Transfer of the horizontal patient: the effect of a friction reducing assistive device on low back mechanics

Recognizing that the transfer of bedridden patients is associated with a high rate of low back injuries, various devices have been developed to assist with sparing the patient handlers. The purpose of this study was to quantify the friction-reducing ability of three different 'sliding' patient transfer devices together with the subsequent consequences on the low back loads of people performing the transfers. Coefficients of friction of the devices were determined by 'transferring' a standard object and a 'patient' over several surfaces common to a hospital setting. Then three participants performed controlled transfers with the various devices. Electromyography to measure muscle activation levels together with external forces and kinematic positional data were collected during push, pull and twist transfers. Spine loads were estimated with a three-dimensional biomechanical static link-segment model of the human body. Simply sliding a patient on a cotton sheet (control condition) produced a coefficient of friction of 0.45. The assistive devices substantially reduced friction by well over one-half (coefficients of 0.18 - 0.21). However, when using the devices the subjects adopted a variety of postures and techniques, such that there were no consistent influences on trunk inclination, low back compression or muscle activation profiles. Direct measurement of reduced friction between the bed and the patient with a friction-reducing device together with measurement of the back loads when actually transferring a patient formed a proof of principle. Specifically, while the device lowers friction, the transfer technique adopted by the lifter must be proper to reduce low back loading and any subsequent risks of back troubles associated with patient transfers. The direction of hand forces and torso position remains important.     

Effects of low back disability status on lower back discomfort during sustained and cyclical trunk flexion

A laboratory study was conducted to determine the effects of back disability status on endurance time and perceived discomfort during trunk flexion. Eighty participants (40 with chronic or recurrent low back pain (CRLBP), 40 pain-free) were tested. The trunk was flexed to 15°, 30°, 45° and 60° under three conditions: 1) continuous static flexion; 2) cyclical flexion with 20% rest; and 3) cyclical flexion with 40% rest. Each condition was performed for up to 600?s or until the participant reached his/her pain tolerance limit. Dependent variables included time to distracting discomfort (TDD), total endurance time (TET) and perceived discomfort. For continuous exertions, CRLBP participants had lower TDD (p?<?0.001), lower TET (p?<?0.001) and greater discomfort (p?<?0.001) compared to pain-free controls. In both groups, TDD and TET decreased and perceived discomfort increased as the flexion angle increased. For intermittent exertions, CRLBP participants reported greater discomfort than pain-free participants (p?<?0.001). Increasing rest from 20 to 40% reduced discomfort in CRLBP participants, but produced no consistent benefit in pain-free participants. To accommodate persons with CRLBP, consideration should be given to reducing both the magnitude (angle) and duration of trunk flexion required by their jobs.     

The effects of job rotation on the risk of reporting low back pain

Job rotation has been widely recommended as an administrative control to reduce the risk of developing work-related musculoskeletal disorders. However, evidence of its benefits are hard to find in the literature. The effect of job rotation on predictions for the risk of reporting low back pain was estimated using Low Back Pain Reporting (LBPR) and Time Weighted Average (TWA) approaches. Index scores calculated using the peak hand force, the peak L4/L5 shear force and the L4/L5 moment cumulated over the entire shift were used to estimate the effects of job rotation on the probability of reporting low back pain. Simulations of realistic rotations between two jobs showed that workers in low demand jobs who rotate into higher demand jobs experience a linear increase in reporting probability using the TWA approach. With the LBPR approach a step increase in reporting probability occurred because of the immediate exposure to the peak loading parameters associated with the more demanding job. With a 50-50 rotation the TWA and LBPR index scores increased by 39% and 57%, respectively. With the LBPR approach the redistribution of risk was not uniform with job rotation. The increase was greater for those who rotated into the demanding job compared to the reduction experienced by those who rotated out of the demanding job. The effects of job rotation are not easily estimated because of the complex effect that mixing jobs has on peak and cumulative tissue loading.     

