Comparison of self-management and spa therapy for upper-extremity musculoskeletal disorders: A randomized controlled trial

BACKGROUND

Musculoskeletal disorders (MSDs) are common in the workplace and are a public health issue. Persistent pain despite conservative treatment or surgery may lead to poor long-term outcomes.

OBJECTIVE

To compare the effect of a combined 6-day program of exercise, self-management workshops and spa therapy with self-management on functional capacity in personal and professional daily life at 3 months in people with musculoskeletal disorders.

METHODS

We conducted a prospective, randomized controlled trial. Participants were employed (any type of work) and aged between 18 and 65 years, with latent or symptomatic upper extremity MSDs, with or without a history of sick leave. They were randomized to participate in 6 days (2 h per day) of spa therapy, exercise, and self-management workshops immediately (intervention) or at 3 months (control). The control group performed self-management until 3 months. The primary outcome was the score on the self-reported Quick Disability of Arm-Shoulder-Hand (QuickDASH) at 3 months. The primary analysis was conducted using analysis of covariance with baseline QuickDASH score as the covariate.

RESULTS

In total, 150 participants were randomized (85 % women): 78 to the control group and 72 to the intervention group. At 3 months, the QuickDASH total and work scores did not differ between groups (effect-size [ES] = -0.15, 95 %CI, -0.38 to 0.09, p = 0.215, and ES = -0.11, 95 % CI, -0.35 to 0.12, p = 0.343). However, QuickDASH sport/performing arts score was significantly different between randomization groups at 3 months (ES =-0.25, 95 % CI, -0.48 to -0.02, p = 0.035).

CONCLUSIONS

This study provided no evidence in favor of a short-course, personalized self-management, intensive spa therapy intervention over self-management alone for the management of upper-extremity MSDs.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02702466) retrospectively registered.

Nurses' Knowledge and Practice of Appropriate Techniques of Body Mechanics and Non-specific Back Pain

Background Nursing is a compassionate profession that carries occupational hazards, including work-related injuries. Back pain is a common concern due to the physically demanding tasks performed by nurses. Utilizing proper techniques of body mechanics is vital to prevent work-related back pain and enhance overall well-being. Aim To assess the knowledge and practice of the nurses working in Jordanian hospitals about the appropriate techniques of body mechanics and their relation to non-specific back pain. Methods A cross-sectional design with a convenience sample of 280 participants was randomly selected from hospitals. The tool included the use of a paper questionnaire or scanning the barcode at nursing stations; a reliable, adopted tool was used in this study. Results Out of 280 participants, six (2.1%) had poor knowledge, 96 (34.3%) had average knowledge, and 178 (63.6%) had good knowledge, with a mean score of 3.72±0.58. For practice, seven (2.5%) had poor, 225 (80.4%) had average, and 48 (17.1%) had good practice, with a mean score of 3.30±0.49. Both knowledge and practice scores were negatively correlated with non-specific back pain (rpb = -.393 and rpb = -.306, p < .001), respectively. Furthermore, sociodemographic characteristics did not significantly affect body mechanics knowledge and practice scores (p > 0.05) for all variables. Conclusion Nurses working in Jordanian hospitals had good knowledge of body mechanics but average practice. Higher knowledge and practice levels were correlated with less experience of non-specific back pain. Additionally, there was no significant difference in sociodemographic data between nurses with knowledge and practice scores.

Effectiveness of Safe Patient Handling Equipment and Techniques: A Review of Biomechanical Studies

OBJECTIVE

This review aimed to evaluate all studies that have evaluated the biomechanical effects when using assistive devices.

INTRODUCTION

The physical demands of patient handling activities are well known. One safety strategy for the reduction of the physical risks is use of assistive devices.

METHOD

The search process identified articles published in English-speaking journals through Google Scholar, Medline, and ISI Web of Science. The included 56 studies contained a biomechanical assessment of a patient handling activity with assistive devices.

RESULTS

The biomechanical effects included four groups: changes in body posture (spinal, other joints), subjective assessment (force, effort, discomfort), measured force (hand force, ground reaction force, spine force, joint torque), and physiological measures. The evidence showed caregivers benefited from using lift hoists, air-assisted devices, and to a lesser extent friction reducing devices for lateral transfers and repositioning, while floor and ceiling lifts were most effective for patient transfers. Some gaps were noted in the evidence and other handling tasks such as sit-to-stand, turning patient in bed, limb lifting, and repositioning and some more high hazard activities like supporting people with limited balance and those that fall need to be investigated with respect to biomechanical outcomes.

CONCLUSION

There is a growing level of biomechanical evidence to support the use of assistive devices for many patient-handling tasks, but the benefits of equipment use in some transfers remain uninvestigated.

PRACTICAL APPLICATION

Evidence indicates the best way to lift patients safely is with floor or ceiling lifts, and air-assisted devices for lateral and repositioning tasks.

Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up

While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of "pain control" and "pain influence," controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with "high" as reference, hazard ratios of 1.30 (95% CI 1.03-1.64) and 2.09 (95% CI 1.45-3.01) are observed for "moderate" and "low," respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11-1.87) and 2.10 (1.53-2.89), respectively. Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.

Participatory Action Design and Engineering of Powered Personal Transfer System for Wheelchair Users: Initial Design and Assessment

Caregivers that assist with wheelchair transfers are susceptible to back pain and occupational injuries. The study describes a prototype of the powered personal transfer system (PPTS) consisting of a novel powered hospital bed and a customized Medicare Group 2 electric powered wheelchair (EPW) working together to provide a no-lift solution for transfers. The study follows a participatory action design and engineering (PADE) process and describes the design, kinematics, and control system of the PPTS and end-users' perception to provide qualitative guidance and feedback about the PPTS. Thirty-six participants (wheelchair users (n = 18) and caregivers (n = 18)) included in the focus groups reported an overall positive impression of the system. Caregivers reported that the PPTS would reduce the risk of injuries and make transfers easier. Feedback revealed limitations and unmet needs of mobility device users, including a lack of power seat functions in the Group-2 wheelchair, a need for no-caregiver assistance/capability for independent transfers, and a need for a more ergonomic touchscreen. These limitations may be mitigated with design modifications in future prototypes. The PPTS is a promising robotic transfer system that may aid in the higher independence of powered wheelchair users and provide a safer solution for transfers.

The differences between normal and obese patient handling: re- structural analysis of two questionnaires

BACKGROUND

Precise causes of musculoskeletal complaints among nurses are not known well, but many studies have pointed to manual patient handling tasks. Subjective judgment and decision-making process for patient lifting is crucial for gathering data regards patient handling. The aim of this study was to consider reliability and validity and re-structure of two special tools for patient handling's tasks.

METHODS

In this cross- sectional study 249 nurses were fully participated. As recommended by literature for cultural adaptation of instruments, forward/backward translation method was applied. Reliability of the translated version was assessed by Cronbach's alpha coefficient. Validity testing for the two scales was based on content validity index/ratio analysis and also Exploratory Factor Analysis was run to extract latent factors.

RESULTS

Reliability estimated by internal consistency reached a Cronbach's Alpha of above 0.7 for all subscales of two questionnaires. After testing the validity, the final version of questionnaires was remained by 14 and 15 questions respectively.

CONCLUSIONS

These instruments evaluated for manual handling of normal and obese patients had acceptable validity and reliability in Iranian Nursing context. So, these tools can be used in further studies with the same cultures.

Motor variability during a repetitive lifting task is impaired by wearing a passive back-support exoskeleton

PURPOSE

Evaluate whether wearing a passive back-support exoskeleton during repetitive lifting impairs motor variability of erector spinae muscle and spine movement and whether this association is influenced by lifting style.

SCOPE

Thirty-six healthy males performed ten lifts in four randomized conditions with exoskeleton (without, with) and lifting style (squat, stoop) as dependent variables. One lifting cycle contained four phases: bending/straighten without/with load. Erector spinae muscular activity, thoracic kyphosis and lumbar lordosis were measured with surface electromyography and gravimetric position sensors, respectively. Absolute and relative cycle-to-cycle variability were calculated. The effects of exoskeleton and exoskeleton × lifting style were assessed on outcomes during the complete lifting cycle and its four phases.

