[Equipment at the special nursing homes for the elderly: a workplace survey of new nursing homes in Osaka Prefecture]

Hip Lift Transfer Assistive System for Reducing Burden on Caregiver's Waist

In Japan, the aging population is expected to increase the number of elderly people in the future. The purpose of this study was to develop a hip lift transfer assistive system to improve the QOL of elderly living and to prevent back pain for caregivers. We extracted the impediment factor and the necessary scene for the assistance, decided on the transfer process from the wheelchair in the toilet, and considered the reduction method of the burden based on the quantitative evaluation of the caregiver's lumbar burden and developed the device. Then we proposed the algorithm of the system by grasping the behavior and lumbar burden characteristics at the time of using the hip lift transfer assistive system by the developed device in which the proposed support algorithm of standing seating assistance operation is implemented in the actual use environment. Through the assistive movement evaluation experiment and the actual operation in the toilet, we have verified that the use of this device can reduce the caregivers' lumbar burden below the standard value (3400 N) and have proved the effectiveness of the proposed transfer assistive system.

[Low back load reduction using mechanical lift during transfer of patients]

In Japanese care-work sites, care-workers (CWs) have lacked basic health risk awareness for transferring patients. Knowledge of lifting equipment and skills for transfer of patients have not been disseminated and many CWs have suffered from work-related musculoskeletal disorders, especially low back pain (LBP). In order to find better ways of patient transfer which reduce and prevent LBP, we conducted a study of low back loads and operation time during the transfer of a simulated patient, who was totally dependent from bed to wheelchair, using a mechanical lift (Lift) and manual handling (handling). Moreover we examined the levels of skill which CWs had acquired in transfer by Lift and the effects of acquired skill on low back loads and operation time. We explored low back load using surface electromyography (EMG) of the lumbar paraspinals between L3 and L4 and the trunk inclination angle (TIA) measurement method. The subjects were 5 caregivers who performed the task of transferring a simulated patient from lying on the bed to sitting in a wheelchair using the Lift and by handling. Handling transfer was assisted by two-persons at the head and foot. A 'simulated' patient (a 70 kg healthy male; instructed to keep whole body relaxed) was used in all transfer tasks. When subjects used the Lift, we made an ergonomics checklist for reduction of low back load of caregivers. Subjects performed the task 4 times and were evaluated with the checklist. The level of acquired skill was significantly improved by the guidance of the checklist. TIA was observed to be significantly lower in Lift than in handling, but with EMG no significant differences were seen between Lift and handling. The effects of acquired skill on low back loads showed that TIA was statistically reduced at high skill as compared to low skill. However, there were no significant differences between both skills in Lift and handling by EMG. Operation time of Lift showed significant shortening of operation time with high skill as compared to low skill. Operation time of Lift was about 10 times longer than handling. Thus, we suggest that transfer by Lift is a valid way of reducing the burden on CWs low back. Additionally, this study found that for reduction of LBP risk for CWs, it will be important not only to use the Lift but also to observe proper procedure and raise CW skill levels in patient transfer.

[The actual condition of musculoskeletal disorders of workers working at new special nursing homes for the aged in Osaka Prefecture--comparison of musculoskeletal disorder between manager's awareness and care workers' complaints by questionnaire survey]

In order to examine the actual condition of health problems of workers working at new special nursing homes for the aged, we conducted an interview survey with the managers and a questionnaire survey among the workers. Subjects of the interview survey were managers at the 7 nursing homes. Subjects of the questionnaire survey were 362 workers employed at the 7 nursing homes, 214 care workers (CWs) and 104 workers other than care workers (non-CWs); 299 questionnaires were returned. The response rate was 82.6%. We asked the managers "How many CWs are complaining of low back pain (LBP) and upper extremity pain at your nursing home?" One manager answered that 80% of CWs were complaining of LBP, but other managers answered that a few but no more than 5 CWs were complaining of LBP. On the other hand, the prevalence of LBP among CWs by the questionnaire survey was high. The point prevalence of LBP was 70.0%, the one month prevalence of LBP was 81.6%, and the period prevalence of LBP in present job was 88.6%. The managers had less interest in upper extremity pain than in LBP. But more than 60% of CWs had complained of upper extremity pain in the previous 1 month. Seventy-three percent of CWs had not received any education about work-related musculoskeletal disorders although about half of them had got some education or training to minimize the risk of injury in training school. Regarding female workers (77% of all CWs, 73% of all non-CWs), the percentages of current smokers and night shift workers were higher in CWs than in non-CWs with statistically significant differences. The percentages of workers working without work breaks and working overtime were higher in non-CWs than in CWs with statistically significant differences. For prevalence of LBP among female CWs and female non-CWs, the workers having LBP now, having had LBP in present job, and having first experienced LBP in present job were higher in CWs than in non-CWs with statistically significant differences. All nursing homes surveyed had provided no special health examination for LBP. For managers to grasp the actual condition of musculoskeletal disorders of workers working at the nursing homes for the aged, we recommend that care workers should have a special health examination for LBP.

