With an aging population there is a growing need to assist people with disabilities. Particularly crucial is assisting people who cannot stand between positions necessary for everyday living, such as from a wheelchair to the toilet. It is unsafe to transfer people with direct manual techniques, thus a patient handling device is required. To reduce the burden on the healthcare system it is beneficial for disabled people to be cared for in-home. Many in-home caregivers may be physically impaired, thus patient handling devices for this use must require as little effort as possible. This thesis found that existing manual patient handling devices contained significant weaknesses when used for in-home care and there is potential to improve upon them. Expert interviews, computer modelling and physical models were used to develop a novel patient handling device which addresses these identified weaknesses. A reduction in the number of operator tasks, operation time and operation force was achieved. A method of supporting the patient solely by their upper body is required by the novel patient handling device, though an acceptable way of incorporating this has yet to be achieved. Testing of an upper body enclosure support revealed that a person may be supported by their lower thorax without substantial clamping or physical effort from the patient. Such a support has potential to be developed into an acceptable solution. Further development and testing in variable conditions encountered during practical patient handling is required.

Redundancy and variation are characteristics of humans. Many muscles contribute to producing a movement at a joint, allowing different strategies for task performance. Further, the shoulders and back are involved in many tasks, including manual materials handling, but flexibility as to their relative roles in performing a task exists. In nursing, where manual patient handling (MPH) occurs daily, a risk of injury exists resulting from interactions with patients that may require awkward postures or sudden shifts in hand forces. Although some recommended MPH techniques have been advocated, many focus on lowering the risk of low back injury, without considering the effect of these techniques on other body regions. This study aimed to identify differences in shoulder and back physical exposures between performing self-selected and recommended patient handling techniques designed to reduce low back exposures. Twenty female participants performed three repetitions of five manual patient handling tasks using a self selected technique, followed by three repetitions of the same tasks using techniques learned in an interposed training session. Peak, mean and cumulative muscle activity, peak resultant moment, and ratings of perceived exertion were compared for each of the tasks before and after training, as well as identifying meaningful changes between the joints in mean population strength using a static strength prediction program. Significant decreases occurred at both the left and right shoulders and the low back for most measures, generally supporting the recommended techniques. Important exceptions existed, however, for the Sit-to-Chair tasks and Turn Toward tasks, where increases in several individual shoulder muscle activities, along with peak resultant moment, existed. Future recommendations for patient handling techniques should take into account potential negative exposures at the shoulders that may result from a back-centric injury avoidance paradigm.

Redundancy and variation are characteristics of humans. Many muscles contribute to producing a movement at a joint, allowing different strategies for task performance. Further, the shoulders and back are involved in many tasks, including manual materials handling, but flexibility as to their relative roles in performing a task exists. In nursing, where manual patient handling (MPH) occurs daily, a risk of injury exists resulting from interactions with patients that may require awkward postures or sudden shifts in hand forces. Although some recommended MPH techniques have been advocated, many focus on lowering the risk of low back injury, without considering the effect of these techniques on other body regions. This study aimed to identify differences in shoulder and back physical exposures between performing self-selected and recommended patient handling techniques designed to reduce low back exposures. Twenty female participants performed three repetitions of five manual patient handling tasks using a self selected technique, followed by three repetitions of the same tasks using techniques learned in an interposed training session. Peak, mean and cumulative muscle activity, peak resultant moment, and ratings of perceived exertion were compared for each of the tasks before and after training, as well as identifying meaningful changes between the joints in mean population strength using a static strength prediction program. Significant decreases occurred at both the left and right shoulders and the low back for most measures, generally supporting the recommended techniques. Important exceptions existed, however, for the Sit-to-Chair tasks and Turn Toward tasks, where increases in several individual shoulder muscle activities, along with peak resultant moment, existed. Future recommendations for patient handling techniques should take into account potential negative exposures at the shoulders that may result from a back-centric injury avoidance paradigm.

