Application of MAPO (movement and assistance of hospitalized patients) method in hospitals and nursing homes: 20 years of experience and evolution - part 1.

This article illustrates the evolution of the MAPO method for quantifying the risk of musculoskeletal disorders associated with patient handling.The main factors that have influenced MAPO risk determinants include the rising number of disabled patients (D), growing understaffing, and the increased availability of equipment and training.Hospital wards and especially nursing homes have been provided with lifting equipment since 2008; however, 73.8% of the workforce in nursing homes is exposed to a high level of MAPO risk versus only 8.1% of hospital workers. This study presents organisational data in hospital wards (no.=528) and nursing homes (no.=214) involving 14,246 caregivers: the D/Op ratio in nursing homes is significantly higher compared to the corresponding ratio in hospital wards (p-value < 0.001). Moreover, the number of healthcare workers involved in manual patient handling activities over the night shift in nursing homes is much lower than the corresponding number in hospital wards. Practitioner summary: The purpose of this article is to illustrate organisational data from hospital wards and nursing homes, gathered over 20 years of implementing the MAPO method. The protocols for adapting the method to recent changes in care delivery are also presented.

[Preventive strategies for patient manual handling in a major hospital]. / Strategie preventive per la movimentazione manuale dei pazienti in una grande azienda ospedaliera.

SUMMARY: Patient manual handling (MHP) and an increase in the average age of the healthcare workforce increase the risk of musculoskeletal disorders and diseases, leading to sickness absence. Targeted interventions, supported by management, have been proven effective for workplace safety and can lead to improved quality of care.

MAPO Method to Assess the Risk of Patient Manual Handling in Hospital Wards: A Validation Study.

OBJECTIVE: To validate the effectiveness of MAPO method (Movement and Assistance of Hospital Patient) after the introduction of some changes to improve assessment objectivity. BACKGROUND: The number of operators exposed to patient manual handling is increasing considerably. MAPO, proposed in 1999 as a useful tool to estimate the risk of patient manual handling, is a method characterized by analytical quickness. It has recently been improved to better match the 2012 ISO (International Organization for Standardization) technical report. METHODS: A multicenter study was conducted between 2014 and 2016 involving 26 Italian hospitals in the Apulia Region. MAPO method was used to assess the risk of patient manual handling in 116 wards. A total of 1,998 exposed subjects were evaluated for the presence or absence of acute low back pain in the previous 12 months. RESULTS: Only 12% of the investigated wards fell in the green exposure level (MAPO index = 0.1-1.5), 37% resulted in the average exposure level (MAPO index = 1.51-5) and the remaining 51% in the higher exposure level (MAPO index >5). The results confirmed a positive association between increasing levels of MAPO index and the number of episodes of acute low back pain (adjusted p trend = .001). CONCLUSION: The improvements made over the past years led to a more objective assessment procedure. Despite the changes, the study confirmed the effectiveness of MAPO method to predict low back pain. APPLICATION: MAPO method is an accurate risk assessment tool that identifies and evaluates workplace risks. The proper application of the method significantly improves working conditions.

Context specificity in the assessment of psychosocial risk at work: an empirical study on Italian call centre workers.

BACKGROUND: Following EU requirements, in recent years standard procedures for the assessment of work-related stress have been developed in Italy. However, while such standardization has facilitated the spread and use of these procedures, it has brought a lack of specificity in risk assessment. OBJECTIVES: To exemplify a method for the assessment of work-related stress that was developed by the University of Milan to allow the definition of risk profiles tailored to the different organizational settings. METHODS: We examined risk factors for work-related stress in call centre operators employed by two separate Italian companies. At an early stage of the assessment procedure, we conducted a wide series of consultation and training activities that allowed the identification of context-specific risk factors and homogeneous groups, which fuelled the preparation of both the "objective" and the "subjective" evaluation instruments. RESULTS: Results obtained by means of the standardized "Effort-Reward Imbalance Questionnaire" and "Job Content Questionnaire", interpreted in the light of consultations with key organizational figures and individual interviews with employees, have allowed the detection of different risk profiles and priorities for intervention at both the group and the organizational levels. CONCLUSIONS: Findings demonstrated the existence of both common and specific risk factors in the two companies, which would have remained undetected with the exclusive use of standardized approaches.

