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.     

Initial training as a stimulus for optimal physical fitness in firemen

Abstract

In this investigation the physical fitness of 34 recruits to the UK Fire Service was assessed before and after their initial training (tests 1–2) and on three occasions (tests 3–5) during the first 18 months of their service (n=34+6=40). The initial training (test 2-test 1) resulted in an increase in maximum aerobic power (11% p<0·05), body mass (2 kg, p<0·001), lean body mass (2·02 kg, p<0·001), grip and lifting strengths (/><0·001), and in calf girth (p<0·05). But no change in waist girth, maximum anaerobic power or measures of lung function was noted. There was evidence therefore that the men became physically fitter. In the first eighteen months of their service, subjects' maximum oxygen consumption declined to pre-training levels, while body mass continued to increase with a decrease in lean body mass (p<0·001). Strength remained unaltered or tended to fall with a decrease in calf girth (p<0·05). These changes reflected a return towards pre-training physical fitness levels. It is suggested that the initial training, while ill-matched to the firemen's habitual activity, produced levels of physical fitness which may approximate more closely to the infrequent peak requirements experienced by the men during actual fire fighting. Consequently it is concluded that the physical training during service was insufficiently intense and that a more effective programme could be designed to maintain an appropriate level of physical fitness     

Reducing back stress to nursing personnel: an ergonomic intervention in a nursing home

A prospective epidemiologic study was conducted in two units (140 beds and 57 nursing assistants) of a nursing home to demonstrate the efficacy of an ergonomic intervention strategy to reduce back stress to nursing personnel. The total programme involved the following: determining patient handling tasks perceived to be most stressful by the nursing assistants (NAs); performing an ergonomic evaluation of these tasks; and conducting a laboratory study to select patient transferring devices perceived to produce less physical stress than existing manual patient-handling methods. The intervention phase included training NAs in the use of these devices, modifying toilets and shower rooms, and applying techniques to patient care. Immediately after completing the intervention programme, a post-intervention analysis (which lasted eight months in unit 1 and four months in unit 2) was performed.

A biomechanical evaluation of the physical demands required to perform stressful patient-handling tasks showed that the mean compressive force on the L5/S1 disc, the mean hand force required to make a transfer, and the strength requirements (expressed as percentage female population capable) were 1964?N, 122?N, and 83% after intervention as compared to 4751?N, 312?N, and 41% before intervention. Subjectively, the mean rating of perceived exertion was less than ‘very light’ after intervention as compared to between ‘somewhat hard’ and ‘hard’ before intervention. Overall, the mean acceptability rates for the walking belt and the mechanical hoist were 81% and 87% for patient transfers. The incidence rate for back injuries prior to the intervention, 83 per 200 000 work-hours, decreased to 47 per 200 000 work-hours after the intervention. There were no injuries resulting in lost or restricted work days during the last four months of the post-intervention. It is concluded that an appropriate ergonomic intervention programme offers great promise in reducing physical stress and risk of low-back pain to nursing personnel. However, large-scale studies in different nursing homes are needed to confirm the above findings.     

Reducing back stress to nursing personnel: an ergonomic intervention in a nursing home.

A prospective epidemiologic study was conducted in two units (140 beds and 57 nursing assistants) of a nursing home to demonstrate the efficacy of an ergonomic intervention strategy to reduce back stress to nursing personnel. The total programme involved the following: determining patient handling tasks perceived to be most stressful by the nursing assistants (NAs); performing an ergonomic evaluation of these tasks; and conducting a laboratory study to select patient transferring devices perceived to produce less physical stress than existing manual patient-handling methods. The intervention phase included training NAs in the use of these devices, modifying toilets and shower rooms, and applying techniques to patient care. Immediately after completing the intervention programme, a post-intervention analysis (which lasted eight months in unit 1 and four months in unit 2) was performed. A biomechanical evaluation of the physical demands required to perform stressful patient-handling tasks showed that the mean compressive force on the L5/S1 disc, the mean hand force required to make a transfer, and the strength requirements (expressed as percentage female population capable) were 1964 N, 122 N, and 83% after intervention as compared to 4751 N, 312 N, and 41% before intervention. Subjectively, the mean rating of perceived exertion was less than 'very light' after intervention as compared to between 'somewhat hard' and 'hard' before intervention. Overall, the mean acceptability rates for the walking belt and the mechanical hoist were 81% and 87% for patient transfers. The incidence rate for back injuries prior to the intervention, 83 per 200,000 work-hours, decreased to 47 per 200,000 work-hours after the intervention. There were no injuries resulting in lost or restricted work days during the last four months of the post-intervention. It is concluded that an appropriate ergonomic intervention programme offers great promise in reducing physical stress and risk of low-back pain to nursing personnel. However, large-scale studies in different nursing homes are needed to confirm the above findings.     

