The effect of a structured personalized ergonomic intervention program for hospital nurses with reported musculoskeletal pain: An assigned randomized control trial

Evaluating the Effectiveness of a Training on Ergonomic Risks of Measuring Blood Pressure

Background: Musculoskeletal disorders (MSDs) occur as a result of long-term exposure to inappropriate working postures and repetitive use of body postures, leading to harmful consequences for patients, employees, and employers. Evaluating distinct working postures can contribute to effective interventions. Purpose: The aim of this study was to determine ergonomic risks of MSDs during repeated blood pressure measurement processes and to evaluate the effectiveness of a training on this topic. Methods: A pretest/posttest quasi-experimental design studied 64 nurses in a training and research hospital in Turkey. Participants were evaluated for the prevalence and risk of MSDs using the Nordic Musculoskeletal Questionnaire Extended Version and the Rapid Entire Body Assessment (REBA) Checklist, and by photographing them performing the procedure. Nurses with high risk for MSDs received an ergonomics training program and were followed up twice in 3 months. Results: Reduction in prevalence of MSDs in neck, shoulder, and hip/thigh areas, and in mean REBA scores after the training were statistically significant. Conclusion: Nurses should be trained about correct posture for specific high-risk activities that may cause MSDs, and offered exercise programs that support the musculoskeletal system.

Efficacy of Interventions in Reducing the Risks of Work-Related Musculoskeletal Disorders Among Healthcare Workers: A Systematic Review and Meta-Analysis

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.

A first step towards a framework for interventions for individual working practice to prevent work-related musculoskeletal disorders: a scoping review

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) are a key topic in occupational health. In the primary prevention of these disorders, interventions to minimize exposure to work-related physical risk factors are widely advocated. Besides interventions aimed at the work organisation and the workplace, interventions are also aimed at the behaviour of workers, the so-called individual working practice (IWP). At the moment, no conceptual framework for interventions for IWP exists. This study is a first step towards such a framework.

METHODS

A scoping review was carried out starting with a systematic search in Ovid Medline, Ovid Embase, Ovid APA PsycInfo, and Web of Science. Intervention studies aimed at reducing exposure to physical ergonomic risk factors involving the worker were included. The content of these interventions for IWP was extracted and coded in order to arrive at distinguishing and overarching categories of these interventions for IWP.

RESULTS

More than 12.000 papers were found and 110 intervention studies were included, describing 810 topics for IWP. Eventually eight overarching categories of interventions for IWP were distinguished: (1) Workplace adjustment, (2) Variation, (3) Exercising, (4) Use of aids, (5) Professional skills, (6) Professional manners, (7) Task content & task organisation and (8) Motoric skills.

CONCLUSION

Eight categories of interventions for IWP are described in the literature. These categories are a starting point for developing and evaluating effective interventions performed by workers to prevent WMSDs. In order to reach consensus on these categories, an international expert consultation is a necessary next step.

Multicomponent exercises to prevent and reduce back pain in elderly care nurses: a randomized controlled trial

Background

Sports science is making an important contribution to health services research and supports the development of tailored interventions, e.g., in nursing settings. Working in elderly care is associated with a high prevalence of low back pain (LBP). Due to the diverse requirements and high strains, multicomponent programs are essential to address all relevant factors. This randomized controlled trial investigated the effects of a tailored ten-week ergonomics and twelve-week strength training on lifting behavior, strength endurance, LBP, functional impairment and adherence.

Methods

n = 42 nurses were randomly assigned to the intervention (IG; n = 20) or control group (CG; n = 22). They were eligible for participation if they were active in residential care and if they provided written informed consent. Other employees were excluded. The data were collected at baseline, at ten weeks (after ergonomics training), at 22 weeks (after strength training), and at 34 weeks (follow-up). The analysis combined physical tests with questionnaires (Progressive Isoinertial Lifting Evaluation, PILE-Test; Biering-Sørensen-Test; Visual Analog Scale Pain, VAS; Oswestry Disability Index, ODI; self-developed questionnaire for adherence). Group differences were analyzed by Chi²-Tests, ANOVA, and Linear Mixed Models.

Results

The IG showed an improved lifting performance (PILE-Test; 95% CI 1.378–7.810, p = .006) and a reduced LBP compared to the CG (VAS; 95% CI − 1.987 to 0.034, p = .043) after ergonomics training (PILE-Test, F_(1,34) = 21.070, p < .001; VAS, F_(1,34) = 5.021, p = .032). The results showed no differences concerning the Biering-Sørensen-Test and the ODI. Positive adherence rates were observed.