Validity and reliability of Japanese version of the MAPO index for assessing manual patient handling in nursing homes.

OBJECTIVES: Low back pain (LBP) among caregivers in Japanese nursing homes has long been considered an occupational health issue. This study aimed to verify the reliability and validity of our developed Japanese version of the Movement and Assistance for Hospitalized Patients (J-MAPO) index, a risk assessment tool for LBP, in nursing homes. METHODS: Two inspectors assessed 15 nursing homes using J-MAPO, and deduced 3 LBP risk levels as follows: low, moderate, and high risk. Caregivers in nursing homes responded to a self-administered questionnaire on LBP over the past 12 months. Data from 296 caregivers with no missing data were used. We further used logistic regression models to analyze the association between LBP as a dependent variable, and J-MAPO risk level as an independent variable. We used Cohen kappa coefficient to assess interrater reliability to further assess the agreement between the 2 inspectors. RESULTS: The multivariate logistic regression analysis showed that the adjusted odds ratio and 95% CIs for LBP increased progressively with J-MAPO risk level (Low-risk: 1.00; Moderate-risk: 1.70 [0.74-3.91]; High-risk: 2.67 [1.28-5.56]). Furthermore, the J-MAPO risk levels assessed by the 2 inspectors were in perfect agreement (κ = 1) observed for interrater reliability using Cohen kappa coefficient. CONCLUSIONS: There was high interrater reliability, and J-MAPO risk levels were associated with LBP. Therefore, our results suggest that the J-MAPO is a useful risk assessment tool for LBP in Japanese nursing homes.

First results of the application of the Latin Questionnaire in comparison with populations of reference workers obtained through preliminary epidemiological studies.

Introduction: The authors proposed an application study of the Latin Questionnaire, an updated protocol to conduct the anamnestic study of work-related musculoskeletal disorders through closed questions and the introduction of a predetermined severity threshold that allows for epidemiological studies to be conducted, comparing the results of the exposed population with those of a reference population. Background: Similar protocols describing work-related musculoskeletal disorders occurring in the previous 12 months are available in the literature. For many of these, problems arise when the results must be processed collectively. Objectives: Here we present application examples, with comments on the results in terms of statistical significance of the comparison. Methods: The anamnestic study of the Latin Questionnaire is based on symptoms: discomfort, pain, and evaluation of paresthesia. Each symptom is described considering: location, duration, number of episodes, irradiation, and treatment. The model, which covers the previous 12 months, is designed to identify in the spine, upper and lower limbs: positive anamnestic case, case with minor disorders, negative case. Results: The original application examples show the scope of the disorders presented in the groups of workers exposed to known risk, in comparison with those of the reference group: the significance of the differences is estimated statistically. Conclusions: The Latin Questionnaire, also implemented in the digital format (free to download), allows for comparing the data of exposed and unexposed workers and their statistical significance easily and automatically.