RESULTS

For the complete lifting cycle, muscular variability and thoracic kyphosis variability decreased whereas lumbar lordosis variability increased with exoskeleton. For lifting phases, effects of exoskeleton were mixed. Absolute and relative muscular variability showed a significant interaction effect for the phase straighten with load; variability decreased with exoskeleton during squat lifting.

CONCLUSION

Using the exoskeleton impaired several motor variability parameters during lifting, supporting previous findings that exoskeletons may limit freedom of movement. The impact of this result on longer-term development of muscular fatigue or musculoskeletal disorders cannot yet be estimated.

Staff Low Back Injury Risk During Assisted Falls Virtual Reality Simulations

BACKGROUND

Assisted falls occur when staff try to minimize the impact of falls by slowing a patient's descent. Assisting a patient fall may decrease patient injury risk, but biomechanical risk of injury to staff has not been evaluated. Assisted falls virtual reality (VR) simulations were conducted to examine staff low back injury risk during common assisted falls scenarios.

METHODS

VR simulations of a toilet to wheelchair transfer were developed with a male patient avatar for three assisted falls scenarios: standing up from toilet, sitting down on wheelchair, and ambulation. Patient avatar weight was modified to reflect normal, underweight, and overweight adult patients. The average spinal compression force at L5/S1 was calculated for each participant with five trials per three scenarios while utilizing physical ergonomic techniques and compared to the safe spinal compression limit of 3,400 Newtons (N).

FINDINGS

Six staff participants completed 90 VR simulations in total. The average calculated spinal compression force ranged from 7,132 N to 27,901 N. All participant trials exceeded the safe spinal compression limit of 3,400 N for every assisted falls scenario and avatar weight despite application of ergonomic techniques including wide stance, knees bent, and backs straight.

CONCLUSIONS/APPLICATION TO PRACTICE

Staff are at risk for low back injury if they assist falls regardless of the adult patient weight and application of ergonomic techniques. Safer alternatives like the implementation of mobility screening tools and safe patient handling and mobility technology are needed to help prevent assisted falls to decrease injury risk to both patients and staff.

The Effect of Key Anthropometric and Biomechanics Variables Affecting the Lower Back Forces of Healthcare Workers

Wearable devices are becoming ubiquitous and can be used to better estimate postures and movements to reduce the risk of injuries. Thirty-three participants were recruited in this study to perform two daily repetitive patient transfer tasks while the full body movements were acquired using a set of magneto-inertial wearable devices. The use of wearable devices allowed for the estimation of the forces provoked on the lower back during the entire task performance. In postures where the forces exceeded the warning threshold found in the literature, healthcare workers were considered to have a greater risk of injury. Additionally, the maximum force exerted by each hand to avoid injury to the spinal column was also estimated. Knowing the key anthropometric variables associated with musculoskeletal disorders (MSDs) will enable engineers and researchers to design better assistive devices and injury prevention programs in diverse workplaces.

Organization factors influencing quality of work life among seniors' care workers with severe low back pain

OBJECTIVES

The prevalence of work-related low back pain (LBP) is high among care workers and can negatively affect quality of work life (QWL). To improve workplace satisfaction, this study aimed to identify factors influencing QWL among seniors' care workers with severe LBP.

METHODS

A questionnaire survey including items on demographics, qualifications, basic job responsibilities, job stressors, LBP severity, QWL, and job satisfaction was conducted in 2018. In total, 1000 senior care facilities were selected via random sampling and eight care workers per institution were asked to complete the survey. Multiple logistic regression analysis was used to identify independent factors influencing QWL of care workers with and without severe LBP.

RESULTS

Data from 1247 care workers with severe LBP and 2009 with nonsevere LBP were included in the analysis. Overall QWL was lower in the severe LBP group than in the nonsevere LBP group. In both groups, human relationships, workplace support, discretionary responsibility level, and working hours or time off were identified as common factors influencing QWL. In the severe LBP group, the salary was also a significant influence on QWL, while in the nonsevere LBP group, the number of workers, promotion or official position, and caregiving technique were identified as significant QWL factors.

CONCLUSIONS

The QWL of care workers with severe LBP was strongly influenced by salary. Since care workers suffering from severe LBP are working for a salary while enduring the pain and do not have found a worth doing, they need to prevent LBP and get job satisfaction and self-progress.

THE RELATIONSHIP BETWEEN PSYCHOSOCIAL WORK ENVIRONMENT AND NURSES' PERFORMANCE, ON STUDIES THAT USED THE VALIDATED INSTRUMENT COPENHAGEN PSYCHOSOCIAL QUESTIONNAIRE (COPSOQ): AN EMPTY SCOPING REVIEW

OBJECTIVE

Aim: This study was to map the relationship between psychosocial work environment and nurses' performance, on studies that used the Copenhagen Psychosocial Questionnaire (COPSOQ).

PATIENTS AND METHODS

Materials and Methods: The review intended to answer following questions: 'Can COPSOQ screen completely psychosocial risks of nurses' work environment?' 'Which of these dimensions affect more nurses psychosocial world? A scoping review was developed guided by the JBI methodology and using PRISMA-ScR.

CONCLUSION

Conclusions: Hospital workers, and in particular nurses, are exposed to different risk factors with the most important being psychosocial risks. These arise from problematic work planning, organization and management, as well as from an unhealthy social context of work and may lead to negative psychological, physical and social outcomes. The review highlighted the need for further research using the entire COPSOQ questionnaire in order to fully study the psychosocial risks that nurses face in their work environment.

Ergonomic and individual risk factors for musculoskeletal pain in the ageing workforce

Background

The present study aimed to investigate the possible association between specific ergonomic and individual risk factors and musculoskeletal pain (MSP) in the back, shoulder, hip and knee region in workers aged 50-65y.

Methods

The study was a population based cross-sectional survey. The study population comprised citizens born between 1952–1966, living in Esbjerg municipality, Denmark, ultimo 2016 (n = 23,463). A questionnaire was sent electronically or by mail. The analysis included the working population only. A multivariate logistic regression was used for each of the following dependent variables; musculoskeletal pain for the past 3 months in the back, shoulder, hip and knee, where independent variables included ergonomic exposure, age, sex, body mass index (BMI) and leisure time physical activity (LTPA).

Results

The overall response rate was 58% and the data of individuals at work (n = 9,263) demonstrated several ergonomic exposures with increased odds for pain in specific regions. Exposure to back twisted or bend, squatting or lying on knees and to carrying or lifting were associated with musculoskeletal pain in the back, whereas exposure to back twisted or bend, arms above shoulder and repeated arm movement were associated with pain in the shoulder. Exposure to back twisted or bend, repeated arm movement, squatting or lying on knees and to carrying or lifting were associated with musculoskeletal pain in the hip. Important individual risk factors were also identified. Increasing age was significantly associated with increased pain in the hip but associated with less risk for pain in the back and shoulder. Males had higher odds for pain in the back and knee compared to females but lower odds for pain in the hip. BMI was particularly important for knee pain. The level of LTPA did not have an important association with MSP in any region.

Conclusion

There is a significant positive association between ergonomic exposures and musculoskeletal pain, which were specific for the back, shoulder, hip and knee. In addition, the data demonstrated a differential association with age, sex and BMI. This needs to be considered for the treatment and classification of musculoskeletal pain and for future preventive initiatives.

What affects musculoskeletal risk in nursing assistants and orderlies?