Physical employment standard for Canadian wildland firefighters: examining test–retest reliability and the impact of familiarisation and physical fitness training

Abstract

To assess the impact of repeat performances (familiarisation) plus exercise training on completion time for the Ontario Wildland Firefighter (WFF) Fitness Test circuit (WFX-FIT), normally active general population participants (n = 145) were familiarised to the protocol then randomised into (i) exercise training, (ii) circuit only weekly performances or (iii) controls. At Baseline, the WFX-FIT pass rate for all groups combined was 11% for females and 73% for males, indicating that the Ontario WFX-FIT standard had a possible adverse impact on females. Following test familiarisation, mean circuit completion times improved by 11.9% and 10.2% for females and males, respectively. There were significant improvements in completion time for females (19.8%) and males (16.9%) who trained, plus females (12.2%) and males (9.8%) who performed the circuit only, while control participants were unchanged. Post training, the pass rate of the training group was 80% for females and 100% for males.

Practitioner Summary: This paper details the impact of familiarisation plus exercise training as accommodation to mitigate potential adverse impact on initial attack wildland firefighter test performance. The results underscore the importance of test familiarisation opportunities and physical fitness training programmes that are specific to the demands of the job.     

Evaluation of training in patient handling and moving skills among hospital and home care personnel

The aim of the study was to evaluate the training programme in patient handling and moving skills according to the Stockholm Training Concept. The evaluation focused on work technique, musculoskeletal problems, job strain and the experience of the person being transferred. The training programme consisted of two models of learning: traditional groups and quality circles. Fifty-one people employed at geriatric hospitals and in primary care, participated in the training programme. For the evaluation, the participants were video-recorded in one standardized transfer situation: moving the patient from bed to wheelchair, before and after the training. The participants' work technique during the patient transfer was assessed using seven items. A questionnaire covering individual factors, physical exertion, job strain, and musculoskeletal problems, was filled in by the participants before training and also six months after. The results showed improvements in six of the seven work technique items, directly after training. A decrease in the participants' physical exertion during transfers of patients from ‘bed to chair’ was shown six months after completion of the training programme. There was no significant decrease in the participants' musculoskeletal problems and job strain after training. Ninety-eight per cent of the participants were positive about having participated in the training. Training in patient handling and moving skills led to improved work technique. The participants improved their transfer technique and experienced less discomfort during the transfer, and patients experienced greater comfort and safety when being transferred.     

A direct observation instrument for assessment of nurses' patient transfer technique (DINO)

The aim of this project was to develop a direct observation instrument to assess the work technique of nursing personnel during patient transfers and to test the validity and reliability of the instrument. An expert group developed this instrument, called DINO (DIrect Nurse Observation instrument for assessment of work technique during patient transfers), which contains 16 items divided into three phases of a transfer: the preparation, performance and result phases. To quantify the assessments a scoring system was constructed, giving an overall score for each transfer, depending on the level of musculoskeletal health and safety. Four observers assessed 45 patient transfers at hospital wards and showed in an evaluation that the inter-observer reliability and criterion-related validity of DINO was satisfactory. The assessments with the DINO instrument are done directly when the transfer occurs, without costly equipment. Therefore, it has a wide range of applications. For example, when evaluating training in work technique or when identifying an unsafe work technique as a risk factor for musculoskeletal problems in epidemiological studies.     

Reducing musculoskeletal disorders among computer operators: comparison between ergonomics interventions at the workplace

Typing is associated with musculoskeletal disorders (MSDs) caused by multiple risk factors. This control study aimed to evaluate the efficacy of a workplace intervention for reducing MSDs among computer workers. Sixty-six subjects with and without MSD were assigned consecutively to one of three groups: ergonomics intervention (work site and body posture adjustments, muscle activity training and exercises) accompanied with biofeedback training, the same ergonomics intervention without biofeedback and a control group. Evaluation of MSDs, body posture, psychosocial status, upper extremity (UE) kinematics and muscle surface electromyography were carried out before and after the intervention in the workplace and the motion lab. Our main hypothesis that significant differences in the reduction of MSDs will exist between subjects in the study groups and controls was confirmed (χ² = 13.3; p = 0.001). Significant changes were found in UE kinematics and posture as well. Both ergonomics interventions effectively reduced MSD and improved body posture.