The effect of dynamic sitting on the prevention and management of low back pain and low back discomfort: a systematic review

Dynamic sitting has been proposed to reduce low back pain (LBP) and/or low back discomfort (LBD) while sitting. This is supported by studies suggesting that subjects with LBP assume more static, sustained postures while sitting. This systematic review investigated the effect of dynamic sitting on LBP among subjects with LBP and the development of LBD among pain-free subjects. Electronic databases were searched by two independent assessors. All prospective studies which compared the effect of a dynamic sitting condition on LBP or LBD to another sitting condition were eligible, with no minimum follow-up period applied. The quality of the included studies was assessed using the PEDro scale. Seven high-quality studies were eligible, including five crossover studies and two randomised controlled trials. The results suggest there is currently no evidence to support the use of dynamic sitting as a stand-alone approach in the management of LBP. PRACTITIONER SUMMARY: This systematic review investigated the effect of dynamic sitting on LBP or LBD. Seven high-quality studies met the inclusion and exclusion criteria. Overall, the evidence suggests that dynamic sitting approaches are not effective as a stand-alone management approach for LBP.     

The influence of a back support harness on spinal forces during sheep shearing

Previous research has classified the occupation of sheep shearing as heavy work where shearers flex their spine and hips for long periods of time, handle awkward loads and expend high amounts of energy. The aim of this research was to investigate the magnitude of spinal forces produced during the shearing phase of the work and to determine whether the use of a commercially available back support harness would reduce these forces. Following discussion on task complexity and risk of back injury with senior shearing instructors, three component tasks of the shearing phase were identified as posing high risk of injury and were prioritized for primary analysis. Although the dragging out of a sheep in preparation for shearing and an unexpected loss of animal control were also identified as being of high risk, technological and instrumentation difficulties precluded their analysis. Twelve experienced shearers were videotaped while shearing with and without the use of a back harness. Surface mounted retro-reflective markers placed on the trunk defined three linked segments: Pelvis, Lumbar and Head, Arms, and Upper Trunk (HAUT). A 3D, link segment, top down, inverse dynamics approach was used to describe the motion and to estimate forces involved during the identified tasks of shearing. The spinal force/time profiles of this sample of shearers demonstrated large compressive and shear forces for all three tasks that are close to the NIOSH and University of Waterloo action limits for compressive and shear forces respectively (McGill , Yingling and McGill , Marras ). The use of the back support harness reduced these forces by substantial and statistically significant amounts. This effect was consistent across all three tasks. The results of this study demonstrate the production of high levels of compressive and shear forces within the spine of shearers during the three shearing tasks studied and that the use of a back support harness can substantially reduce these forces. Therefore the use of a back harness may reduce the cumulative load on the spine during shearing thereby moderating damage to the articular structures. However it is not known whether the harness would protect the spine from a sudden or unexpected force.     

Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain

The purpose of this study was to assess sleep quality and comfort of participants diagnosed with low back pain and stiffness following sleep on individually prescribed mattresses based on dominant sleeping positions. Subjects consisted of 27 patients (females, n = 14; males, n = 13; age 44.8 yrs ± SD 14.6, weight 174 lb. ±SD 39.6, height 68.3 in. ± SD 3.7) referred by chiropractic physicians for the study. For the baseline (pretest) data subjects recorded back and shoulder discomfort, sleep quality and comfort by visual analog scales (VAS) for 21 days while sleeping in their own beds. Subsequently, participants’ beds were replaced by medium-firm mattresses specifically layered with foam and latex based on the participants’ reported prominent sleeping position and they again rated their sleep comfort and quality daily for the following 12 weeks. Analysis yielded significant differences between pre- and post means for all variables and for back pain, we found significant (p < 0.01) differences between the first posttest mean and weeks 4 and weeks 8-12, thus indicating progressive improvement in both back pain and stiffness while sleeping on the new mattresses. Additionally, the number of days per week of experiencing poor sleep and physical discomfort decreased significantly. It was concluded that sleep surfaces are related to sleep discomfort and that is indeed possible to reduce pain and discomfort and to increase sleep quality in those with chronic back pain by replacing mattresses based on sleeping position.     

The effects of speed,frequency, and load on measured hand forces for a floor to knuckle lifting task

The purpose of this study was to describe and quantify measured hand forces during floor to knuckle lifting of various loads. Hand forces of five subjects were measured with a strain gauge apparatus for normal and fast speeds of lifting at 1,4, and 8 l/min. The pattern of hand force over time exhibited peaks in force in the shape of a spike for all fast lifts, indicating that subjects did not lift smoothly. For normal speed of lift, only one of the five subjects executed some lifts smoothly, indicating that it may be possible to lift smoothly, but most lifters probably do not. Peaks of horizontal and vertical components of hand force were tabulated by speed of lift, frequency, and load.     