In a 1994 survey, on incidence rates of musculoskeletal injuries among private industries within the U.S, nurses ranked first nationally. Patient handling tasks are considered to be a precipitating factor in the development of many musculoskeletal injuries. For many decades personnel training has been an intervention widely used for the nursing back problem. Inconsistency regarding the effectiveness of many personnel training programs, lack of controlled research among existing studies, and a primary focus only on long term reduction of injury rates makes the interpretation of the success of personnel training programs a difficult one. This study is based on the assumption that, if a training program is to be effective as a means of reducing musculoskeletal injuries, it must first modify worker behaviors and biomechanical stresses to a measurable degree. This research investigated the effects of training (Video and Lecture/Practice) on modifying working behaviors and biomechanical stress. Two tasks were examined (wheelchair to bed and lift up in bed) with two types of assistance (one-person or two-person) and two levels of patient's dependence (semi-dependent or dependent). Changes in behaviors were examined immediately following training (1-2 days delay) and after a short period of time (4-6 weeks) and evaluated using the criteria of subjective ratings of exertion, and postural and biomechanical measures. Results indicated that training led to several significant changes in the knee, hip, elbow and torso angles, whole body, shoulders and low back RPE, shear forces and shoulder moments. No differences were observed in these measures after a short period of time, suggesting retention of the information presented during the training programs. Results as a whole suggest that training can positively affect the working postures and biomechanical stress during common patient handling tasks. All the postural changes and biomechanical measures were advantageous in terms of reducing musculoskeletal stress. It was also found that after a short period of time (4-6 weeks) still retained the information presented during the training programs. Training using a combination of lecture and practice in some cases achieved better results than Video-based training. / Master of Science

Background: Healthcare workers are ranked among one of the top occupations for musculoskeletal disorder (MSD) injuries that affect the muscles, the bones, the nervous system and due to repetitive motion tasks (Centers for Disease Control and Prevention, 2017). Numerous high-risk patient handling tasks such as lifting, transferring, ambulating and repositioning of patients cause injuries that can be prevented when evidence-based solutions are used for safe patient handling and mobility (SPHM) tasks. Purpose: The purpose of this quality improvement project was to evaluate the knowledge and attitudes of orthopedic nurses regarding the use of SPHM algorithms as the standard of care when transferring patients. Theoretical Framework. Lewin’s Theory of Change Methods. A quasi-experimental pretest-post-test design was utilized in this evidenced-based practice project. Results. Descriptive statistics that evaluated pre and post questionnaires of the orthopedic nurses noted nurses displayed behavioral and attitudinal intent to use the SPHM algorithms as the standard of care to improve patient outcomes by decreasing falls. Although the behavioral beliefs and attitudes reflected acknowledgement of SPHM skills and knowledge, nursing did not improve in their documentation of SPH fall risk as two separate tools were required on each patient. Conclusions: SPHM evidenced-based standards do guide staff to critically examine how to safely transfer and mobilize a patient. Patient fall rates did decrease during educational sessions, prompting the need for on-going education of all staff on the unit that transfers patients. The findings from this quality project may encourage future practice approaches to use of the safe patient handling (SPH) fall risk assessment tool for all patients to prevent patient falls.

BACKGROUND: Healthcare workers are among the most injured workers in the United States. This is due to the high rate of patient handling. The low back is the most injured in this population. This study observed biomechanical factors and how these factors affect low back and ground reaction forces. This study further investigated pain and its relationship to low back force, multifidus cross-sectional area, and multifidus activation in healthcare workers. METHODS: The 45 participants included 10 healthy subjects in the preliminary study and 35 active healthcare workers in the main study. Subjects filled out the VAS to determine current pain level. Ultrasound images of the multifidus muscles were taken. The participants were fitted with reflective markers and surface EMG sensors. A series of patient transfers at various bed heights using three different transfer devices was undertaken. The transfer devices included a Cotton sheet, a Skil-Care™ Transfer Sling, and an AirPal® device. RESULTS: There was a downward trend in resultant low back force when comparing lower bed heights to higher. Therefore, the highest bed position was determined to be optimal. There were significant differences in low back force between self-chosen and optimal bed heights among healthcare workers. There was no significant difference between peak low back or ground reaction forces between pain and nonpain groups. There was a significant difference in multifidus cross-sectional area between these groups at S1, a trend toward significance at L5, and no difference at L4. There was a trend toward significance when comparing multifidus activation between these groups as recorded by surface EMG. CONCLUSIONS: Healthcare workers should choose higher bed heights and appropriate equipment to reduce low back force and those who have smaller multifidus have more pain.