Practitioner Summary: This study aimed to test the efficacy of an individual workplace intervention programme among computer workers by evaluating musculoskeletal disorders (MSDs), body posture, upper extremity kinematics, muscle activity and psychosocial factors were tested. The proposed ergonomics interventions effectively reduced MSDs and improved body posture.     

Evaluation of training in patient handling and moving skills among hospital and home care personnel

The aim of the study was to evaluate the training programme in patient handling and moving skills according to the Stockholm Training Concept. The evaluation focused on work technique, musculoskeletal problems, job strain and the experience of the person being transferred. The training programme consisted of two models of learning: traditional groups and quality circles. Fifty-one people employed at geriatric hospitals and in primary care, participated in the training programme. For the evaluation, the participants were video-recorded in one standardized transfer situation: moving the patient from bed to wheelchair, before and after the training. The participants' work technique during the patient transfer was assessed using seven items. A questionnaire covering individual factors, physical exertion, job strain, and musculoskeletal problems, was filled in by the participants before training and also six months after. The results showed improvements in six of the seven work technique items, directly after training. A decrease in the participants' physical exertion during transfers of patients from 'bed to chair' was shown six months after completion of the training programme. There was no significant decrease in the participants' musculoskeletal problems and job strain after training. Ninety-eight per cent of the participants were positive about having participated in the training. Training in patient handling and moving skills led to improved work technique. The participants improved their transfer technique and experienced less discomfort during the transfer, and patients experienced greater comfort and safety when being transferred.     

Design and evaluation of robot patient for nursing skill training in patient transfer

We developed a robot patient for patient transfer training for simulating a patient’s performance during patient transfer and for enabling nurses to practice their nursing skills on it. To realize the robot patient, we focused on addressing the problems of designing its limb actions to enable it to respond to nurses’ operations. RC servos and electromagnetic brakes were installed in the joints to enable the robot to simulate a patient’s limb actions, such as embracing and remaining standing. To enable the robot to automatically respond to nurses’ operations, an identification method for these operations was developed that used voice commands and the features of the limbs’ posture measured by angle sensors installed in the robot’s joints. The robot patient’s performance was examined by a control test in which four experienced nursing teachers performed patient transfer with the robot patient and a human-simulated patient. The results revealed that the robot patient could successfully simulate the actions of a patient’s limbs according to the nursing teachers’ operations and that it is suitable for nursing skill training.     

个性化的智能护理排班管理系统的设计与运用

目的:为了提高护理排班的效率,在满足病区个性化排班需求的同时保证护理部的统一管理。方法:该文设计了一种个性化的智能护理排班管理系统,采用分级管理的思路,提供从护士到护理部的多层级闭环管理。结果:新设计的系统为病区提供了个性化、人性化、智能化的排班功能,显著地改善了医院的护理排班工作效率和护士满意度。结论:该文的护理排班管理系统为医院进一步提高护理管理水平和护士满意度提供了新的方法。     

The ageing Australian firefighter: an argument for age-based recruitment and fitness standards for urban fire services

Currently, there is no enforcement of physical standards within Australian fire services post-recruitment, possibly leading to inappropriate fitness and body composition. This study evaluated the impacts of ageing on physical standards of Australian firefighters. Seventy-three firefighters from three different 10-year age groups [25–34 years (n = 27), 35–44 years (n = 27), 45–54 years (n = 19)] volunteered for physical testing using dual-energy X-ray analysis and existing fitness tests used for recruitment by an Australian fire service. Older (45–54 years) participants demonstrated significantly poorer physical standards compared with younger participants including cardiovascular fitness (p < 0.05), strength (p = 0.001) and simulated operational power testing tasks (p < 0.001). Age-related body composition changes were also observed independent of body mass index. Minimum recruitment standards and fitness programs need to account for age-related declines in physical capabilities to ensure that the minimum standard is maintained regardless of age.

