The effect of power stretchers on occupational injury rates in an urban emergency medical services system.

BACKGROUND: To examine occupational injury rates in a dual-response emergency medical services (EMS) system before and after implementation of a power-lift stretcher system. METHODS: The seasonally-adjusted occupational injury rate was estimated relative to medical call volume (per 1000 calls) and workers (per 100 FTEs) from 2009 to 2019, and stratified by severity (lost-time, healthcare only), role (EMS, FIRE) and type (patient-handling). Power-lift stretchers were adopted between 2013 and 2015. Preinjury versus postinjury rates were compared using binomial tests. Interrupted time series (ITS) analysis was used to estimate the trend and change in injuries related to patient-handling, with occupational illnesses serving as control. RESULTS: Binomial tests revealed varied results, with reductions in the injury rate per 1000 calls (-14.0%) and increases in the rate per 100 FTEs (+14.1%); rates also differed by EMS role and injury severity. ITS analysis demonstrated substantial reductions in patient-handling injuries following implementation of power-lift stretchers, both in the injury rate per 1000 calls (-50.4%) and per 100 FTEs (-46.6%), specifically among individuals deployed on the ambulance. Injury rates were slightly elevated during the winter months (+0.8 per 100 FTEs) and lower during spring (-0.5 per 100 FTEs). CONCLUSIONS: These results support the implementation of power-lift stretchers for injury prevention in EMS systems and demonstrate advantages of ITS analysis when data span long preintervention and postintervention periods.

Efficacy of lifting devices for wheelchair transfers: a systematic review and meta-analysis.

A high prevalence of work-related musculoskeletal disorders (WMSDs) has been reported among nurses as a result of the injuries caused by patient transfer and handling. This review examines the impact of motorised and non-motorised lifting devices on reducing physical stress during wheelchair transfers among nurses. Systematic electronic database searches were performed, and the review was prepared according to the PRISMA guidelines. The results of 20 studies on biomechanical stresses related to WMSDs were synthesised qualitatively, and 13 were analysed quantitatively using meta-analysis. Motorised lifting devices significantly decreased biomechanical stress among nurses [SMD -0.68; 95% CI -1.02 to -0.34], whereas non-motorised counterparts showed no significant change [SMD - 0.23; 95% CI -0.59 to 0.13]. This study underscores the effectiveness of motorised lifting devices in mitigating WMSD risk during wheelchair transfers. The findings provide practical guidance for hospital administrators, policymakers, and experts seeking suitable devices to prevent WMSDs in nursing professionals.Practitioner Summary: This study investigated the impact of motorised and non-motorised lifting devices on nurses during wheelchair transfers. Findings revealed that motorised devices significantly reduce biomechanical stress, while non-motorised devices showed limited effectiveness. The research emphasises the superior role of motorised devices in preventing WMSDs during wheelchair transfers among nurses.

Ward-level leadership quality and prospective low-back pain of eldercare workers: do resident handlings mediate the association?

OBJECTIVE: We investigated the extent to which ward-level leadership quality was associated with prospective low-back pain among eldercare workers, and how this association was mediated by observed resident handlings. METHODS: 530 Danish eldercare workers, employed in 121 wards, distributed across 20 nursing homes were evaluated. At baseline, leadership quality was measured using the Copenhagen Psychosocial Questionnaire, and resident handlings [handlings per shift, handlings not using assistive devices, handlings done alone, interruptions to handlings, impediments to handlings] were assessed using observations. Frequency and intensity of low-back pain was assessed monthly during the following year. All variables were averaged for each ward. We used ordinary least squares regressions to examine direct effects of leadership on low-back pain and indirect effects through handlings, using PROCESS-macro for SPSS. RESULTS: After adjustments for low-back pain at baseline, type of ward, staff ratio (i.e., number of workers divided by number of residents) and proportion of devices not in place, leadership quality showed no effect on prospective low-back pain frequency (ß = 0.01 [- 0.05:0.07]) and a small beneficial effect on pain intensity (ß = - 0.02 [- 0.04:0.00]). Resident handlings did not mediate the association between leadership quality and frequency or intensity of low-back pain. CONCLUSIONS: Good leadership quality was associated with a small decrease in prospective low-back pain intensity, but resident handlings did not seem to play a mediating role, although better ward-level leadership quality contributed to fewer workplace-observed resident handlings without assistance. Potentially, organizational factors, such as type of ward and staff ratio, may have a greater influence on handlings and low-back pain than leadership quality per se among eldercare workers.