The effects of military body armour on the lower back and knee mechanics during toe-touch and two-legged squat tasks

While effective in the prevention of otherwise lethal injuries, military body armour (BA) has been suggested to reduce warfighter's performance and increase injury-related musculoskeletal conditions. Providing the significant role of joint biomechanics in both performance and risk of injury, the immediate and prolonged effects of wearing BA on biomechanics of the lower back and knee during toe-touch (TT) and two-legged squat (TLS) tasks were investigated. The immediate effects of BA were an increase of >40 ms (p ≤ 0.02) in flexion duration of the dominant joint and an ～1 s (p ≤ 0.02) increase in overall task duration as well as an ～18% (p = 0.03) decrease in the lumbopelvic rhythm ratio near the mid-range of trunk flexion. In general the prolonged duration of wearing BA (i.e. 45 min of walking) was not found to cause more changes in our measures than walking without BA.     

Little effect of transfer technique instruction and physical fitness training in reducing low back pain among nurses: a cluster randomised intervention study

The aim of this study was to evaluate the effect of a transfer technique education programme (TT) alone or in combination with physical fitness training (TTPT) compared with a control group, who followed their usual routine. Eleven clinical hospital wards were cluster randomised to either intervention (six wards) or to control (five wards). The intervention cluster was individually randomised to TT (55 nurses) and TTPT (50 nurses), control (76 nurses). The transfer technique programme was a 4-d course of train-the-trainers to teach transfer technique to their colleagues. The physical training consisted of supervised physical fitness training 1 h twice per week for 8 weeks. Implementing transfer technique alone or in combination with physical fitness training among a hospital nursing staff did not, when compared to a control group, show any statistical differences according to self-reported low back pain (LBP), pain level, disability and sick leave at a 12-month follow-up. However, the individual randomised intervention subgroup (transfer technique/physical training) significantly improved the LBP-disability (p = 0.001). Although weakened by a high withdrawal rate, teaching transfer technique to nurses in a hospital setting needs to be thoroughly considered. Other priorities such as physical training may be taken into consideration. The current study supports the findings of other studies that introducing transfer technique alone has no effect in targeting LBP. However, physical training seems to have an influence in minimising the LBP consequences and may be important in the discussion of how to prevent LBP or the recurrence of LBP among nursing personnel.     

Little effect of transfer technique instruction and physical fitness training in reducing low back pain among nurses: a cluster randomised intervention study

The aim of this study was to evaluate the effect of a transfer technique education programme (TT) alone or in combination with physical fitness training (TTPT) compared with a control group, who followed their usual routine. Eleven clinical hospital wards were cluster randomised to either intervention (six wards) or to control (five wards). The intervention cluster was individually randomised to TT (55 nurses) and TTPT (50 nurses), control (76 nurses). The transfer technique programme was a 4-d course of train-the-trainers to teach transfer technique to their colleagues. The physical training consisted of supervised physical fitness training 1 h twice per week for 8 weeks. Implementing transfer technique alone or in combination with physical fitness training among a hospital nursing staff did not, when compared to a control group, show any statistical differences according to self-reported low back pain (LBP), pain level, disability and sick leave at a 12-month follow-up. However, the individual randomised intervention subgroup (transfer technique/physical training) significantly improved the LBP-disability (p = 0.001). Although weakened by a high withdrawal rate, teaching transfer technique to nurses in a hospital setting needs to be thoroughly considered. Other priorities such as physical training may be taken into consideration. The current study supports the findings of other studies that introducing transfer technique alone has no effect in targeting LBP. However, physical training seems to have an influence in minimising the LBP consequences and may be important in the discussion of how to prevent LBP or the recurrence of LBP among nursing personnel.     

The assessment of material handling strategies in dealing with sudden loading: The effects of load handling position on trunk biomechanics

Back injury caused by sudden loading is a significant risk among workers that perform manual handling tasks. The present study investigated the effects of load handling position on trunk biomechanics (flexion angle, L5/S1 joint moment and compression force) during sudden loading. Eleven subjects were exposed to a 6.8 kg sudden loading while standing upright, facing forward and holding load at three different vertical heights in the sagittal plane or 45° left to the sagittal plane (created by arm rotation). Results showed that the increase of load holding height significantly elevated the peak L5/S1 joint compression force and reduced the magnitude of trunk flexion. Further, experiencing sudden loading from an asymmetric direction resulted in significantly smaller peak L5/S1 joint compression force, trunk flexion angle and L5/S1 joint moment than a symmetric posture. These findings suggest that handling loads in a lower position could work as a protective strategy during sudden loading.     