A validation study of devices designed to reduce loads in provision of care: whether these assistive devices are used, or not, and whether work posture is appropriate or not

Our country already faces an aging society, but many care workers suffer from work-related musculoskeletal disorders and assistive devices have not been adopted in care-work sites. In order to evaluate the effectiveness of assistive devices, we conducted a study on care work-load; whether the assistive devices are used or not, and whether work posture is appropriate or not, on five female healthcare workers by measuring surface electromyography (SEMG) of biceps brachii, the trapezius (upper extremity) and lumbar paraspinals between L3 and L4 (low back), and the trunk inclination angle (TIA). Moreover, subjective evaluations both by the caregivers and also the care receivers were verified. The caregivers were asked to rate perceived exertion using the Borg scale and the care receiver was asked to rate dissatisfaction. Work condition 1: Repositioning of a supine patient towards the head of bed. Work condition 2: Transferring a patient from sitting on the bed to sitting in a wheelchair. Under the two work conditions there were five set tasks in which subjects used or did not use the assistive devices and worked with or without the appropriate procedure and posture. The representative value adopted was the 95 percentile value. SEMG: Under both work conditions and at all measurement sites, we observed the statistically significant effectiveness of the appropriate procedure and posture as compared to manual handling. When the assistive devices were used improperly, or in work with low bed height, there was no reduction in workloads on the upper extremities. TIA: In both work conditions we observed statistically significant effectiveness of the appropriate procedure and posture as compared to not only manual handling but also working with improper assistive devices and with low bed heights. Findings of the subjective evaluations: The caregiver's perceived exertion and care receiver's dissatisfaction, showed statistical significance in satisfaction with the appropriate procedure and posture as compared to manual handling. Therefore, to reduce workload, and prevent work-related musculoskeletal disorders of caregivers, it is necessary not only to provide assistive devices but also to supervise the proper procedures and work postures and to improve the work environment.

[Low back load and satisfaction rating of caregivers & care receivers in bathing assistance given in a nursing home for the elderly practicing individual care]

Since the public nursing care insurance system was enacted by the Japanese government, a transition from conventional group treatment to the individual care is required. In Japanese nursing homes for the elderly, bathing assistance methods have shifted from use of traditional mechanical bathtubs or a big bathtub to methods using small homestyle bathtubs, known as "individual bathing assistance". A study on the work load of caregivers with individual bathing assistance has never been conducted. Therefore, in a nursing home for the elderly practicing the individual bathing assistance method, we explored low back load using surface electromyography and trunk inclination angle measurement. Moreover, subjective evaluations by not only the caregivers but also the care receivers were investigated. The individual bathing assistance time per person was about 35 min. When caregiver used the mechanical lift equipment to assist getting into and out of the bathtub, trunk inclination angle and muscle load were lower than with manual handling. Mechanical lift equipment had the advantage of reducing low back load. When caregivers gave assistance with dressing and ablution of the lower limbs, and in setting wheelchair footrests, trunk inclination angle and muscle load showed high values. The satisfaction rating of using the mechanical lift equipment showed the best score, and ratings of perceived exertion were about the same. Thus, the importance of safe and comfortable care for both caregivers and care receivers should be stressed to make effective use of assistance products and care equipment.

[Usage survey of care equipment in care service facilities for the elderly]

Musculoskeletal disorders(MSD)have been increasing recently among care workers. Since providing care workers with appropriate equipment is effective for preventing MSD, we conducted a questionnaire survey in two nursing homes and a healthcare facility for the elderly to clarify equipment usage, problems and points for improvement. A total of 81 care workers(average age 32.2 yr; 63 females, 18 males)participated in the survey. The average number of residents and the average resident's care level were 70.0 and 3.6, respectively. Wheelchair and height adjustable beds were fully available and always used in all facilities. Portable lifts, ceiling lifts and transfer boards were, however, few in all 3 facilities and the proportion of use was 14.8%, 16.0%, and 23.5%, respectively. Participants reported that it is time consuming to move residents from place to place with lifts and there is a danger of dropping a resident. Although approximately 90% of care workers had received education and training on care techniques, the workload on the low back was found to be great. Therefore, we thought that care workers must consistently use care equipment. To achieve such increased usage, we must improve the usability of the equipment.