Conclusions

This approach and the positive results are essential to derive specific recommendations for effective prevention. The study results can be completed in future research with additional strategies to reduce nurses’ burden further.

Trial registration

The trial was registered at DRKS.de (DRKS00015249, registration date: 05/09/2018).

Does Postural Feedback Reduce Musculoskeletal Risk?: A Randomized Controlled Trial

Background: There is a high prevalence of musculoskeletal disorders among personnel working in the healthcare sector, mainly among nursing assistants and orderlies. Objective: The objective is to analyze the effectiveness of a multi-component intervention that included postural feedback in reducing musculoskeletal risk. Method: A total of 24 nursing assistants and orderlies in a hospital setting were randomly assigned to an intervention group or a control group. After collecting sociodemographic information, a selection of tasks was made and assessed using the REBA (rapid entire body assessment) method. A multi-component intervention was designed combining theoretical and practical training, including feedback on the postures performed by the professionals involved, especially those involving high musculoskeletal risk. This program was applied only to participants in the intervention group. Subsequently, eight months after the first assessment and intervention, the second assessment was carried out using the same method and process as in the first evaluation. Results: The results indicate that the musculoskeletal risk in the second assessment in the intervention group was significantly reduced. However, no significant changes were observed in the control group. Conclusion: The multi-component intervention applied can significantly reduce the musculoskeletal risk of nursing assistants and orderlies. In addition, it is a low-cost intervention with great applicability.

Musculoskeletal discomfort in veterinary healthcare professions

BACKGROUND

Veterinarians appear to be at risk for work-related musculoskeletal discomfort (MSD), based on surveys conducted outside the US.

OBJECTIVE

This study provides new information about MSD prevalence in veterinarians and veterinary technicians in the US.

METHODS

Cross-sectional survey and observation.

RESULTS

A survey of 56 veterinarians and 38 veterinary technicians in Ohio found 12-month prevalence of MSD exceeded 60% in the neck, low back, and legs/feet. More than 85% of participants reported that work activities exacerbated discomfort in at least one region. Less than one-third of participants reported symptom-related lost work time. Personal and work-related burnout scores were higher for veterinary technicians, compared with veterinarians. Nine percent of observed work activities performed by veterinarians and 43% performed by veterinary technicians were rated high or very high risk.

CONCLUSIONS

High prevalence of MSD and low lost work time suggest many individuals are working in pain. Increased adoption of existing ergonomics solutions (equipment and process changes), in addition to further investigation of unmet needs, could improve working conditions and reduce musculoskeletal stress in veterinary health professions.

The prevalence of upper quadrants work-related musculoskeletal disorders and their predictors among registered nurses

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) represent a significant health challenge facing nurses. However, very few studies investigated the prevalence of WMSDs among nurses and their predictors comprehensively using a valid and reliable set of standardized outcome measures.

OBJECTIVE

This study aimed to investigate the prevalence WMSDs of upper quadrants and their predictors among registered nurses in Jordanian hospitals.

METHODS

A cross-sectional study recruited 597 registered nurses from different hospitals in Jordan. A self-administered survey distributed in targeted hospitals wards. Outcome measures included Nordic Musculoskeletal Questionnaire (NMQ), Depression Anxiety Stress Scale (DASS), Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire (IPAQ), sociodemographic data, and manual handling and work habits. Prevalence of musculoskeletal complaints was reported using descriptive analysis. Logistic regression analyses were used to identify predictors of WMSDs at each upper quadrant body site.

RESULTS

Twelve-month WMSDs prevalence was the highest at the neck (61.1%), followed by the upper back (47.2%), shoulders (46.7%), wrist and hands (27.3%), and finally at the elbow (13.9%). Being a female, poor sleep quality, high physical activity level, poor ergonomics, increased workload, and mental stress were significant predictors of increased upper quadrant WMSDs among nurses.

CONCLUSIONS

Upper quadrant WMSDs among nurses in Jordan are highly prevalent. Identified significant predictors of these WMSDs should be given full consideration by clinicians and health policymakers. Future studies are needed to reveal the progressive nature of upper quadrant WMSDs and strategies to modify their risk factors.

Effectiveness of a multidimensional intervention program in improving occupational musculoskeletal disorders among intensive care unit nurses: a cluster-controlled trial with follow-up at 3 and 6 months

Background

Intensive care unit (ICU) nurses are at high risk for work-related musculoskeletal disorders (WRMDs). Data on occupational injuries indicate the significance of WRMDs among ICU nurses. Intervention programs have previously been developed to reduce WRMDs, but different intervention methods need to be adopted for different groups of people. This study aimed to evaluate the effectiveness of a multidimensional intervention program to prevent and reduce WRMDs in ICU nurses.