An evaluation on the effects of safe person handling program implementation at long term care facilities for persons with complex intellectual, developmental, and medical conditions.

BACKGROUND: This retrospective chart review sought to determine whether the introduction of a safe person handling and mobility (SPHM) program resulted in changes to the frequency, severity, cost, or profile of staff injuries incurred during person handling (PH) tasks at long-term care settings for persons with complex conditions. METHODS: This study analyzed the SPHM program implementation at an organization providing long-term residential, day habilitation, and special education services for persons with complex conditions. Data covered two 4-year periods before and after implementation. Analyses compared the frequency, severity, and cost of staff PH injuries, as well as of the affected body area, staff role, level of treatment, and the incurred costs of Workers' Compensation (WC) claims. RESULTS: There were substantive decreases in the total number of staff PH injuries and WC claims. Staff PH injuries affecting the trunk, the area most associated with PH injuries, decreased the most, followed by the upper extremities. Reductions were concentrated among direct care employees and their supervisors, job titles where PH exposures are most commonly seen. The proportion of staff injuries requiring medical treatment decreased significantly, as did injury severity. The number of lost workdays decreased by 94.6%. Incurred WC costs decreased by 91.1%. The proportion of WC claims associated with lost time decreased significantly. CONCLUSIONS: Substantive reductions in the frequency, severity, and incurred WC cost of staff PH injuries followed implementation of the SPHM program. Likewise, proportional changes were identified among the programs where cases occurred, the need for medical treatment, and WC cost type.

Underreporting of work-related low back pain among registered nurses: A mixed method study.

BACKGROUND: Identifying and addressing work-related health problems early is crucial, but workers often perceive barriers in reporting these to management. This study aimed to investigate the factors associated with nurses' reporting of work-related low back pain to their managers and explored the reasons why nurses with patient handling injuries did not report them. METHODS: This study is a concurrent mixed-method analysis of data from two statewide cross-sectional surveys of California registered nurses conducted in 2013 and 2016. The reporting of work-related low back pain to management (n = 288) was examined for associations with individual, occupational, and organizational factors. For qualitative analysis, the reasons for not reporting patient handling injuries were explored using open-ended responses (n = 42). RESULTS: Reporting was associated with BIPOC (Black, Indigenous, and People of Color) men (adjusted odds ratio [AOR]: 1.31, 95% confidence interval [CI]: 1.07-1.59) compared to non-Hispanic White women; being a non-US educated nurse (AOR: 0.90, 95% CI: 0.80-1.01); experiencing greater low back pain (AOR: 1.07, 95% CI: 1.02-1.12); missing work (AOR: 1.38, 95% CI: 1.21-2.62); perceiving high physical workload (AOR: 0.89, 95% CI: 0.81-0.98); perceiving high people-oriented culture (AOR: 1.14, 95% CI: 1.04-1.25); and perceiving high ergonomic practices (AOR: 0.89, 95% CI: 0.81-0.98). Identified themes on the reasons for not reporting injuries included organizational-culture attitudes toward work-related injuries and injury characteristics of musculoskeletal disorders. CONCLUSIONS: The findings indicate a need for management to remove structural barriers and improve organizational practices, and for a culture that promotes trust and open communication between workers and management.

Effectiveness of Safe Patient Handling Equipment and Techniques: A Review of Biomechanical Studies.

OBJECTIVE: This review aimed to evaluate all studies that have evaluated the biomechanical effects when using assistive devices. INTRODUCTION: The physical demands of patient handling activities are well known. One safety strategy for the reduction of the physical risks is use of assistive devices. METHOD: The search process identified articles published in English-speaking journals through Google Scholar, Medline, and ISI Web of Science. The included 56 studies contained a biomechanical assessment of a patient handling activity with assistive devices. RESULTS: The biomechanical effects included four groups: changes in body posture (spinal, other joints), subjective assessment (force, effort, discomfort), measured force (hand force, ground reaction force, spine force, joint torque), and physiological measures. The evidence showed caregivers benefited from using lift hoists, air-assisted devices, and to a lesser extent friction reducing devices for lateral transfers and repositioning, while floor and ceiling lifts were most effective for patient transfers. Some gaps were noted in the evidence and other handling tasks such as sit-to-stand, turning patient in bed, limb lifting, and repositioning and some more high hazard activities like supporting people with limited balance and those that fall need to be investigated with respect to biomechanical outcomes. CONCLUSION: There is a growing level of biomechanical evidence to support the use of assistive devices for many patient-handling tasks, but the benefits of equipment use in some transfers remain uninvestigated. PRACTICAL APPLICATION: Evidence indicates the best way to lift patients safely is with floor or ceiling lifts, and air-assisted devices for lateral and repositioning tasks.