BACKGROUND: There are many musculoskeletal disorders in staff members at health centres, given the specific characteristics of their work. OBJECTIVE: The objective was to analyse the postural risk of patient handling tasks performed by nursing assistants and orderlies, as well as task factors, individual or organisational, that may be associated with increased postural risk. METHOD: This is a cross-sectional observational study. Analysis was done on 170 postures in five different tasks performed by 39 participants at three hospitals in Andalusia (Spain). The questionnaires collected sociodemographic variables, the task done, and REBA were used for assessment of postural risk. RESULTS: Overall the average REBA score was 9.0±2.4. Moving the patient to the head of the bed was the task with the highest risk (9.8). Handling involving more than two participants at once increased postural risk. Using mechanical aids were associated with high risk in the legs. Logistic regression analyses showed that age, stature, and not having adjustable beds available were associated with postural risk (p < 0.05). CONCLUSION: Health centre staff perform many tasks with high musculoskeletal disorder risk. Age, stature of the participants, and adjustment of bed height were associated with postural risk.

Translation and cross-cultural adaptation of the risk assessment instrument TilThermometer for a Swedish version – patient handling in the healthcare sector

Background

Work-related musculoskeletal disorders are common in the healthcare sector due to exposure of physical demanding work tasks. Risk assessment is necessary to prevent injuries and promote a safety culture. The TilThermometer has proved to be useful in the Netherlands for assessing healthcare workers’ physical exposure to patient handling. The aim of this study was to translate the risk assessment instrument TilThermometer from Dutch to Swedish, perform cross-cultural adaptation, and evaluate its linguistic validity to a Swedish healthcare context.

Methods

Translation and validation process was performed according to following eight steps: 1) Translation (two translators), 2) Synthesis, 3) Back-translation (two back-translators), 4) Synthesis, 5) Linguistic review (one bilingual reviewer), 6) fifteen experts in a panel review according to Delphi-method, 7) Semi-structured interviewing eleven informants, analyzed using qualitative content analysis and step 8) discussion and input from creators of the instrument.

Results

A new Swedish version, the TilThermometer, was provided through the translation process (steps 1–5). The linguistic validity and usefulness were confirmed thru step 6 and 7. Consensus was reached in the expert review after two rounds, comments were analyzed and grouped into five groups. The qualitative content analyses of the interviews emerged in to three categories: 1) “User-friendly and understandable instrument”, 2) “Further development”, and 3) “Important part of the systematic work-environment management”.

Conclusion

In this study, the cross-cultural adaption and translation performed of the Swedish version of TilThermometer assured linguistic validity. This is this first phase before further testing the psychometrics aspects, inter-rater reliability and feasibility of TilThermometer. In the second phase TilThermometer will be implemented and evaluated together with other measures in the Swedish healthcare sector.

Lauren M, Cooper R, Bendixen R, Koontz AM, Cooper RA. Clinical and Ergonomic Comparison Between a Robotic Assisted Transfer Device and a Mobile Floor Lift During Caregiver-Assisted Wheelchair Transfers

BACKGROUND

The robotic assisted transfer device was developed as an updated lift technology to reduce adjustments in posture while increasing capabilities offered by transfer devices. The purpose of this study was to compare the trunk biomechanics of a robotic assisted transfer device and a mechanical floor lift in the transfer of a care recipient by a caregiver during essential transfer tasks.

METHODS

Investigators enrolled 28 caregiver/care recipient dyads to complete 36 transferring tasks. Surface electromyography for the back muscles and motion data for trunk range of motion were collected for selected surfaces, phase, and direction tasks using a robotic assisted transfer device and a mechanical floor lift.

RESULTS

Robotic assisted transfer device transfers required significantly smaller range of trunk flexion (P < 0.001), lateral bend (P < 0.001), and axial rotation (P = 0.01), in addition to smaller distance covered (P < 0.001), average instantaneous velocity (P = 0.01), and acceleration (P < 0.001) compared with a mobile floor lift. The robotic assisted transfer device transfers required significantly smaller peak erector spinae (left: P = 0.001; right: P < 0.001) and latissimus dorsi (right: P < 0.001) and integrated erector spinae left (P = 0.001) and latissimus dorsi right (P = 0.01) electromyography signals compared with the floor lift.

CONCLUSIONS

The robotic assisted transfer device provides additional benefits to mobile floor lifts which, coupled with statistically lower flexion, extension, and rotation, may make them an appealing alternative intervention.

The effects of patient transfer devices on the risk of work-related musculoskeletal disorders (WMSDs): a systematic review

Objectives. This study aimed to evaluate the efficacy of patient transfer assistive devices in reducing the risk of work-related musculoskeletal disorders (WMSDs) among nurses. Methods. PubMed, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews were searched to identify studies with a quantitative assessment of the efficacy of patient transfer assistive devices on the incidence and injury claims of WMSDs as compared to the manual lifting of patients. A health impact analysis of the pre-post intervention of assistive device implementation was performed. The percentage of the reduction of forces, incidence of WMSDs, number of missed workdays and injury compensation claims were calculated, pooled and presented as boxplots. Results. A total of 25 studies met the inclusion criteria. The best post-intervention outcomes of assistive devices deployment in the healthcare setting included a reduction in WMSD incidence by 59.8%, missed workdays by 90.0% and workers' compensation claims by 95.0%. Additionally, hand force declined by 71% (p < 0.05) and 70% (p < 0.05) with the use of air-assisted devices and ceiling lifts respectively. Conclusions. Overall, the evidence suggests that patient transfer assistive devices, notably ceiling lifts and air-assisted devices, are effective in reducing the risk of WMSDs among nurses.

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.

Analysis, Design and Experimental Research of a Novel Bilateral Patient Transfer Robot

Patient transfer has always been a difficult problem in the hospital. For medical staff, there are problems including high risk of infection, heavy physical labor and low efficiency of transfer; for patients, there are problems including poor comfort and secondary injury. In this paper, a novel bilateral patient transfer robot is investigated and designed. The following tasks are conducted: (1) Based on the process of patient transfer, a transfer model, which consists of two degrees of freedom, is proposed, and the working principle of bilateral patient transfer robot is obtained and analyzed in detail. (2) Force analysis of the patient transfer robot is conducted. The corresponding relationship between the patient comfort and the insertion angle is proposed, and the optimal sizes of mechanical structure are obtained. (3) Based on the theoretical analysis, the mechanical structure and the control system of the robot are designed, and the prototype is manufactured. (4) Experimental research is conducted. The results show that the prototype can complete the required motion performance with a carrying capacity up to 150 kg and patient comfort is excellent. The results of this paper prove that this kind of patient transfer robot has good performance, it can also reduce the burden on medical staff.

Workability in the Ageing Workforce-A Population-Based Cross-Sectional Study

Background: The purpose of this study was to investigate the impact of age, musculoskeletal pain and ergonomic exposure on workability in the oldest group of workers. Methods: The study was a population based cross-sectional survey. The study population comprised citizens born between 1952–1966, living in Esbjerg municipality ultimo 2016 (n = 23,463). A questionnaire was sent electronically or by mail. The analysis included the working population only. A stereotype logistic regression was used with the primary dependent variable being workability and independent variables included age, musculoskeletal pain, and ergonomic exposure. Results: The response rate was 58% and the data demonstrated a significant negative association between age and workability. With excellent workability as a reference, the odds for poor workability increased by 97% being 60+ y compared to 50–55 y. Both moderate intensity and severe musculoskeletal pain in the back, shoulder and knee/hip all showed significantly higher odds for poor workability. Ergonomic exposures, such as standing/walking, working with back bent or twisted and carrying or lifting had a significant negative impact on workability. Conclusion: Age, musculoskeletal pain and ergonomic exposures showed a significant negative impact on workability in the oldest group of workers and should be targeted with preventive initiatives.