The effect of pallet distance on torso kinematics and low back disorder risk

Intervention research for prevention of occupational low back injuries has focused on the effects of reducing extreme torso flexion and the external moment. Little is known about prevention strategies for torso twisting and lateral bending. The objective of this study was to assess the effect of pallet distance with regard to a constant lift origin on the torso kinematics and a measure of low back disorder risk. Fifteen male participants transferred 11.3?kg boxes from a constant origin to six different regions on a pallet. Two pallet distances with regard to the lift origin were investigated. ANOVA indicated that increasing the pallet distance resulted in increases in torso kinematics (velocities and accelerations) as well as a measure of risk of low back disorder. The increases in torso kinematics (e.g. twisting and lateral awkward postures and bending velocities) occurred mostly at the lower height regions on the pallet. It is concluded that increasing the pallet distance with regard to the lifting origin, with the intention to influence the participant to take a step during a palletizing task does not appear to be an effective intervention strategy to reduce the risk of low back disorder associated with torso kinematics.     

The effects of transfer distance on spine kinematics when placing boxes at different heights

Twisting and lateral bending motions in repetitive lifting tasks are associated with occupational low back injuries and can be challenging to reduce with engineering controls. This study tested the hypothesis that twisting and lateral bending can be reduced by changing the transfer distance. Eighteen males, with no material handling experience lifted 10.9 kg boxes from 0.9 m above the floor and placed the boxes at a destination located 0.50, 0.75, 1.00, 1.25, 1.50, or 1.75 m away and at heights of 0.5 m, 0.9 m, and 1.3 m above the floor. Overall, twisting and forward bending decreased with increased transfer distance when placing the box. Conversely, the lateral bending when lifting and placing the box increased with increasing transfer distance. In short, having a transfer distance between 1 and 1.25 m when performing palletizing tasks to different heights may optimally balance spine kinematics, back injury risk, and productivity measures.     

The effect of pallet distance on torso kinematics and low back disorder risk

Intervention research for prevention of occupational low back injuries has focused on the effects of reducing extreme torso flexion and the external moment. Little is known about prevention strategies for torso twisting and lateral bending. The objective of this study was to assess the effect of pallet distance with regard to a constant lift origin on the torso kinematics and a measure of low back disorder risk. Fifteen male participants transferred 11.3 kg boxes from a constant origin to six different regions on a pallet. Two pallet distances with regard to the lift origin were investigated. ANOVA indicated that increasing the pallet distance resulted in increases in torso kinematics (velocities and accelerations) as well as a measure of risk of low back disorder. The increases in torso kinematics (e.g. twisting and lateral awkward postures and bending velocities) occurred mostly at the lower height regions on the pallet. It is concluded that increasing the pallet distance with regard to the lifting origin, with the intention to influence the participant to take a step during a palletizing task does not appear to be an effective intervention strategy to reduce the risk of low back disorder associated with torso kinematics.     

The functional evaluation of a back belt rehabilitation for low-back pain patients

Back belts are used for preventative and therapeutic purposes. The outcome measures fail to support the use of back belts to treat or prevent back injuries. The purposes of this study were (1) to estimate the reliability and responsiveness of the health outcome for individuals participating in back belt rehabilitation, and (2) to compare the health-related quality of life between individuals with low-back pain (LBP) and normal subjects. Twenty-three volunteers without any complaint of LBP and 95 LBP patients participated in this study. The mobility test and the SF-36 provide reliable and responsive measurements, but they appear to provide different information about the health status of LBP patients. Compared with normal subjects, LBP patients had lower scores for health-related quality of life, but these scores improved after 12 weeks of back belt rehabilitation.

Relevance to industry

A clinically based outcome measure can provide a reliable and responsive tool for the routine assessment of perceived health in patients undergoing back belt rehabilitation. This evaluation program will be continuously used to screen workers using back belts for successful back injury prevention.     

The effects of a lower body exoskeleton load carriage assistive device on limits of stability and postural sway

The study investigated the effects of using a lower body prototype exoskeleton (EXO) on static limits of stability and postural sway. Measurements were taken with participants, 10 US Army enlisted men, standing on a force platform. The men were tested with and without the EXO (15 kg) while carrying military loads of 20, 40 and 55 kg. Body lean to the left and right was significantly less and postural sway excursions and maximal range of movement were significantly reduced when the EXO was used. Hurst values indicated that body sway was less random over short-term time intervals and more random over long-term intervals with the EXO than without it. Feedback to the user's balance control mechanisms most likely was changed with the EXO. The reduced sway and relatively small changes in sway with increasing load weights suggest that the EXO structure may have functioned to provide a bracing effect on the body.     

