Staff Low Back Injury Risk During Assisted Falls Virtual Reality Simulations

Abstract

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.

Original Research: What Health Care Staff Who Experienced Assisted Patient Falls Can Teach Us: Implications for Fall and Fall Injury Risk

“…A related assisted falls project used virtual reality simulations of patient falls to test staff risks for lower back injury, and found that staff members remained at risk for such injury despite using ergonomic techniques. 4 Taken together, this project's findings may support the conclusion reached by others that assisted falls can decrease patient injury risk, 2,8,32 with the added understanding that staff injury risk may increase. These findings have important implications for staff guidance on assisted falls, but further research is…”

“…The findings further demonstrate the complicated influence of individual staff members' perceptions on this topic, with some continuing to view assisted falls as safe, even when they had experienced injury in the past. A related assisted falls project used virtual reality simulations of patient falls to test staff risks for lower back injury, and found that staff members remained at risk for such injury despite using ergonomic techniques 4…”

“…2,3 But other research suggests that assisted falls may contribute to occupational injuries among staff, especially musculoskeletal injuries. 4 While there is a body of literature on the risk to staff during other forms of patient handling such as lifts and transfers, 5, 6 scant research exists concerning patient and staff injury outcomes specifically related to assisted falls. Thus, there is limited evidence-based guidance to help staff assess the risks of assisting falling patients.…”

“…Several secondary data analyses have demonstrated that, compared to unassisted falls, assisted falls are associated with reduced patient injury and injury severity 2, 3. But other research suggests that assisted falls may contribute to occupational injuries among staff, especially musculoskeletal injuries 4. While there is a body of literature on the risk to staff during other forms of patient handling such as lifts and transfers,5, 6 scant research exists concerning patient and staff injury outcomes specifically related to assisted falls.…”