The Effects of Workplace Interventions on Low Back Pain in Workers: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to analyze the effects of workplace interventions (WI) on clinical outcomes related to low back pain (LBP) in a worker population, and to assess socio-economic parameters as participants on sick leave, days of sick leave, and return to work following WI. A systematic literature search was performed to select randomized clinical trials that investigated the effectiveness of WI on return to work, sick leave, and working capacity of workers affected by nonspecific LBP. Fourteen articles were included in the review and meta-analysis. The meta-analysis showed improvements in pain (p = 0.004), disability (p = 0.0008), fear-avoidance for psychical activity (p = 0.004), and quality of life (p = 0.001 for physical scale and p = 0.03 for mental scale) for patients who underwent WI compared to controls. Moreover, the pain reduction following WI was statistically significant in the healthcare workers’ group (p = 0.005), but not in the other workers’ group. The participants on sick leave and the number of days of sick leave decreased in the WI group without statistical significance (p = 0.85 and p = 0.10, respectively). Finally, LBP recurrence was significantly reduced in the WI group (p = 0.006). WI led to a significant improvement of clinical outcomes in a workers’ population affected by LBP.

Process evaluation of a complex workplace intervention to prevent musculoskeletal pain in nursing staff: results from INTEVAL_Spain

Background

INTEVAL_Spain was a complex workplace intervention to prevent and manage musculoskeletal pain among nursing staff. Process evaluations can be especially useful for complex and multifaceted interventions through identifying the success or failure factors of an intervention to improve the intervention implementation.

Objectives

This study performed a process evaluation of INTEVAL_Spain and aimed to examine whether the intervention was conducted according to the protocol, to investigate the fulfilment of expectations and the satisfaction of workers.

Methods

The intervention was a two-armed cluster randomized controlled trial and lasted 1 year. The process evaluation included quantitative and qualitative methods. Quantitative methods were used to address the indicators of Steckler and Linnan’s framework. Data on recruitment was collected through a baseline questionnaire for the intervention and the control group. Reach and dose received were collected through participation sheets, dose delivered and fidelity through internal registries, and fulfilment of expectations and satisfaction were collected with two questions at 12-months follow-up. Qualitative methods were used for a content analysis of discussion groups at the end of the intervention led by an external moderator to explore satisfaction and recommendations. The general communication and activities were discussed, and final recommendations were agreed on. Data were synthesized and results were reported thematically.

Results

The study was performed in two Spanish hospitals during 2016-2017 and 257 workers participated. Recruitment was 62 and 51% for the intervention and the control group, respectively. The reach of the activities ranged from 96% for participatory ergonomics to 5% for healthy diet. The number of sessions offered ranged from 60 sessions for Nordic walking to one session for healthy diet. Fidelity of workers ranged from 100% for healthy diet and 79% for participatory ergonomics, to 42 and 39% for Nordic walking and case management, respectively. Lowest fidelity of providers was 75% for case management and 82% for Nordic walking. Fulfilment of expectations and satisfaction ranged from 6.6/10 and 7.6/10, respectively, for case management to 10/10 together for the healthy diet session. Discussion groups revealed several limitations for most of the activities, mainly focused on a lack of communication between the Champion (coordinator) and the workers.

Conclusions

This process evaluation showed that the implementation of INTEVAL_Spain was predominantly carried out as intended. Process indicators differed depending on the activity. Several recommendations to improve the intervention implementation process are proposed.

Trial registration

ISRCTN15780649.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00716-x.

Musculoskeletal pain intensity in different body regions and risk of disability pension among female eldercare workers: prospective cohort study with 11-year register follow-up

Background

Musculoskeletal pain is a risk factor for leaving the labour market temporarily and permanently. While the presence of multi-site pain increases the risk of disability pension, we lack detailed knowledge about pain intensity as a risk factor. This study investigated the association between musculoskeletal pain intensity in different body regions and risk of future disability pension among eldercare workers.

Methods

Eight thousand seven hundred thirty-one female eldercare workers replied to a questionnaire on work and health in 2005 and were followed for 11 years in the Danish Register for Evaluation of Marginalization. Time-to-event analyses estimated hazard ratios (HR) for disability pension from pain intensities (0–9 numeric rating scale (NRS)) in the low-back, neck/shoulders, and knees during the previous 3 months. Analyses were mutually adjusted for pain regions, age, education, lifestyle, psychosocial work factors, and physical exertion at work.

Results

During 11-year follow-up, 1035 (11.9%) of the eldercare workers received disability pension. For all body regions among all eldercare workers, dose-response associations were observed between higher pain intensity and risk of disability pension (p < 0.001). The risk for disability pension was increased when reporting “very high” pain levels (≥7 points on the 0–9 NRS) in the low-back (HR 2.19, 95% CI 1.70–2.82), neck/shoulders (HR 2.34, 95% CI 1.88–2.92), and knees (HR 1.89, 95% CI 1.44–2.47). Population attributable risks (PAR) were 15.5, 23.2, and 9.6% for pain > 2 on NRS in the low-back, neck/shoulders, and knees, respectively, indicating that 15.5, 23.2, and 9.6% fewer eldercare workers would likely receive disability pension if the pain intensity was reduced to 2 or less. For workers ≤45 years and > 45 years, PAR was highest for neck/shoulder pain (27.6%) and low-back pain (18.8%), respectively.

Conclusions

The present study found positive dose-response associations between pain intensity in the low-back, neck/shoulders, and knees, and risk of disability pension during 11-year follow-up. Moderate to very high levels of musculoskeletal pain in eldercare workers should, therefore, be considered an early warning sign of involuntary premature exit from the labour market. These findings underscore the importance of preventing, managing, and reducing musculoskeletal pain to ensure a long and healthy working life.

Healthcare workers' knowledge for safe handling and moving of the patient

Objectives. Healthcare workers are at risk of injury during patient handling activities. There is a lack of research in safe patient handling. The objective of this study was to examine the knowledge level of safe patient handling among Brazilian healthcare workers and to analyze its associated factors. Methods. This cross-sectional study was performed in two hospitals and 47 outpatient facilities with 644 participants in Brazil. Healthcare workers completed a self-administered questionnaire about their working characteristics, history of lower back pain and knowledge of safe patient handling. Results. The mean score of safe patient handling knowledge was 11.89 out of 22 maximum points. More than half (59%) of the participants did not see the risk of their activity. Educational level, type of healthcare facility and outpatient clinics were associated with safe patient handling knowledge in the logistic regression model. Conclusion. There was a substantial deficit in safe patient handling knowledge. There is a need for courses and textbooks to move beyond ineffective preventive strategies and minimize the risk of manual patient handling. Healthcare workers are at risk of injury during patient handling activities. Nursing schools in developing countries must focus on researching this topic to ensure safe patient handling.

Physical exposure during patient transfer and risk of back injury & low-back pain: prospective cohort study

BACKGROUND

Work-related musculoskeletal disorders (MSDs) are common among healthcare workers. Because frequent patient transfer has been associated with increased risk of MSDs, we aim to quantify the physical load associated with commonly-used assistive devices and to investigate associations between accumulated physical exposure and risk of MSDs.

METHODS

By applying an exposure matrix based on objective measurements of electromyography and trunk flexion on a large (n = 1285) prospective cohort, intensity of low-back pain (LBP) and odds of back injury at 1-year follow-up were modelled using linear models and logistic regressions, respectively. The cohort was divided into groups according to physical exposure; i.e. low (1st quartile), moderate (2nd and 3rd quartiles) and high (4th quartile) exposure.

RESULTS

Exposure profiles are provided for 9 groups of assistive devices, with ceiling lifts and intelligent beds eliciting the lowest physical exposure. In the fully-adjusted model, we report differences in LBP intensity at follow-up between the low and moderate exposure groups (p = 0.0085). No difference was found between the moderate and high exposure groups (p = 0.2967). Likewise, we find no associations between physical exposure and odds of back injury at 1-year follow-up, with a prevalence of 11, 13 and 11% for the three groups, respectively.

CONCLUSIONS

Low physical exposure during patient transfer was prospectively associated with lower intensity of LBP. Consistent use of assistive devices associated with low physical exposure, namely ceiling-lifts and intelligent beds, may play a role in reducing the incidence of MSDs among healthcare workers.