Practitioner Summary: Using dual-energy X-ray analysis and established fitness testing protocols, this study aimed to gain an appreciation of the current standards of body composition and fitness of Australian firefighters and the effects of ageing on their physical abilities post-recruitment. The study demonstrated a significant decline in physical standards due to age.     

Development of an intervention to prevent work-related musculoskeletal disorders among hospital nurses based on the participatory approach

The participatory approach has been widely used to improve the work environment. The purpose of this study was to develop an intervention to prevent work-related musculoskeletal disorders in hospital nurses using the participatory approach. Based on the Participatory Action Oriented Training (PAOT) approach, the multidisciplinary team conducted the trainer workshop to develop a comprehensive intervention protocol, which yielded several practical and low-cost solutions to reduce the risk factors for musculoskeletal disorders. Structured tools that were focused on the hospital environment were developed. The developed action checklist consisted of 43 items that were focused on five areas of nursing tasks (i.e., patient care and treatment; safe handling of drugs, medical devices, and equipment; workstation design; physical environment; and welfare facilities and administration). The final intervention protocol consisted of a series of structured participant workshop, follow-up visits, and presentation of achievements.     

MAPO index for risk assessment of patient manual handling in hospital wards: a validation study

Manual handling of disabled patients – as regards movement – is one of the major factors affecting acute low back pain of exposed nursing staff. In the absence of quantitative methods assessing this kind of risk, the Research Unit Ergonomics of Posture and Movement of Milan developed in 1997 a risk assessment method called Movement and Assistance of Hospital Patients (MAPO), which is applicable in hospital wards.

A first study conducted in 1999 allowed the identification of three levels of MAPO index corresponding with increasing probabilities of being affected by acute low back pain. In accordance with the well-known traffic light model, for MAPO index values between 0 and 1.5 the risk is considered to be absent or negligible. For values between 1.51 and 5.00 the risk is considered to be moderate. For values exceeding 5.00 the risk is considered to be high. In view of the limitations of the previous study, the results needed confirmation and so, in 2000–2001, another cross-sectional study was carried out, which included 191 hospital wards for acute and chronic patients and 2603 exposed subjects. This paper presents the analytical results of the association between the MAPO index and acute low back pain in this new data sample.

The agreement between results of the two studies indicates that the MAPO index can be used as a risk index, although with some caution, as detailed in the paper. It can assess the risk exposure level of patient manual handling in wards and can be a useful tool for planning effective preventive actions to reduce the risk of work-related musculoskeletal disorders in health-care workers looking after disabled patients.     

Biomechanical analysis of peak and cumulative spinal loads during simulated patient-handling activities: a substudy of a randomized controlled trial to prevent lift and transfer injury of health care workers

Back injuries are a serious problem for nursing personnel who perform frequent patient-handling activities. Common prevention strategies include body mechanics education, technique training, and ergonomic interventions such as the introduction of assistive equipment. This investigation assessed and compared the effectiveness of two patient-handling approaches to reducing injury risk. One strategy involved using improved patient-handling technique with existing equipment, and the other approach aimed at eliminating manual patient handling through the use of additional mechanical and other assistive equipment. Both intervention arms received training in back care, patient assessment, and use of the equipment available on their particular wards. An analysis of compliance with interventions and the effects of patient-handling methods on both peak and cumulative spinal compression and shear during various tasks was conducted. Results showed greater compliance with interventions that incorporated new assistive patient-handling equipment, as opposed to those consisting of education and technique training alone. In several tasks, subjects who were untrained or non-compliant with interventions experienced significantly higher peak spinal loading. However, patient-handling tasks conducted with the aid of assistive equipment took substantially longer than those performed manually. This, along with variations in techniques, led to increases in cumulative spinal loading with the use of patient-handling equipment on some tasks. Thus, the use of mechanical assistive devices may not always be the best approach to reducing back injuries in all situations. No single intervention can be recommended; instead all patient-handling tasks should be examined separately to determine which methods maximize reductions in both peak and cumulative lumbar forces during a manoeuver.     

Association between objectively measured static standing and low back pain – a cross-sectional study among blue-collar workers*

This study aims to investigate the cross-sectional association between objectively measured total time and temporal patterns of static standing (short bouts: 0–5 min; moderate bouts: >5–10 min; and long bouts: >10 min) during work and leisure and low back pain (LBP) among 698 blue-collar workers. Workers reported LBP on a 0–10 scale. The association between time spent on static standing and LBP was tested with linear regression. A positive association with LBP intensity was found for long bouts of static standing (β = 0.27) during total day (work + leisure), and total static standing time at leisure (β = 0.12). No significant associations were found for static standing during work and LBP intensity. These findings indicate that particularly long bouts of static standing over the entire day contribute to LBP in blue-collar workers.