Methods

This study was designed as a two-armed cluster-controlled trial with an intervention group and a control group. The clusters were independent hospital ICUs, and the participants consisted of registered nurses in China. By cluster random sampling, 89 nurses from two ICUs were assigned to the intervention group, and 101 nurses from two other ICUs were assigned to the control group. A multidimensional intervention program based on previous studies was designed. This program combined improving risk perception, health behavior training, and promoting a safe working environment. The multidimensional intervention program was implemented in the intervention group, whereas routine specialist training was implemented in the control group. Baseline and follow-up (3 and 6 months) data were collected using self-reported online questionnaires. The primary outcome was the report rate of WRMDs in the past 7 days. Secondary outcomes were risk perception, application of health behavior, and perception of a safe working environment. The data were statistically analyzed using SPSS 19.0.

Results

A total of 190 nurses provided three recorded outcome measurements (intervention group, N = 89 (94.68%); control group, N = 101 (94.39%)). After 6 months, the intervention group experienced significant improvement relative to the control group in the report rate of WRMDs in the past 7 days (OR = 1.953, p = 0.037), risk perception (OR = 0.517, p < 0.001), application of health behavior (OR = 0.025, p < 0.001), and perception of a safe working environment (OR = 1.637, p = 0.024).

Conclusion

The multidimensional intervention program was superior to routine specialist training in preventing the occurrence of WRMDs in ICU nurses. WRMD training should include multifaceted approaches and pay increased attention to specific department functions.

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.

Effect of an Ergonomics Educational Program on Musculoskeletal Disorders in Nursing Staff Working in the Operating Room: A Quasi-Randomized Controlled Clinical Trial

Background: Nursing staff working in the operating room are exposed to risk factors that can cause musculoskeletal disorders (MSDs) and work-related disabilities. The use of ergonomics principles can help with the prevention of MSDs. This study aimed to examine the effect of an ergonomics educational program on MSDs among nursing staff working in the operating room. Methods: In this pragmatic parallel group quasi-randomized controlled clinical trial, 74 nursing staff working in the operating rooms of two teaching hospitals participated. The hospitals were randomly assigned to either the intervention or the control group and all nursing staff working in the operating room of each hospital were invited to take part in this research. They were initially assessed for the prevalence and risk of MSDs by using the Nordic questionnaire and the rapid entire body assessment (REBA) checklist. The intervention group received the ergonomics educational program and were assessed in two-week intervals over a period of three months. At the end of the study, the risk and prevalence of MSDs were compared between the intervention and control groups. Results: Statistically significant differences were reported between the groups in terms of the prevalence and risk of MSDs. The overall risk of MSDs decreased in the intervention group after the educational program (p = 0.03). The reduction in the prevalence of MSDs in the different parts of the body in the intervention group was as follows: ankle (p = 0.005), hand/wrist (p = 0.041), low back (p = 0.000), the neck (p = 0.003), hip (p = 0.001) and shoulder (p = 0.043). Conclusion: The education of nursing staff about ergonomics can influence the prevalence and risk of MSDs. Therefore, it should be incorporated into the degree education and on-the-job training initiatives for nurses working in the operating theatre in order to reduce workplace injuries and associated absences, and increase the quality of care delivered by them. This clinical trial has been registered in the Iranian Registry of Clinical Trials: IRCT2015081823677N1.

Comparison of musculoskeletal load using two devices for manual height adjustment of the hospital bed

Objectives. Patient manual handling in bed causes lower back pain (LBP) among Thai nurses. This study aims to develop an extension device for manual height adjustment of the hospital bed, and to evaluate its efficiency in preventing LBP among Thai nurses. Methods. Eleven participants were enrolled for electromyography measurement in eight right muscles. Subsequently, 56 volunteer nurses were recruited by convenience sampling for observational risk assessment by rapid entire body assessment (REBA) and satisfaction evaluation. The characteristics of the participants, percentage of maximum voluntary contraction (%MVC) of each muscle, REBA scores and satisfaction in using the device were analyzed by descriptive statistics, multivariate analysis of variance, paired t test and Wilcoxon signed-rank test, respectively. Results. %MVC values of the six muscles, i.e., biceps brachii, deltoideus, trapezius, latissimus dorsi, erector spinae and hamstring, were found to have a 4-18% decrease. The REBA scores decreased for both left and right when using the extension device, and all participants were more satisfied with the extension device than the hand crank of the hospital bed. Conclusions. The use of the extension device for manual height adjustment of the hospital bed developed from this study helps to prevent LBP among healthcare workers across settings.