Biomechanical load during patient transfer with assistive devices: Cross-sectional study

This study utilised a cross-sectional design to perform measurements of muscle activity as well as forward - and lateral trunk inclination angle during a full workday among 52 female healthcare workers from 16 different departments at five Danish hospitals. Using linear mixed models, the 95th percentile ranks of the normalised root mean square (nRMS) values were analysed for the different types of assistive devices. Compared to no assistive device (mean nRMS 27.9%, 95% CI 24.8%-31.0%), the use of intelligent beds (23.9%, CI 20.2%-27.6%) and ceiling-lifts (24.0%, CI 20.3%-27.7%) led to lower erector spinae nRMS values across all types of patient transfers. Conversely, the use of bedsheets (30.6%, CI 27.1%-34.2%), sliding-sheets (30.3%, CI 26.8%-33.9%) and sliding-boards (33.5%, CI 29.5%-37.6%) were associated with higher levels of erector spinae muscle activity.Consistent use of ceiling-lifts and intelligent beds reduces the physical workload and may thereby decrease the risk of musculoskeletal disorders among healthcare workers. Practioner Summary: Frequent patient transfer is associated with an increased risk of back pain and injury among healthcare workers. This analysis compares the level of physical load during patient transfer with commonly used assistive devices. The results show that use of the ceiling-lift and intelligent bed is associated with relatively low physical load during patient transfer. Abbreviations: RMS: root mean square; nRMS: normalized root mean square; EMG: electromyography; MSD: musculoskeletal disorder; LBP: low-back pain; VAS: visual analogue scale; MVC: maximal voluntary contraction.

Musculoskeletal disorders in aged care workers: a systematic review of contributing factors and interventions

BACKGROUND

There is limited evidence on contributing factors and effective interventions for musculoskeletal injuries in aged care workers.

PURPOSE

To systematically review the factors that contribute to musculoskeletal disorder risk amongst workers in the aged care industry, and to undertake a qualitative comparison of the interventions designed and implemented to prevent injury within this workforce.

METHODS

A systematic review of the literature was conducted in Web of Science, Scopus, ProQuest, Medline, and PubMed. Relevant grey literature was also examined. Articles that reported factors that contribute to musculoskeletal injuries, or interventions to prevent and manage musculoskeletal injuries in residential aged care workers were included.

FINDINGS

Of the 864 articles and 35 grey literature publications found, 63 and 29 were included in the review respectively. Results indicate that physical factors such as manual handling of people, use of assistive devices, and physical work environment are most commonly associated with musculoskeletal disorders in this population. Limited evidence of organisational and psychosocial factors considered staffing issues, work schedules, and violence. The heavy emphasis on physical factors is echoed in the grey literature in relevant guidance material and codes of practice focused on assessment and control of risks. There was limited evidence for interventions specific to aged care; existing evidence focused on equipment, training and education, policy and procedure. Interventions incorporating a combination of approaches, such as equipment and training, showed promise while preliminary evidence of the effectiveness of participatory approaches are positive.

DISCUSSION

Interventions which address multiple types of contributing factors are needed to adequately prevent musculoskeletal injuries in aged care workers. Tweetable abstract: Review of contributing factors, interventions, and application of knowledge for work-related musculoskeletal injuries in aged care.

Effect of a brief progressive resistance training program in hospital porters on pain, work ability, and physical function

BACKGROUND

Hospital porters are possibly exposed to the greatest mechanical loads within the hospital environment. However, the evidence about preventive strategies in this population is scarce.

OBJECTIVE

To investigate the effect of a workplace-based progressive resistance-training program on musculoskeletal pain among hospital porters.

METHOD

A total of 37 hospital porters (27 women, 10 men) participated. Participants allocated to the intervention group performed five brief resistance training sessions/week, for 9 weeks during working hours at the hospital. Intensity was progressively increased. Participants allocated to the control group maintained their usual physical activity. The primary outcome was pain assessed with the patient global impression of pain change scale. Secondary outcome measures were average pain intensity, work ability, use of analgesics, and physical function. Additionally, perceived general changes were evaluated at follow-up: wellness, satisfaction at work, desire to exercise, motivation to eat healthy, energy to be with family and friends, and socialization with colleagues.

RESULTS

For the primary outcome, the intervention group showed lower general pain (p < 0.0001) and greater wellbeing (p < 0.0001), work satisfaction (p = 0.0048), desire for practicing exercise (p = 0.0007), and energy (p = 0.0474) compared with the control group. Significant between-group interactions were found for work impairment due to diseases (d = -1.2), hips/thighs pain (d = 0.7), ankles/feet pain (d = 0.4), the Biering-Sorensen test (d = -0.6) and the push-ups test (d = -2.3) favoring the intervention group. All between-group differences were clinically important.

CONCLUSION

A progressive resistance training program performed at the workplace is feasible and effective in reducing musculoskeletal pain and improving work ability and physical function among hospital porters.

Improving mental health of student and novice nurses to prevent dropout: A systematic review

Aims

To provide: (a) an overview of interventions aimed at improving mental health of student or novice nurses; and (b) an evaluation of their effectiveness on dropout‐related outcomes.

Design

Systematic review.

Data sources

Research papers published between January 1971–February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science, and Google Scholar.

Review methods

We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer‐reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout‐related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta‐analysis of studies was performed.

Results

We identified 21 studies with three areas of focus: managing stress or stressors (N = 4); facilitating the transition to nursing practice (N = 14); and a combined approach (N = 3). Five studies showed a statistically significant effect on dropout‐related outcomes. The overall risk of bias was high.

Conclusion

A wide range of interventions are available, but the evidence for their effectiveness is limited. There is a need for high‐quality studies in this field, preferably with a randomized controlled design.

Effective interventions for preventing work related physical health complaints in nursing students and novice nurses: A systematic review

From the start of their career, nursing students and novice nurses are at risk of developing physical health problems due to high physical workload, which may lead to early exit from nursing. To provide an overview of interventions preventing physical health problems in early career, a systematic review was performed. A comprehensive search of the literature was conducted up to December 2017. Primary outcome of interest was education/work dropout. Secondary outcomes were musculoskeletal symptoms. Independent authors selected studies, appraised quality and extracted data. After screening 7111 titles and abstracts, eleven studies were included. Seven studies evaluated interventions for moving/handling training. Four evaluated other interventions. None focused on our primary outcome education/work dropout. All studies reported on physical complaints among student nurses only. Overall, risk of bias was high and clinical heterogeneity prohibited pooling of data. Intervention effects were small and inconsistent. In conclusion, evidence for the effectiveness of interventions in the nursing curricula for the prevention/treatment of physical complaints is scarce and where available conflicting. We recommend high quality research on dropout due to physical health problems, as well as on the prevention/treatment of physical complaints.

Impacts of Manual Handling Training and Lifting Devices on Risks of Back Pain among Nurses: An Integrative Literature Review

Background: Musculoskeletal injuries, notably lower back injuries, are major occupational health problems among nurses. These injuries occur mainly due to incorrect use of body mechanics upon handling, lifting, and transfer of patients. It is the leading cause of occupational disability and is associated with increased healthcare costs. Reducing these injuries can lead to a significant reduction in healthcare costs.Purpose: This integrative literature review aims to examine the impacts of manual handling and lifting devices on the risk of back pain among hospital nurses.Methods: This study uses an integrative literature review design. Proquest, Science Direct, MEDLINE, and CINAHL were searched comprehensively. A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram was used to check the number of publications that were identified and screened for eligibility, and the number of publications excluded and reasons for exclusion. The Critical Appraisal Skills Programme (CASP) and the Centre for Evidence-Based Management critical appraisal checklist for a cross-sectional study (CEBM) were used to appraise the quality of selected articles.Results: Fifteen studies were found to highlight the importance of manual handling training programs and the consistent use of lifting devices in the prevention of low back pain. Ergonomics training, proper body mechanics and posture, use of body slings, workplace characteristics, availability of equipments and complexity of work, lost work days including nurses’ knowledge, experience, attitude and compliance are essential factors that impacts back pain.Conclusion: Manual handling training programs and the use of patient lifting equipment are effective in preventing lower back pain among nurses.