Practitioner Summary: The association between LBP and static standing time was investigated. This study indicates that prolonged time standing during total day and standing during leisure are positively associated with LBP among blue-collar workers. Therefore, practitioners should consider long periods of standing as a potential risk factor for LBP.     

Shoulder muscular activity in individuals with low back pain and spinal cord injury during seated manual load transfer tasks*

This study aimed to compare the activity of four shoulder muscles in individuals with low back pain (LBP), spinal cord injuries (SCI) and a control group, during one-handed load transfer trials. Nine individuals with minimum one-year of LBP, eleven with thoracic/lumbar SCI and nine healthy controls participated in this study. The activations of anterior deltoid, upper trapezius, infraspinatus and pectoralis major were recorded by surface EMG during one-handed transferring of a cylinder from a home shelve to six spatially distributed target shelves. The integrated EMG values were compared using repeated measure ANOVA. Both LBPs and SCIs had higher anterior deltoid activation and LBPs required more upper trapezius activation than controls (p < 0.05). The spatial position of the targets also significantly influenced demands for these two muscles. The anterior deltoid and upper trapezius in LBP and SCI individuals are under higher demand during occupational load transfer tasks.

Practitioner Summary: This study aimed to compare the activation of four shoulder muscles in individuals with low back pain, spinal cord injuries and healthy condition. EMG analysis showed that the injured groups required more upper trapezius and anterior deltoid activation during load transfer tasks, which may predispose them to muscle overexertion.     

Nursing staff's communication modes in patient transfer before and after an educational intervention

The objective was to explore and describe nursing staff's body awareness and communication in patient transfers and evaluate any changes made after an educational intervention to promote staff competence in guiding patients to move independently. In total, 63 nursing staff from two hospitals wrote weekly notes before and after the intervention. The topics were: A) reflect on a transfer during the last week that you consider was good and one that was poor; B) reflect on how your body felt during a good and a poor transfer. The notes were analysed with content analysis. The results showed five different communication modes connected with nursing staff's physical and verbal communication. These communication modes changed after 1 year to a more verbal communication, focusing on the patient's mobility. The use of instructions indicated a new or different understanding of patient transfer, which may contribute to a development of nursing staff's competence.

Statement of Relevance: The present findings indicate that patient transfer consists of communication. Therefore, verbal and bodily communication can have an integral part of training in patient transfer; furthermore, the educational design of such programmes is important to reach the goal of developing new understanding and enhancing nursing staff's competence in patient transfer.     

The effects of an active development of the mental model in the training process: experimental results in a word processing system

Abstract

Three different training programmes for a word processing system were experimentally compared: (1) a sequential programme, which taught low-level skills and which did not help the user actively to develop a mental model, (2) a hierarchical programme, which provided an explicit and integrated conceptual model of the system to the user and (3) a programme in which the users were asked to develop hypotheses on the functioning of the software and in which they were encouraged to use an active and exploratory approach. From an action theory point of view it was hypothesized that the third group would be superior to the first group. In an experimental study with two training sessions each of two hours and a two-hour testing session (n = 15), this was shown to be the case for several performance criteria (error time, transfer and experimenter rating). Additionally, an interindividual difference variable lo measure the individual learning style was used, giving results that could be interpreted in a similar way to the experimental results.     

Nursing staff's movement awareness, attitudes and reported behaviour in patient transfer before and after an educational intervention

The objective was to evaluate changes after a two half-day patient transfer course regarding nursing staff’s movement and body awareness, attitudes, reported behaviour, strain, disorder and sick leave. The course aimed at increasing staff’s self-awareness of movements and body, and their communication competence, with the intention to promote the patient’s independent mobility. Ninety-nine staff in an intervention group and 77 staff in two control groups answered a questionnaire before and after the intervention. After one year there was a significant increase in the number of instructions given and nursing staff’s movement awareness in the intervention group compared to the control group. Reported physical disorders decreased significantly in the intervention group compared with both control groups. Increased movement awareness and frequent use of instructions during transfers may encourage patients to move independently and thereby reduce the strain in nursing staff.