Safe patient handling legislation and musculoskeletal disorders among California healthcare workers: Analysis of workers' compensation data, 2007-2016.

BACKGROUND: California requires general acute care hospitals to have a comprehensive plan to prevent patient handling injuries (PHIs) among employees. The California safe patient handling (SPH) law took effect in 2012. This study assessed the impact of the SPH law on workers' compensation claims for musculoskeletal disorders (MSDs) in California hospital workers. METHODS: We used California Workers' Compensation Information System data from 2007 to 2016 and analyzed claims for MSDs that occurred in acute care hospitals compared with nursing and residential care facilities. MSD claims were classified into PHI and non-PHI claims. RESULTS: We identified 199,547 MSD claims that occurred during 2007-2016 in acute care hospitals (62.8%) and nursing and residential care facilities (37.2%). MSDs accounted for 42.8% of all claims. Of the MSD claims, 81.0% were strains or sprains and 33.5% of MSDs were related to patient handling activities. From 2011 to 2016, MSD claim rates showed significant reductions among both hospital and nursing/residential care workers. However, the MSD-PHI claim rate showed a significant reduction only among hospital workers (7.3% per year, incidence rate ratio [IRR] = 0.927, 95% confidence interval [CI] 0.903-0.952). There was no significant change among nursing/residential care workers (IRR = 0.990, 95% CI 0.976-1.005). The non-PHI claim rate showed no significant change among hospital workers (IRR = 0.982, 95% CI 0.956-1.009). CONCLUSIONS: Our study identified significant reductions of PHI claims among California hospital workers after the passage of the SPH legislation, suggesting that SPH legislation played a crucial role in reducing the risk of injury among healthcare workers.

Application of MAPO (Movement and Assistance of Hospitalized Patients) method in hospitals and nursing homes: frequency of manual patient handling-part 2.

This study examines the evolution of MAPO method for estimating the frequency of overloading tasks in healthcare workers during different shifts. The data presented were collected from 51 in-patient wards (25 hospitals and 26 nursing homes), and 917 workers: the frequency of MPH tasks is a complementary value to the MAPO exposure level, which is useful to implement a prevention plan targeted towards the reduction of overloading tasks. Based on the frequency of manual patient handling, it appears that the afternoon shift is at greatest risk, with tasks liable to cause overloading occurring within a frequency range of 70-85 per worker. The study analyzes different pieces of equipment and their relative percentages of use, concluding that, overall, they are underutilised (especially minor aids and height-adjustable beds). Practitioner summary: The organisational data collected in hospitals and nursing homes confirms the availability of patient handling aids and equipment, but also indicates that they are underutilised with respect to the frequency of overloading tasks.

Critical review on applications and roles of exoskeletons in patient handling.

Musculoskeletal Disorders (MSDs) remain a major concern for workers in the healthcare industry. Healthcare workers are at high risk of work-related MSDs mainly caused by overexertion from manually handling patients. Exoskeletons may be a useful tool to help reduce the risk of MSDs during patient handling. As a review study, we surveyed articles focusing on applying exoskeletons to patient handling tasks specifically. We also reviewed relevant government databases and other studies related to Safe Patient Handling and Mobility (SPHM) programs and exoskeleton applications in general. The exoskeletons specifically designed for patient handling were found to be sparse. To have a better understanding of the needs and challenges of developing and using exoskeletons for reducing risks of work-related MSDs in healthcare workers during patient handling, this critical review (1) provided an overview of the existing issues and projected future burdens related to work-related MSDs during patient handling tasks, (2) recognized current and potential roles and applications of existing exoskeletons, and (3) identified challenges and needs for future exoskeleton products. In conclusion, we do not expect exoskeletons to replace the existing SPHM programs, but rather play a complementary role to these multi-pronged programs. We expect that emerging exoskeleton products can be introduced to uncontrolled or specialized healthcare environments. There are various expectations and requirements for an exoskeleton used in different healthcare settings. Additionally, introducing certain types of exoskeletons for patients to assist them during treatment and rehabilitation may help reduce the MSD risks to the healthcare workers.