Sliding Sheet Use in Nursing Practice: An Intervention Study

Background: Previous studies have discovered that the utilization of sliding sheets in patient care is a valuable technique for repositioning bedridden patients compared with traditional cotton sheets or carriers. Our aim was to examine the effects of sliding sheet usage on work-related musculoskeletal disorders and disability, perceived workload, burnout, and job satisfaction, among nurses and nursing assistants. Method: This repeated measurement study included 41 female nurses and nursing assistants from three internal medicine departments who provided direct patient care. Participants completed an eight-part questionnaire (demographics, Neck Disability Index, Quick Disability of the Arms, Shoulder and Hand Questionnaire, Modified Oswestry Low Back Pain Disability Questionnaire, BackAche Disability Index workload, burnout, and job satisfaction) 4 times during the study period: 3 months prior to the intervention, on the first day of the intervention, and 3 and 6 months after commencement of the intervention. Findings: After 3 and 6 months of sliding sheet usage, pain and disability decreased in the neck ( p < .001); arms, shoulders, hands ( p = .041); and lower back ( p < .001), with an increase in job satisfaction ( p < .001). Discussion/Application to Practice: The findings of our study indicate a clear influence of reducing work-related musculoskeletal pain and disability while increasing job satisfaction when sliding sheets are introduced into nursing practice. Occupational health nurses in health care should consider this type of low-cost intervention as a method for reducing musculoskeletal injury among direct patient care providers.

Multifaceted intervention for the prevention and management of musculoskeletal pain in nursing staff: Results of a cluster randomized controlled trial

BACKGROUND

Nurses and nursing aides are at high risk of developing musculoskeletal pain (MSP). This study aimed to evaluate a multifaceted intervention to prevent and manage MSP in two hospitals.

MATERIAL AND METHODS

We performed a two-armed cluster randomized controlled trial, with a late intervention control group. Clusters were independent hospital units with nursing staff as participants. The intervention comprised three evidence-based components: participatory ergonomics, health promotion activities and case management. Both the intervention and the control group received usual occupational health care. The intervention lasted one year. MSP and work functioning data was collected at baseline, six and 12-month follow-up. Odds ratios (OR) and their 95% confidence intervals (95%CI) were calculated for MSP risk in the intervention group compared to the control group using logistic regression through GEE. Differences in work functioning between the intervention and control group were analyzed using linear regression through GEE. The incidence of sickness absence was calculated through logistic regression and Cox proportional hazard modeling was used to analyze the effect of the intervention on sickness absence duration.

RESULTS

Eight clusters were randomized including 473 nurses and nursing aides. At 12 months, the intervention group showed a statistically significant decrease of the risk in neck, shoulders and upper back pain, compared to the control group (OR = 0.37; 95%CI = 0.14-0.96). A reduction of low back pain was also observed, though non statistically significant. We found no differences regarding work functioning and the incidence and duration of sickness absence.

CONCLUSIONS

The intervention was effective to reduce neck, shoulder and upper back pain. Our results, though modest, suggests that interventions to prevent and manage MSP need a multifactorial approach including the three levels of prevention, and framed within the biopsychosocial model.

Physical and Psychosocial Work Environmental Risk Factors for Back Injury among Healthcare Workers: Prospective Cohort Study

The incidence of occupational back injury in the healthcare sector remains high despite decades of efforts to reduce such injuries. This prospective cohort study investigated the risk factors for back injury during patient transfer. Healthcare workers (n = 2080) from 314 departments at 17 hospitals in Denmark replied to repeated questionnaires sent every 14 days for one year. Using repeated-measures binomial logistic regression, controlling for education, work, lifestyle, and health, the odds for back injury (i.e., sudden onset episodes) were modeled. On the basis of 482 back injury events, a higher number of patient transfers was an important risk factor, with odds ratio (OR) 3.58 (95% confidence interval (CI) 2.51–5.10) for 1–4 transfers per day, OR 7.60 (5.14–11.22) for 5–8 transfers per day, and OR 8.03 (5.26–12.27) for 9 or more transfers per day (reference: less than 1 per day). The lack of necessary assistive devices was a common phenomenon during back injury events, with the top four lacking devices being sliding sheets (30%), intelligent beds (19%), walking aids (18%), and ceiling lifts (13%). For the psychosocial factors, poor collaboration between and support from colleagues increased the risk for back injury, with OR 3.16 (1.85–5.39). In conclusion, reducing the physical burden in terms of number of daily patient transfers, providing the necessary assistive devices, and cultivating good collaboration between colleagues are important factors in preventing occupational back injuries among healthcare workers.

Person transfer assist systems: a literature review

OBJECTIVE

Novel developments in the robotics field have produced systems that can support person wheelchair transfers, maximize safety and reduce caregiver burden. The purpose of this study was to identify and describe these systems, their usability (or satisfaction), the context for which they have been or can be used and how they have been evaluated to determine evidence for their effectiveness.

METHOD

Available research on Person Transfer Assist Systems (PTAS) was systematically gathered using similar standards to the PRISMA guidelines. The search terms were derived from common terms and via exploring similar review articles. Initial search terms displayed 1330 articles and by using the inclusion/exclusion criteria 96 articles were selected for abstract review. After full- text reviewing 48 articles were included.

RESULTS

29 articles concerned research in robotic transfer systems, 10 articles used both ceiling and floor-mounted lifts and 9 articles used only floor-mounted lifts as an intervention/control group. The results of this analysis identified a few usability evaluations for robotic transfer prototypes, especially ones comparing prototypes to existing marketed devices.

CONCLUSION

Robotic device research is a recent development within assistive technology. Whilst usability evaluations provided evidence that a robotic device will provide better service to the user, the sample number of subjects used are minimal in comparison to any of the intervention/control group articles. Experimental studies between PTASs are required to support technological advancements. Caregiver injury risk has been the focus for most of the comparison articles; however, few articles focus on the implications to the person.IMPLICATIONS FOR REHABILITATIONCeiling mounted lifts are preferred over floor-based lifts due to lower injury rates.Many robotic transfer systems have been developed; however, there is a paucity of quantitative and qualitative studies.Based on the results of this review, rehabilitation settings are recommended to use ceiling over floor assist systems, and it is recommended to provide training on using devices to assist with patient transfers to lower the risk of injuries.

Lateral Transfer Assist Robot (LTAR): Development of a proof-of-concept prototype

BACKGROUND

Falls during transfer to and from a wheelchair are associated with numerous problems. Factors responsible for difficulty in transferring include horizontal/vertical gaps between surfaces; obstacles, such as armrests; and complicated brake/footrests configurations before transferring. Moreover, controlling a wheelchair sufficiently close to the transfer surface within the confined home space is difficult.

OBJECTIVE

We described the design of the novel Lateral Transfer Assist Robot (LTAR) for solving problems during transfer. Furthermore, the effectiveness and usability of the robot were preliminary examined in healthy adults.

METHOD

The transfer problems and basic designs were organized. The effectiveness of the prototype was measured by three-dimensional motion analysis and questionnaire.

RESULTS

The prototype LTAR was developed. With just a push on a button, the footplate lowers to the floor and the seat and armrest lowers to the height of the seating surface to fill the gap between the surfaces. Using these features, users can transfer by simply shifting their buttocks sideways. Additionally, LTAR has omnidirectional wheels that help move it within a narrow space. The LTAR was confirmed to reduce the physical and subjective burden, except for maneuverability.

CONCLUSION

The LTAR was found to be effective for home use and reducing burden of transfer.

Evaluation of the effectiveness of the sliding sheet in repositioning care in terms of working time and subjective fatigue: A comparative study with an experimental design

BACKGROUND

Manual patient handling is a major cause of low back pain among healthcare staff. The sliding sheet is an assistive device designed to aid healthcare staff performing patient repositioning in bed. The use of sliding sheets in healthcare facilities is currently relatively rare because of the perceived additional time required compared with non-assisted handling. However, the details of the time difference between techniques and the barriers to the use of sliding sheets have not been examined in depth.