Introducción: Los autores propusieron un estudio de aplicación del Cuestionario Latino, un protocolo actualizado para realizar el estudio anamnésico de los trastornos musculoesqueléticos relacionados con el trabajo a través de preguntas cerradas y la introducción de un umbral de gravedad predeterminada que permiten realizar estudios epidemiológicos comparando los resultados de la población expuesta con los de una población de referencia. Antecedentes: Se encuentran disponibles en la literatura protocolos similares que describen los trastornos musculoesqueléticos relacionados con el trabajo ocurridos en los 12 meses anteriores. Para muchos de estos surgen problemas cuando los resultados deben procesarse colectivamente. Objetivos: Aquí presentamos ejemplos de aplicación, con comentarios sobre los resultados en términos de significación estadística de la comparación. Métodos: El estudio anamnésico del Cuestionario Latino se basa en los síntomas: molestia, dolor y evaluación de parestesia. Cada síntoma se describe considerando: localización, duración, número de episodios, irradiación, tratamiento. El modelo, que cubre los 12 meses anteriores, está diseñado para identificar en la columna y en los miembros superiores e inferiores: caso anamnésico positivo, caso con trastornos menores, caso negativo. Resultados: Los ejemplos originales de aplicación muestran el alcance de los trastornos presentados en los grupos de trabajadores expuestos a un riesgo conocido, en comparación con los del grupo de referencia; la significancia de las diferencias se estima estadísticamente. Conclusiones: El Cuestionario Latino, implementado también en forma digital (de descarga gratuita), permite comparar de manera fácil y automática los datos de trabajadores expuestos y no expuestos y su significación estadística.

[Screening of patient manual handling risk using the MAPO method]. / Screening del rischio da movimentazione manuale pazienti con metodo MAPO.

BACKGROUND: International standards draw attention to the steps that risk assessment should follow to first identify hazards, then proceed to risk evaluation and lastly, if necessary, risk assessment. The same logic also applies to risk assessment of manual patient handling. OBJECTIVES: To check appropriateness of approach to "risk evaluation" of manual patient handling using MAPO, a cross sectional study was carried out aimed at checking the relationship between this new risk assessment model (MAPO screening) and occurrence of acute low back pain. METHODS: After proper training the MAPO screening method was used to assess risk of manual handling of patients in 31 wards, covering 411 exposed subjects employed in geriatric hospitals belonging to the UNEBA (National Union Institutions and Social Welfare Initiatives) of the Veneto Region. At the same time health data were collected on the occurrence of low back pain episodes during the last year both in the group of exposed subjects and in an external reference group (237 subjects). Risk and clinical assessment data were verified and checked by the EPM research unit. Logistic analysis was used as a method to evaluate the relationship between MAPO screening risk index and acute low back pain. RESULTS: Investigating the relationship between acute low back pain episodes and levels of MAPO screening index, carried out only on exposed subjects who reported working for at least 30 hours per week (N=178), showed definitely positive trends: for MAPO screening index of exposure levels between 1.51 and 5, OR were double (OR=2.22; IC 95% 0.88-5.63) whereas for index levels exceeding 5, OR were about 4 (OR=3.77; IC 95% 1.33-10.74). These results did not show significant differences when correcting the analysis for confounding factors such as gender and age classes. CONCLUSIONS: The results of the study indicate that the proposed method, "MAPO screening", can be a useful tool to estimate risk due to manual handling of patients and can also be used to test the efficacy of preventive measures.

Latin Questionnaire: a threshold strategy for anamnestic screening of occupational musculoskeletal disorders through specific reference groups.

Introduction: Health surveillance programs conducted for both individual workers and working populations as a whole are managed by occupational health physicians and focus on disorders and diseases caused by biomechanical overload, primarily for preventive purposes. Objectives: The purpose of the paper is to update an anamnestic protocol for studying musculoskeletal disorders after more than 40 years experience of its application. The updated version has been re-named the Latin Questionnaire. The protocol enables preliminary epidemiological evaluation, by comparing results of exposed populations to those from a reference population, thanks to the introduction of a severity threshold, a concept lacking in similar questionnaires. Methods: The Latin Questionnaire is based on symptoms of discomfort, pain, and paraesthesia. Each symptom is described in terms of location, duration, number of episodes, irradiation, and treatment. The model covers present symptoms during the previous 12 months and is designed to identify positive anamnestic cases (when positive according to the threshold), cases with minor disorders, and negative cases for conditions involving the spine and upper and lower limbs. Results: The updated anamnestic model was validated again through the collaborative effort involving 37 physicians from 14 Latin countries. To enable comparisons with exposed populations, an updated reference population (4,000 unexposed workers) is presented, evaluating the percentages of subjects positive according to thresholds for spine and upper and lower limbs and the incidence of acute lower back pain, broken down by gender and age groups. Examples of application of the questionnaire are also presented. Conclusions: The Latin Questionnaire, which has also been implemented in digital form (free download), allows selection of significant anamnestic cases compared to cases with minor disorders. This strategy is indispensable for correctly conducting preliminary epidemiological studies. Example applications confirm the presence of significant differences between the percentages of subjects with positive thresholds in exposed compared to reference groups, with surpluses proportional to their levels of biomechanical overload.