Ergonomic exposures and control measures associated with mass fatality decedent handling in morgues and body collection points in a New York healthcare system during COVID-19: A case series.

INTRODUCTION: In April 2020, novel coronavirus SARS-CoV-2 (COVID-19) produced an ongoing mass fatality event in New York. This overwhelmed hospital morgues necessitating emergent expansion of capacity in the form of refrigerated trucks, trailers, and shipping containers referred to as body collection points (BCPs). The risks for musculoskeletal injury during routine and mass fatality mortuary operations and experiences of decedent handlers throughout the "first wave" of COVID-19 are presented along with mitigation strategies. METHODS: Awareness of the high rates of musculoskeletal injury among health care workers due to ergonomic exposures from patient handling, including heavy and repetitive manual lifting, prompted safety walkthroughs of mortuary operations at multiple hospitals within a health system in New York State by workforce safety specialists. Site visits sought to identify ergonomic exposures and ameliorate risk for injury associated with decedent handling by implementing engineering, work practice, and administrative controls. RESULTS: Musculoskeletal exposures included manual lifting of decedents to high and low surfaces, non-neutral postures, maneuvering of heavy equipment, and push/pull forces associated with the transport of decedents. DISCUSSION: Risk mitigation strategies through participatory ergonomics, education on body mechanics, development of novel handling techniques implementing friction-reducing aides, procurement of specialized equipment, optimizing BCP design, and facilitation of communication between hospital and system-wide departments are presented along with lessons learned. After-action review of health system workers' compensation data found over four thousand lost workdays due to decedent handling related incidents, which illuminates the magnitude of musculoskeletal injury risk to decedent handlers.

Training in "reasoned handling care": (Re)discovering meaning in work / La formation au « soin de manutention raisonné ¼ : (re)trouver le sens du métier

Context: Patient handling has had adverse health effects on nursing staff for many years. In order to prevent these effects, training programs using a demonstration-based pedagogy, aiming at promoting "good" handling practices, are often proposed. Goals: To develop a training program that enhances learners' reasoning abilities and allows them to formulate situation-appropriate handling practices that emancipate the professional and respect the patient's autonomy and well-being. Method: A training program targeting nurses and nursing students was designed and implemented. Learners were requested to design the simulation scenarios themselves. The training sessions were recorded and analyzed. Results: The scenarios designed by learners were pedagogically and subjectively relevant. Interactions during the different phases­design, simulation, and debriefing­allowed learners to assess acceptable and adapted solutions and to discuss their own practice, considering patient handling as a care activity in its own right. Conclusion: The training program appears as an efficient alternative to classic training programs. It develops learners' reasoning abilities and restores meaning to nursing work.

Contexte: La manutention du patient génère des atteintes à la santé des soignants depuis de nombreuses années. En réponse à cette sinistralité, des formations basées sur une pédagogie démonstrative sont souvent proposées, avec pour objectif l'apprentissage du « bon ¼ geste. Objectifs: Développer une formation qui favorise le raisonnement des apprenants pour la construction d'un geste adapté et situé, émancipateur pour le professionnel et respectueux de l'autonomie, du bien-être du bénéficiaire. Méthode: La recherche s'appuie sur des données empiriques recueillies dans le cadre de la conception et du déploiement de sessions de formation à destination de soignants et d'élèves aides-soignantes. Ces formations font appel à la simulation et proposent aux participants de construire eux-mêmes les scénarios de simulation. Résultats: Les apprenants sont capables de concevoir des scénarios subjectivement et pédagogiquement pertinents. Les échanges lors des phases de conception, de simulation et de débriefing permettent aux apprenants de s'accorder sur des solutions acceptables, singulières, et de débattre du métier en appréhendant la manutention comme un soin à part entière. Conclusion: Le dispositif de formation est une alternative aux approches classiques de la manutention. Il permet de développer la capacité de raisonnement des apprenants pour (re) donner du sens au travail.