OBJECTIVES

We sought to evaluate differences in working time and subjective fatigue between the use of sliding sheets and non-assisted handling techniques for patient repositioning, in order to understand the factors preventing the use of sliding sheets among nurses.

DESIGN

We conducted a comparative study with an experimental design.

SETTINGS

The study was conducted in the nursing practice room at a university in Japan.

PARTICIPANTS

We recruited 30 pairs of nurses and care receivers. All nurses were under 60 years old, with experience in lateral turning and repositioning in the process of changing diapers in clinical settings. Those with a previous or current medical history of low back pain were excluded. Care receivers were older adults (65-80 years old). We excluded adults with bedsores, body mass index values >30, or restricted joint motion due to femoral trochanteric fracture or compression fracture. Thus, 27 pairs were included in the final analysis.

METHODS

The care receivers were instructed to behave as if they were bedridden patients with no limb movement, and as if they had contracture and difficulty communicating. Nurses repositioned the patient using three techniques assigned as interventions in random order: repositioning by one person using a sliding sheet (Sheet), repositioning by two people without a sliding sheet (Double), and repositioning by one person without a sliding sheet (Single). Working time was the primary endpoint for comparative analysis among the three technique conditions.

RESULTS

The results revealed that the Sheet technique required significantly more time than the non-assisted techniques. However, when total staff time was taken into consideration, the Sheet technique outperformed the Double technique. Moreover, the Sheet technique was associated with significantly lower levels of subjective fatigue, compared with the Double technique.

CONCLUSIONS

The use of a sliding sheet can substantially reduce caregiver burden when performing patient repositioning, and requires less staff time than manual techniques involving more than one caregiver.

Priority approaches of occupational safety and health activities for preventing low back pain among caregivers

Objectives

The incidence of occupational low back pain (LBP) is high among caregivers. The use of care equipment and training about care methods could prevent LBP among caregivers. However, in care facilities in Japan, these measures are not adequately employed. Moreover, the care facilities have faced issues regarding poor staffing in recent years. The present study investigated the relationship between LBP and occupational safety and health activities (OSHAs) for preventing LBP among caregivers and aimed to validate the priority approaches of OSHA.

Methods

This cross‐sectional study was conducted in care facilities for the elderly in Japan. Questionnaires for administrators and caregivers were distributed to 1,000 facilities and 5,000 caregivers, respectively. Questionnaires completed by 612 facilities and 2,712 caregivers were analyzed.

Results

No direct association was observed between severe LBP and OSHA, but indirect association was done. A significant relationship was noted between severe LBP and the care methods. Direct factors causing severe LBP were lifting a resident using human power and taking an unsuitable posture. These care methods were associated with the following OSHAs: promoting the use of care equipment, training about care methods, and consultation regarding the use of care equipment and employing an appropriate care method with the person in charge.

Conclusions

These OSHAs decreased lifting a resident using human power and taking an unsuitable posture, which are the primary risk factors of LBP. Therefore, these OSHAs should be implemented as priority approaches to prevent LBP among caregivers in care facilities for the elderly.

Paradoxical Impact of a Patient-Handling Intervention on Injury Rate Disparity Among Hospital Workers

OBJECTIVES

To test whether a comprehensive safe patient-handling intervention, which successfully reduced overall injury rates among hospital workers in a prior study, was differentially effective for higher-wage workers (nurses) versus low-wage workers (patient care associates [PCAs]).

METHODS

Data were from a cohort of nurses and PCAs at 2 large hospitals in Boston, Massachusetts. One hospital received the intervention in 2013; the other did not. Using longitudinal survey data from 2012 and 2014 plus longitudinal administrative injury and payroll data, we tested for socioeconomic differences in changes in self-reported safe patient-handling practices, and for socioeconomic differences in changes in injury rates using administrative data.

RESULTS

After the intervention, improvements in self-reported patient-handling practices were equivalent for PCAs and for nurses. However, in administrative data, lifting and exertion injuries decreased among nurses (rate ratio [RR] = 0.64; 95% confidence interval [CI] = 0.41, 1.00) but not PCAs (RR = 1.10; 95% CI = 0.74,1.63; P for occupation × intervention interaction = 0.02).

CONCLUSIONS

Although the population-level injury rate decreased after the intervention, most improvements were among higher-wage workers, widening the socioeconomic gap in injury and exemplifying the inequality paradox. Results have implications for public health intervention development, implementation, and analysis.

Effect of physical exercise on musculoskeletal pain in multiple body regions among healthcare workers: Secondary analysis of a cluster randomized controlled trial

BACKGROUND

While physical exercise is beneficial for back and neck-shoulder pain, only few intervention studies have evaluated effects on pain in multiple body regions. Furthermore, direct measurement of pain threshold can provide additional information to self-reported pain intensity.

OBJECTIVES

To evaluate the effect of workplace versus home-based physical exercise on pressure pain threshold (PPT) and musculoskeletal pain intensity in multiple body regions.

STUDY DESIGN

Secondary analysis of an examiner-blinded, cluster randomized controlled trial with allocation concealment.

METHOD

Two-hundred female healthcare workers from 18 departments at three hospitals were cluster-randomized to 10 weeks of: 1) home-based physical exercise (HOME) performed alone during leisure time for 5 × 10 min per week or 2) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 min per week and up to 5 motivational coaching sessions. PPT (neck, lower back, lower leg) and perceived pain intensity in multiple body regions (feet, knee, hips, lower and upper back, elbow, hand, shoulder, neck, and head) were measured at baseline and 10-week follow-up.

RESULTS

In some of the body regions, PPT and pain intensity improved more following WORK than HOME. Between-group differences at follow-up (WORK vs. HOME) were 41 kPA [95% CI 13-70, effect size (ES): 0.22] for PPT in the lower back, and -0.7 [95% CI -1.0-0.3, ES: 0.26] and -0.6 points [95% CI -0.9--0.2, ES: 0.23] for pain intensity in the lower back and feet, respectively. HOME did not improve more than WORK for any of the measurements.

CONCLUSION

Physical exercise recommendations for healthcare workers should consider the setting, i.e. performing supervised group-based exercise at work and motivational coaching sessions is more effective than exercising alone at home.

Patient Transfers and Risk of Back Injury: Protocol for a Prospective Cohort Study With Technical Measurements of Exposure

Background

More than one third of nurses experience musculoskeletal pain several times during a normal work week. Consistent use of assistive devices during patient transfers is associated with a lower risk of occupational back injuries and low back pain (LBP). While uncertainties exist regarding which type of assistive devices most efficiently prevent LBP, exposure assessments using technological advancements allow for quantification of muscle load and body positions during common work tasks.

Objective

The main objectives of this study are (1) to quantify low back and neck/shoulder muscle load in Danish nurses during patient transfers performed with different types of assistive devices, and (2) to combine the exposure profile for each type of assistive device with fortnightly questionnaires to identify the importance of muscle load (intensity and frequency of transfers) and body position (degree of back inclination and frequency) on LBP intensity and risk of back injury during a patient transfer.

Methods

A combination of technical measurements (n=50) and a prospective study design (n=2000) will be applied on a cohort of female nurses in Danish hospitals. The technical measurements will be comprised of surface electromyography and accelerometers, with the aim of quantifying muscle load and body positions during various patient transfers, including different types of assistive devices throughout a workday. The study will thereby gather measurements during real-life working conditions. The prospective cohort study will consist of questionnaires at baseline and 1-year follow-up, as well as follow-up via email every other week for one year on questions regarding the frequency of patient transfers, use of assistive devices, intensity of LBP, and back injuries related to patient transfers. The objective measurements on muscle load and body positions during patient handlings will be applied to the fortnightly replies regarding frequency of patient transfer and use of different assistive devices, in order to identify risk factors for back injuries related to patient transfers and intensity of LBP.