[Epidemiological study of UL-WMSDs in 2022 VDU workers]. / Indagine epidemiologica sulle patologie e sui disturbi muscoloscheletrici degli arti superiori in un gruppo di 2022 videoterminalisti.

BACKGROUND: The literature dealing with the health effects of VDU work identified right from the beginning a group of MSDs, mainly affecting the cervicobrachial region, so that VDU work could be considered a risk factor due to biomechanical overload of the upper limbs, OBJECTIVES: The aim of the study was to assess the prevalence of symptoms and diseases of VDU workers. METHODS: A cohort of 2022 workers (1125 males and 897 females) working at VDUs for a duration of time equal to or exceeding 20 hours per week, including insurance and bank employees (no desk activity), was submitted to clinical and functional assessment of the cervical spine and upper limbs following a structured protocol (case history, clinical and instrumental examinations), as used by occupational physicians, in order to identify "anamnestic cases" and diagnose upper limb biomechanical overload diseases. Besides medical data, a series of data was also collected in order to obtain details of the work task: time schedule, duration of VDU use, organizational autonomy, data entry method. RESULTS: The prevalence of subjects with UL-WMSDs was 1.9% for males and 5.8% for females, and basically similar to that found in non-exposed working populations. However, there did seem to be a correlation between cervical disorders and computer use, only for females. CONCLUSIONS: In the sample studied no association was shown between VDU work and onset of upper limb diseases, which was confirmed even considering the different exposure variables. Analysis of"anamnestic cases" made by comparison with non-exposed populations, confirmed the lack of association between upper limb diseases and VDU work.

Digestive endoscopy and risk of upper limb biomechanical overload.

BACKGROUND: For several years the literature has reported a high prevalence of upper limb musculoskeletal disorders among medical staff carrying out digestive endoscopy. OBJECTIVES: The EPM research unit, in cooperation with the Italian Society of Digestive Endoscopy (SIED) and with the patronage of the Italian Society of Ergonomics (SIE), undertook research that would permit assessment of upper limb biomechanical overload using the OCRA method during gastroscopy and colonoscopy and, via a pilot study, collect health data on 179 workers employed in endoscopy services. RESULTS: Risk analysis showed slight exposure levels for the arm bearing the instrument and a medium-to-high exposure for the other arm. However, the study of diseases in this sample showed a higher prevalence than in the reference population not exposed to risk for the upper limbs and in particular in the hand-wrist area. CONCLUSIONS: Risk analysis highlighted possible ergonomic measures that would be easy to implement and which would significantly reduce the risk.

[Criteria for classification of upper limb work-related musculo-skeletal disorders due to biomechanical overload in occupational health. Consensus document by an Italian Working Group]. / Criteri per la trattazione e la classificazione di casi di malattia da sovraccarico biomeccanico degli arti superiori nell'ambito della medicina del lavoro. Documento di consenso di un gruppo di lavoro nazionale.