No description available.

Work-related musculoskeletal disorders (WMSDs) are prevalent among health care workers worldwide and underreporting among nurses may mask the true impact of these injuries. Nursing staff are consistently among the top 10 occupations at risk for experiencing WMSDs and patient-handling tasks are the precipitating event in the majority of back injuries experienced among nursing staff. Existing research has focused on patient-handling issues within long-term care facilities, and identifying physically demanding patient-handling tasks. The first study in this dissertation (Chapter 3) was conducted to determine whether nurses in acute care facilities are exposed to the same hazards as their cohorts in long-term care. The aim was to identify the top 10 patient-handling tasks being conducted and to rank these tasks by perceived physical demand. This two-phase study consisted of a procedural task analysis of patient-handling activities, and a questionnaire to identify the characteristics of the study population and obtain a ranking of physically demanding patient-handling tasks. All nurses providing direct inpatient care were recruited to participate in both phases of this study. Compared to long-term care facilities, in which the majority of tasks have been shown to be associated with performance of ADL tasks, the most frequently observed tasks in the acute care facility were repositioning tasks. Therefore, it is important to determine the patient-handling demands and needs that are unique to each type of healthcare facility. Generalizing across facilities or units may lead to incorrect assumptions and conclusions about physical demands being placed on nurses. A laboratory simulation was used for the second study (Chapter 4). The top four physically demanding patient-handling tasks (taken from Chapter 3) were simulated to determine the effect of an assistive device and assistance from another person. Sixteen nurse volunteers were recruited and provided perceptual responses regarding exertion and injury risk. Nurses perceived that assistance decreased their physical exertion and injury risk; however they consistently perceived exertion to be relatively higher than their injury risk. The aim of the third study (Chapter 5) was to determine the level of agreement between and within different expert groups. Three groups of participants were involved, with different levels of ergonomics expertise (i.e. researchers, consultants, and graduate students). These groups viewed digitized video clips from the laboratory simulation (Chapter 4) and provided ratings of perceived exertion, perceived injury risk and common WMSD risk factors (effort, posture, and speed). The major finding from this study was that poor agreement existed between nurses and the other expert groups (researchers, consultants and students). The current research laid the groundwork for measuring the magnitude of physical exposure to injury risk in the patient-handling environment. The research supports earlier evidence that suggests nurses underreport their discomfort and injury, which, in turn, contributes to increased exposure and risk. This knowledge will enable practitioners to focus interventions and designs on those factors in the work environment that contribute significantly to increased exposure and thereby more effectively reduce WMSD risk. / Ph. D.