Results

Data collection is scheduled to commence during the winter of 2017.

Conclusions

The design of this study is novel in its combination of technical measurements applied on a prospective cohort, and the results will provide important information about which assistive devices are associated with intensity of LBP and risk of back injury related to patient transfers. Furthermore, this study will shed light on the dose-response relationship between intensity, duration, and frequency of patient transfers and the intensity of LPB in Danish nurses, and will thereby help to guide and improve electronic health practices among this population.

Predictors of low back pain in nursing home workers after implementation of a safe resident handling programme

OBJECTIVES

Healthcare workers have high rates of low back pain (LBP) related to handling patients. A large chain of nursing homes experienced reduced biomechanical load, compensation claims and costs following implementation of a safe resident handling programme (SRHP). The aim of this study was to examine whether LBP similarly declined and whether it was associated with relevant self-reported occupational exposures or personal health factors.

METHODS

Worker surveys were conducted on multiple occasions beginning with the week of first SRHP introduction (baseline). In each survey, the outcome was LBP during the prior 3 months with at least mild severity during the past week. Robust Poisson multivariable regression models were constructed to examine correlates of LBP cross-sectionally at 2 years (F3) and longitudinally at 5-6 years (F5) post-SRHP implementation among workers also in at least one prior survey.

RESULTS

LBP prevalence declined minimally between baseline and F3. The prevalence was 37% at F3 and cumulative incidence to F5 was 22%. LBP prevalence at F3 was positively associated with combined physical exposures, psychological job demands and prior back injury, while frequent lift device usage and 'intense' aerobic exercise frequency were protective. At F5, the multivariable model included frequent lift usage at F3 (relative risk (RR) 0.39 (0.18 to 0.84)) and F5 work-family imbalance (RR=1.82 (1.12 to 2.98)).

CONCLUSIONS

In this observational study, resident lifting device usage predicted reduced LBP in nursing home workers. Other physical and psychosocial demands of nursing home work also contributed, while frequent intense aerobic exercise appeared to reduce LBP risk.

Barriers to the Use of Assistive Devices in Patient Handling

Work-related musculoskeletal disorders (WMSD) are a major safety concern in today’s health care environment due to the manual lifting of patients with higher acuity levels and obesity. Nurses move patients multiple times each day, incurring cumulative stress and trauma resulting in chronic pain and potential injury. The purpose of this study was to assess barriers to the use of assistive devices in safe patient handling and mobility (SPHM) that contribute to WMSD in health care workers. Interpersonal, situational, organizational, and environmental influences have both direct and indirect effects on workers’ commitment to use, or their actual likelihood of using, assistive devices. This study confirmed that time constraints contribute to fewer instances of assistive device use. Comprehensive ergonomic programs are needed to promote staff and patient safety. By providing safe environments for health care workers who engage in patient handling and mobility, the risk of injury can be significantly reduced.

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.

Low back pain among nurses in Slovenian hospitals: cross-sectional study

AIM

The study investigated the prevalence and factors predicting low back pain among nurses in Slovenian hospitals.

BACKGROUND

The risk factors for low back pain are physical and psychosocial. Implementation of interventions for reducing low back pain calls for management support, accessible equipment, education, knowledge and risk assessment.

INTRODUCTION

Low back pain prevalence and incidence among healthcare workers is very high compared to the general population and is a strong risk factor for long-term sickness absence.

METHODS

A cross-sectional study design was utilized. We used validated instruments: Nordic Musculoskeletal Disorder Questionnaire, Stanford Presenteeism Scale and Perceived Stress Scale. The sample included 1744 nursing employees from 16 Slovenian hospitals, ranging from practical nurses, registered nurses, nurses with a bachelor's degree and those with a master's degree.

FINDINGS

Results revealed a prevalence of low back pain among 85.9% of respondents. Relevant risk factors included female gender, age, length of employment, years in current position, shift work and the number of nurses per shift. In the regression model, factors predicting low back pain included presenteeism with a negative effect on work, presenteeism and maintaining work productivity, inability to control daily life, number of nurses per shift and respondents' age.

CONCLUSIONS

Future activities should be oriented towards eliminating or reducing risks for low back pain incidents and towards different strategies, guidelines and actions which empower individuals and provide knowledge to manage and prevent low back pain.

IMPLICATIONS FOR MANAGEMENT AND HEALTH POLICY

Slovenian healthcare system planning needs a national strategy to successfully promote LBP preventive and controlling strategies. Management can plan preventive and curative measures to reduce low back pain prevalence among nursing personnel. Management should also implement policies reflecting research findings.

A multi-component patient-handling intervention improves attitudes and behaviors for safe patient handling and reduces aggression experienced by nursing staff: A controlled before-after study

This study evaluated an intervention for patient-handling equipment aimed to improve nursing staffs' use of patient handling equipment and improve their general health, reduce musculoskeletal problems, aggressive episodes, days of absence and work-related accidents. As a controlled before-after study, questionnaire data were collected at baseline and 12-month follow-up among nursing staff at intervention and control wards at two hospitals. At 12-month follow-up, the intervention group had more positive attitudes towards patient-handling equipment and increased use of specific patient-handling equipment. In addition, a lower proportion of nursing staff in the intervention group had experienced physically aggressive episodes. No significant change was observed in general health status, musculoskeletal problems, days of absence or work-related accidents. The intervention resulted in more positive attitudes and behaviours for safe patient-handling and less physically aggressive episodes. However, this did not translate into improved health of the staff during the 12-month study period.

Factors affecting pain relief in response to physical exercise interventions among healthcare workers

The aim of this study is to identify factors associated with musculo-skeletal pain reduction during workplace-based or home-based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0-10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed alone during leisure-time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi-adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure-time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home-based exercise in reducing musculo-skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo-skeletal pain.

Participatory organizational intervention for improved use of assistive devices for patient transfer: study protocol for a single-blinded cluster randomized controlled trial

Background

Epidemiological studies have shown that patient transfer is a risk factor for back pain, back injuries and long term sickness absence, whereas consistent use of assistive devices during patient transfer seems to be protective. While classical ergonomic interventions based on education and training in lifting and transferring techniques have not proven to be effective in preventing back pain, participatory ergonomics, that is meant to engage and motivate the involved parties while at the same time making the intervention maximally relevant, may represent a better solution. However, these findings are largely based on uncontrolled studies and thus lack to be confirmed by studies with better study designs. In this article, we present the design of a study which aims to evaluate the effect and process of a participatory organizational intervention for improved use of assistive devices.

Methods

The study was performed as a cluster randomized controlled trial. We recruited 27 departments (clusters) from five hospitals in Denmark to participate in the study. Prior to randomization, interviews, observations and questionnaire answers (baseline questionnaire) were collected to gain knowledge of barriers and potential solutions for better use of assistive devices. In April 2016, the 27 departments were randomly allocated using a random numbers table to a participatory intervention (14 clusters, 324 healthcare workers) or a control group (13 clusters, 318 healthcare workers). The participatory intervention will consist of workshops with leaders and selected healthcare workers of each department. Workshop participants will be asked to discuss the identified barriers, develop solutions for increasing the use of assistive devices and implement them in their department. Use of assistive devices (using digital counters -, primary outcome, and accelerometers and questionnaire - secondary outcome), perceived physical exertion during patient transfer, pain intensity in the lower back, occurrence of work-related back injuries during patient transfer, organizational readiness to change, knowledge on how to perform proper patient transfer, social capital and work ability (secondary outcomes) were assessed at baseline and will also be assessed at 1 year follow-up. Process evaluation will be based on qualitative and quantitative data to assess the implementation, the change process, and the impact of context aspects.

Discussion

The study will evaluate the effect and process of a participatory intervention on improving the use of assistive devices for patient transfer among hospital healthcare workers. By using cluster-randomization, as well as process- and effect evaluation based on objective measures we will contribute to the evidence base of a promising intervention approach.

Trial registration

ClinicalTrials.gov (NCT02708550). March, 2016.