The effects of "Workplace Health Promotion Program" in nurses: A randomized controlled trial and one-year follow-up

In this study, the authors examined the effects of the "Workplace Health Promotion Program" (WHPP) on pain, fatigue, stress, professional quality of life (Pro-QoL), and coping skills for nurses. The authors conducted a randomized control trial in 30 nurses who agreed to participate in this study. Progressive relaxation training, posture and breath exercises, and ergonomic suggestions as a WHPP were applied to the intervention group (n = 15) during the five weeks. The intervention group showed decrease in pain (p = .001), fatigue (p = .001), and stress levels (p = .003) and increase in coping skills and Pro-QoL (p < .05). In contrast, the authors observed no improvement in the control group. The authors concluded at the end of the study that WHPP remains effective in nurses.

Preventive factors against work-related musculoskeletal disorders: narrative review

Musculoskeletal disorders (MSDs) are major causes of morbidity among workers. They comprise several signs and symptoms, as e.g. pain, paresthesia, fatigue and limited range of motion, which can be related to work tasks. Workplace-related factors include physical, psychological, social and biomechanical hazards. The main kinetic factors associated with MSDs include repetitive movements, exerting excessive force, awkward postures, compression and mechanical vibration. Accurate knowledge of epidemiological aspects, evaluation of ergonomic hazards and musculoskeletal symptoms, and workplace exercise may help reduce the occurrence of MSDs. The aim of the present review is to analyze the applicability of preventive strategies against MSDs among workers. We performed a narrative review based on a survey of databases PubMed and BIREME and included studies published in English, Spanish or Portuguese. We found that workplace exercise is beneficial for both employers and workers. Risk analysis of MSDs is essential for early identification of occupational hazards and to prevent health consequences and costs associated with absenteeism.

An Overview of REBA Method Applications in the World

The objective of this work is to review literature, worldwide, in which the Rapid Entire Body Assessment (REBA) ergonomic assessment method was applied and count the number of times that REBA was applied together with other methods and subsequent incidence. The database used was the "Web of Science-Core Collection". Only scientific articles and bibliographic reviews were included, analysing a total of 314 documents and selecting only 91. The use of the REBA method is indicated in terms of knowledge, country, year and journal sectors. It was most used in the knowledge areas of "Manufacturing" (24.18%), "Agriculture, forestry and fishing" (21.98%) and in "Other activities" (19.78%). One of the benefits of REBA is that it evaluates different body parts: upper limbs (arm, forearm and wrist), lower extremities, trunk and neck. It is a useful method to identify the forced postures adopted by workers to thus develop improvement measures if necessary. It is concluded that REBA method use has increased over the last decade, probably due to the digitization of knowledge. It is almost always applied in combination with other methods, and its use can be a positive indicator of company sustainability.

Education as a strategy for managing occupational-related musculoskeletal pain: a scoping review

BACKGROUND

Musculoskeletal (MSK) pain is the primary contributor to disability worldwide. There is a growing consensus that MSK pain is a recurrent multifactorial condition underpinned by health and lifestyle factors. Studies suggest that education on work-related pain and individualised advice could be essential and effective for managing persistent MSK pain.

OBJECTIVE

The objective of this scoping review was to map the existing educational resources for work-related MSK (WRMSK) pain, and the effects of implementing educational strategies in the workplace on managing WRMSK pain.

METHODS

This scoping review assessed original studies that implemented and assessed education as a strategy to manage WMSK pain. Literature search strategies were developed using thesaurus headings (ie, MeSH and CINAHL headings) and free-text search including words related to MSK in an occupational setting. The search was carried out in PubMed, CINAHL, Cochrane Library and Web of Science in the period 12-14 February 2019.

RESULTS

A total of 19 peer-reviewed articles were included and the study design, aim and outcomes were summarised. Of the 19 peer-reviewed articles, 10 randomised controlled trial (RCT) studies assessed the influence of education on work-related MSK pain. Many studies provided a limited description of the education material and assessed/used different methods of delivery. A majority of studies concluded education positively influences work-related MSK pain. Further, some studies reported additive effects of physical activity or ergonomic adjustments.

CONCLUSIONS

There is a gap in knowledge regarding the best content and delivery of education of material in the workplace. Although beneficial outcomes were reported, more RCT studies are required to determine the effects of education material as compared with other interventions, such as exercise or behavioural therapy.