BACKGROUND AND OBJECTIVE: In a preliminary consensus document the authors proposed criteria and methods to identify upper limb work-related MSDs due to biomechanical overload. With this document they intend to define severity according to shared models and procedures so as to fit behaviours to diagnostic procedures and their medical-legal assessment. This becomes especially important in view of Ministerial Decree of April 27 2004 fixing the new lists of diseases having a possible work-related origin that must be reported by law in accordance with art. 139 of law n. 1124, and also on account of the impact of such diseases which, for the first time in Italy, are regulated by law. CONTENTS: The working group, which included INAIL and ISPESL experts and was fully supported by SIMFER (Italian Society of Physical Medicine and Rehabilitation) and SINC (Italian Society of Clinical Neurophysiology), defined a general clinical procedure (anamnesis, objective examination and instrumental assessment) regarding each portion of the concerned upper limb (shoulder, elbow and wrist/hand). Once the presence and characteristics of anatomic and functional damages are established, the results allow a classification scheme to be proposed of upper limb diseases (tendon disorders and entrapment neuropathy) divided into 6 increasing severity stages: initial, medium, medium-severe, severe and extremely severe. Special attention was paid to two instrumental examinations that proved to be of great clinical interest, at least in occupational health: echography of soft tissues (in appendix) and electroneurography for entrapment neuropathy. The limitations of this proposal are discussed but the main goal was achieved: to standardize terms and provide homogeneous criteria to achieve classification of upper limb damage due to biomechanical overload for increasing severity levels. The working group research activity is part of a research project funded by ISPESL.

[Musculoskeletal conditions of the upper and lower limbs as an occupational disease: what kind and under what conditions. Consensus document of a national working-group. ISPESL]. / Le affezioni muscolo-scheletriche degli arti superiori e inferiori come patologie professionali: quali e a quali condizioni. Documento di Consenso di un gruppo di lavoro nazionale. ISPESL.

BACKGROUND AND OBJECTIVES: In via of the progressive emergence in Italy of work-related musculoskeletal disorders, the EPM Research Unit decided to set up a national working group with the aim of producing a Consensus Document including methods and criteria as an initial attempt towards managing such diseases as true "listed" work-related diseases as is already done in the other European Union countries. The working group includes experts from INAIL, ISPESL, welfare assistance institutions, local prevention and health protection services: The group's research activity was included in ISPESL's funded research plan. CONTENTS: The Consensus Document includes a review of epidemiologic issues reported in the international literature, comments on the application of current legislation, observations on the guilt profiles of employers and occupational physicians, as well as medical-legal issues. The document proposes an analytical list of musculoskeletal disorders of upper (and lower) limbs and the operational criteria for identification of working activities involving a risk from upper limb biomechanical overload. In this case, more than on other occasions, it was realized how difficult it is to adopt consolidated task/risk/damage matrices since the same task may or may not be at risk depending both on the way the task is done and on the technical aspects (lines, work parts, procedures, tools) and organization (rate, rotas, breaks). CONCLUSIONS: For the specific aims of the present document, it is possible to identify, though not exhaustively and with some limitations, a series of jobs and working conditions where the risk may be reasonably presumed and for which it is possible to adopt a list system (at least as regards "significant exposure"). The document also includes a chapter on health surveillance recommendations for the occupational physician.

Screening of risk from patient manual handling with MAPO method.

International standards highlight the steps required by risk assessment and involving first hazard identification, then risk evaluation and finally, if necessary, risk assessment. To check approach appropriateness to "risk evaluation" from manual patient handling through MAPO, a cross study was carried out in view of checking relationship between this new risk assessment model and occurrence of acute low back pain. After proper training the MAPO screening method was assessed in 31 wards, 411 exposed subjects of geriatric hospitals. At the same time health data were collected on occurrence of low back pain episodes during the last year both in the exposed subjects' group and the external reference group (n�237). Risk and clinical assessment data were tutored and checked by EPM research unit. The logistic analysis was used as a method to evaluate the relationship between risk index and acute low back pain. Investigating relationship between acute low back pain episodes and levels of MAPO screening index, carried out only with the people exposed who claimed to work for at least 30 hours per week (n = 178), showed definitely positive trends. The study results indicate that MAPO screening may represent a useful tool to estimate the risk from manual handling patients.