The impact of drywall handling tools on the low back

Carpenters and other construction workers who install drywall have high rates of strains and sprains to the low back and shoulder. Drywall is heavy and awkward to handle resulting in increased risk of injury. The purpose of this study was to evaluate several low-cost coupling tools that have the potential to reduce awkward postures in drywall installers. Five coupling tools were evaluated using the Lumbar Motion Monitor that measures trunk kinematics and predicts probability of low back disorder group membership risk (LBD risk). Workers answered surveys about their comfort while using each tool. The results indicate that use of the 2-person manual lift and the J-handle provide the best reduction in awkward postures, motions, low back sagittal moment, and LBD risk. The two-person manual lift appears to be the safest method of lifting and moving drywall, though using the two-person J-handle also significantly reduces injury risk. Given that carpenters are skeptical about using equipment that can get in the way or get lost, a practical recommendation is promotion of two-person manual lifting. For single-person lifts, the Old Man tool is a viable option to decrease risk of MSDs.     

The effects of a lower body exoskeleton load carriage assistive device on limits of stability and postural sway

The study investigated the effects of using a lower body prototype exoskeleton (EXO) on static limits of stability and postural sway. Measurements were taken with participants, 10 US Army enlisted men, standing on a force platform. The men were tested with and without the EXO (15 kg) while carrying military loads of 20, 40 and 55 kg. Body lean to the left and right was significantly less and postural sway excursions and maximal range of movement were significantly reduced when the EXO was used. Hurst values indicated that body sway was less random over short-term time intervals and more random over long-term intervals with the EXO than without it. Feedback to the user's balance control mechanisms most likely was changed with the EXO. The reduced sway and relatively small changes in sway with increasing load weights suggest that the EXO structure may have functioned to provide a bracing effect on the body.     

The influence of skill and low back pain on trunk postures and low back loads of shearers

Shearing is a rural occupation developing considerable spinal loads and carrying a high risk of low back pain (LBP). Although the workforce has a skill structure, interaction between skill, spinal loads and LBP is unknown. We examined whether skill and LBP influenced trunk postures and loads within a sample of 80 shearers representing shear skill levels. A progression from junior to open class demonstrated a 100% increase in productivity, less time in severe flexion, more time in neutral lateral bend, and more time in axially twisted postures, with no increase in cumulative compressive and anterior shear forces. LBP prevalence increased linearly from 10% for junior through to 76% for open class shearers. Shearers with a history of LBP generated greater cumulative right medio-lateral shear forces, greater left lateral bend and left axial twist moments. Skill-based training that reduces asymmetric forces may help reduce such high prevalence levels of LBP.

Statement of Relevance: Shearing is an important and physically demanding rural occupation. It requires sustained flexed postures that generate considerable spinal loads and a high risk of LBP. This research examines how skill and a history of LBP it carries interact to influence trunk postures and spinal loads within a sample of shearers.     

Potential of adjustable height carts in reducing the risk of low back injury in grocery stockers

While the workers of the Wholesale and Retail Trade industrial sector suffer from musculoskeletal disorders at an alarming rate, there have been few investigative studies into potential effective interventions to reduce the ergonomic stress. The objective of the study was to determine whether a cart with an adjustable shelf could reduce awkward postures and motions while stocking products in a grocery store. Fifteen workers at a small grocery store in Puerto Rico completed stocking tasks with two types of carts: traditional and adjustable height cart or Ergo Cart. Trunk kinematics, LBD risk index, NIOSH lifting index, subjective ratings, and productivity indicators were collected during four typical stocking tasks. The Adjustable Ergo Cart reduced the sagittal trunk flexion by 7° and velocity by about 5°/s but increased twisting by about 2° and twist velocity by 4°/s as compared to the traditional cart. The LBD risk index was reduced by a small 2.4% in probability although greater reductions were found for larger items (e.g. bags of dog food and 2-L of Soda). The consensus among workers was that the adjustable cart would be easier to use. Overall, the study provides objective evidence that an ergonomically designed cart (e.g. adjustable height) has some potential to reduce sagittal trunk flexion, LBD risk index, and the NIOSH lift index. Overall, the results indicate that any intervention such as an adjustable cart can only have marginal effectiveness unless the entire systems perspective is considered.