiveness of training and equipment interventions and multi-component programmes. The reviews provided little information about the content of programme components. The realist synthesis noted the need for management commitment and support, and six core programme components; a policy requiring safe transfer practices, ergonomic assessment of spaces where people are transferred, transfer equipment including lifts, specific risk assessment protocols, adequate training of all care staff, and coordinators coaches or resource staff. These programme components are likely to be synergistic; omitting one component weakens the impact of the other components.

CONCLUSIONS

Five systematic reviews provided little information regarding the core components of effective programmes. Given the absence of experimental trials for multi-component programmes, the best available evidence for the effectiveness of multi-component programmes is from pre-post studies and large-scale surveys. The realist synthesis provided detailed information about the core components for effective programmes. Further studies, which include qualitative data, are needed to provide evidence about the specific mechanisms through which components contribute to effective patient handling programmes.

Development of a program logic model and evaluation plan for a participatory ergonomics intervention in construction

BACKGROUND

Intervention studies in participatory ergonomics (PE) are often difficult to interpret due to limited descriptions of program planning and evaluation.

METHODS

In an ongoing PE program with floor layers, we developed a logic model to describe our program plan, and process and summative evaluations designed to describe the efficacy of the program.

RESULTS

The logic model was a useful tool for describing the program elements and subsequent modifications. The process evaluation measured how well the program was delivered as intended, and revealed the need for program modifications. The summative evaluation provided early measures of the efficacy of the program as delivered.

CONCLUSIONS

Inadequate information on program delivery may lead to erroneous conclusions about intervention efficacy due to Type III error. A logic model guided the delivery and evaluation of our intervention and provides useful information to aid interpretation of results.

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

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

PRACTITIONER SUMMARY

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

Effectiveness of an education program to prevent nurses' low back pain: an interventional study in Turkey

This study was undertaken to evaluate an education program to prevent low back pain among nurses. This interventional study used a one-group, pretest/posttest design and was conducted in four hospitals in Bolu, Turkey. Nurses' knowledge was assessed before and after training; 60 nurses were evaluated while performing five procedures that can lead to low back pain using an observation form. These forms were given to the nurses 3 months after the training to assess their knowledge and observations of the five specified behaviors were repeated. The mean knowledge and procedures scores of the nurses were higher just after and 3 months after the training compared to before training.