The Mechanical Loads on the Low Back during Different Patient Handling Tasks

Abstract

High prevalence rate of low back disorders (LBD) is found among nursing personnel. To get a more detailed knowledge concerning the risk factor in the health care sector, the working postures and the mechanical load of the low back were measured during nine commonly used patient handling tasks. Further the variation in the load between the different tasks was compared with the variation between subjects when they perform the same tasks. The study includes 10 female nurses with no special education or course in patient handling technique and a male stroke patient. The load during the different tasks were quantified from the net moment at L4/L5 joint calculated by use of a 3D biomechanical dynamic multi-segment model, the measured muscle activity (EMG) in erector spinae muscles and the kinematics of the low back. Significant differences in the mean values for all the dependent variable both between tasks and between subjects were found. The highest moment was found during the two tasks typically involving a lifting procedure of the whole bodyweight of the patient. High moment was however also found during tasks where the patient is “only” being repositioned in the bed. The position data measured for the low back are more difficult to interpret since no recommendations for limits are available in the literature. A high intersubject variation is found for all the outcome variables for a given task. This emphasizes the importance of an exposure assessment including individual measures. Otherwise, the risk for misclassification may be high and a detailed task description less effective for recommending prevention strategy.

Evidence-Based Practices for Safe Patient Handling and Movement

“…For example, in geriatric, long-term care settings, over 19 stressful tasks have been identified. These tasks focus primarily on vertical transfers of patients, repositioning patients in bed and chairs, and toileting tasks (Bell, Dalgity, Fennell, & Aitken, 1979;Garg & Owen, 1992;Hui, Ng, Yeung, & Hui-Chan, 2001;Owen, 1987;Owen, Keene, Olson, & Garg, 1995;Schibye & Skotte, 2000;& Smedley, Egger, Cooper, & Coggon, 1995). Many of these same tasks are also apparent in acute care settings (Owen, Keene, & Olson, 2000), where additional high-risk tasks include transferring patients on and off stretchers, repositioning a patient in bed, and patient transport in a bed or stretcher.…”

Harmful Effects in Personal Assistants´ Client Transfer Situations

“…There were also risks of harmful effects in the neck, "yellow flags" were noted according to AFS 1998:1 [15] for all eight personal assistants. An earlier study has confirmed high biomechanical load when transferring clients from sitting to [8]. It has been shown that the use of transfer equipment can reduce the risk for musculoskeletal symptoms and disorders in such situations [3,5].…”

“…A good transfer technique reduces the physical strain and risk for harmful effects by the client's active cooperation in the situation [7]. It is possible to learn and practice a correct transfer technique, which has been shown to reduce neck and back strain [7,8]. Supervisors within home care organizations have to offer the staff education and practice in transfer techniques [1].…”

“…There is an increased risk of harmful effects on the body when moving a patient in bed manually, when transferring a client from bed to wheelchair and when lifting a client from the floor [8,10]. To lift a patient by a shoulder-grip implies a high physical strain on the home care assistant [5].…”

“…In summary, earlier research concerning patent transfer have shown that the most harmful situations are to transfer a client from lying to sitting in bed and from sitting in bed to sitting in a wheelchair [5,8,10,11]. Therefore, these work situations need to be further studied.…”