Remote area staff performing manual patient handling tasks in the absence of patient lifting hoists available in most health care settings are at an elevated risk of musculoskeletal injuries. The objective of this project was to identify the patient handling methods that have the lowest risk of injury. The patient handling task of lifting a patient from floor to a chair or wheelchair is a common task performed in a remote health care setting. The task was performed utilising three methods, these being: (1) heads/tails lift, (2) use of two Blue MEDesign?? slings and (3) use of a drawsheet. The task of the heads/tails lift was broken down into two distinctly separate subtasks: lifting from the (1) head and (2) tail ends of the patient load. These techniques were selected based on criteria including current practice, durability, portability, accessibility, ease of storage and cost to supply. Postural data were obtained using a Vicon 370 three - dimensional motion measurement and analysis system in the Biomechanics & Gait laboratory at the University of New South Wales. Forty reflective markers were placed on the subject to obtain the following joint angles: ankle, knee, hip, torso, shoulder, elbow, and wrist. The raw data were converted into the respective joint angles (Y, X, Z) for further analysis. The postural data was analysed using the University of Michigan???s Three-Dimensional Static Strength Prediction Program (3D SSPP) and the relative risk of injury was based on the following three values: (1) a threshold value of 3,400 N for compression force, (2) a threshold value of 500 N for shear force, and (3) population strength capability data. The effects on changes to the anthropometric data was estimated and analysed using the in-built anthropometric data contained within the 3D SSPP program for 6 separate lifter scenarios, these being male and female 5th, 50th and 95th percentiles. Changes to the patient load were estimated and analysed using the same computer software. Estimated compressive and shear forces were found to be lower with the drawsheet and tail component of the heads/tails lift in comparison to the use of the Blue MEDesign?? straps and head component of the heads/tails lift. The results obtained for the strength capability aspect of each of the lifts indicated a higher percentage of the population capable of both the drawsheet and tail end of the heads/tails lift. The relative risk of back injury for the lifters is distributed more evenly with the drawsheet lift as opposed to the heads/tails (tail) lift where risk is disproportionate with the heavier end being lifted. The use of lifter anthropometrics does not appear to be a realistic variable to base assumptions on which group of the population are capable of safely performing this task in a remote setting. This study advocates the use of the drawsheet lift in a remote setting based on the author???s experience and the biomechanical results obtained in this study. The drawsheet lift is both more accessible and provides a more acceptable risk when more than two patient handlers are involved, in comparison to the other lifts utilised lifting patients from floor to a chair.

Problem Statement: The burden of musculoskeletal injuries among workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results. Strong evidence for intervention effectiveness is lacking.<p> Specific Aims: The goal of this study was to evaluate the effectiveness of a patient handling injury prevention program implemented in the Saskatoon Health Region (SHR) comparing it with a non-randomized control group, Regina QuAppelle Health Region (RQHR), in a pre-post design. Injury rates, lost-time days, and claim costs were the outcomes of interest.<p> Intervention: A Transfer, Lifting and Repositioning (TLR) program, consisting of engineering and administrative ergonomic controls, was implemented in SHR hospitals from 2002-2005.<p> Methods: Data on time loss and non-time loss injuries, lost time days, and claims costs were collected from the SHR and RQHR for corresponding time periods one year pre and one year post-intervention. Age, length of service, profession, and sex were selected as covariates. Full Time Equivalents (FTE) data were collected for each time period. Univariate and multivariate Poisson regression were performed.<p> Results: Rates for all injuries (number of injuries/100 FTE) dropped from 14.68 pre-intervention to 8.1 post-intervention. Control group all injury rates, while overall lower in absolute value, dropped to a lesser degree, from 9.29 to 8.4. Time loss injury rates decreased from 5.3 to 2.51 in the SHR, while they actually increased from 5.87 to 6.46 in the RQHR, for the same intervention periods. Poisson regression showed the greatest reduction in injury rate, both time loss (Rate ratio=0.48, 95% C.I: 0.34-0.68) and non-time loss (Rate Ratio=0.25, 95% C.I: 0.15-0.41) in the smaller long term care facility controlling for hospital size. Analysis of injury rates, incidence rate ratios, and incidence rate differences showed significant differences between the intervention and comparison group for all injuries and time loss injuries. Mean claim cost/injury decreased from $3906.20 to $2200.80 and mean time loss days/claim decreased from 35.87 days to 16.23 days for the SHR.<p> Conclusions: The study provides evidence for the effectiveness of a multi-factor TLR program for direct-care health workers, and emphasizes their implementation, especially in smaller hospitals.