Effect of Repositioning Aids and Patient Weight on Biomechanical Stresses When Repositioning Patients in Bed.

OBJECTIVE: The aim of the study was to estimate the risk of injury when repositioning patients of different weight with commonly used repositioning aids. BACKGROUND: Repositioning dependent patients in bed is the most common type of patient handling activity and is associated with high rates of musculoskeletal disorders in healthcare workers. Several studies have evaluated repositioning aids, but typically for a single patient weight and often without estimating risk of injury based on biomechanical analysis. METHOD: Ten nurses performed four repositioning activities on three participants (50, 77, 141 kg) using three repositioning aids (pair of friction-reducing sheets [FRS], turn and position glide sheet, air-assisted transfer device) and a draw sheet. Motion capture, hand forces, and ground reaction forces were recorded. Spine loading was estimated using a dynamic biomechanical model. RESULTS: Hand forces and spine compression exceeded recommended limits for most patient weights and repositioning tasks with the draw sheet. FRS and glide sheet reduced these loads but still exceeded recommended limits for all but the 50-kg patient. Only the air-assisted transfer device reduced forces to accepted levels for all patient weights. Physical stresses were relatively low when turning patients. CONCLUSION: Most repositioning aids are insufficient to properly mitigate risk of musculoskeletal injury in healthcare workers. Only the air-assisted transfer device was sufficient to adequately mitigate the risk of injury when moving patients of average or above-average weight. APPLICATION: To safely move dependent patients, a robust solution requires mechanical lifts and may utilize air-assisted transfer devices for patient transfers.

Proning Patients With COVID-19: A Review of Equipment and Methods.

OBJECTIVE: To identify and critically evaluate methods for proning patients with COVID-19 in the intensive care unit (ICU). BACKGROUND: Acute respiratory distress syndrome (ARDS) is common in hospitalized patients with COVID-19. Proning improves blood oxygenation and survival rates in these patients but is not commonly performed due to the difficulty of the procedure. METHODS: An academic literature review, internet video search, and consultation with five subject-matter experts was performed to identify known methods for proning. Evaluation of each method considered the number of healthcare workers required, physical stresses on staff, risk of adverse events to patients, and equipment cost and availability. RESULTS: Several variations of manual techniques and-lift assisted techniques were identified in addition to a specialized proning bed. Manual methods require more healthcare workers, higher physical stresses, and greater risk of adverse events than lift-assisted methods or the proning bed. CONCLUSION: Both the specialized proning bed and a lift-assisted method using straps largely eliminated manual forces required for proning while allowing for a controlled lowering and positioning of the patient. APPLICATION: This review will guide practitioners to the most suitable methods for proning patients in the ICU.

Optimal foot-position of caregiver based on muscle activity of lower back and lower limb while providing sit-to-stand support.

[Purpose] In caregivers, low load posture is necessary to prevent lower back pain during patient handling activities such as sit-to-stand support. This study focused on the foot-position of caregivers as an adjustable and useful parameter. A wide stance decreases the stress on the lumbar vertebra. However, this foot-position increases loading of the spinae erector muscles. The aim of this study was to investigate the relationship of anterior-posterior and lateral-medial distances between feet and activity of the spinae erector muscles to determine the optimal foot-position for reducing stress on the lumbar vertebra without increasing spinae erector muscle load. [Participants and Methods] Five young male participants were asked to provide sit-to-stand support 10 times using nine normalized foot-positions with different anterior-posterior and lateral-medial distances. Surface electromyograms of the erector spinae and lower limb muscles were measured during sit-to-stand support. [Results] The results showed that the optimal foot-position (anterior-posterior 55%, lateral-medial 20% of body height) increased muscle activity within the lower limb muscles compared with the lower back muscles and did not increase loads on the erector spinae muscle. [Conclusion] Optimizing foot-position can reduce stress on the lumbar vertebra without increasing load on the spinae erector muscles.

Impact of California's safe patient handling legislation on musculoskeletal injury prevention among nurses.

BACKGROUND: This study evaluated the impact of California's safe patient handling (SPH) legislation on musculoskeletal injury prevention among hospital nurses. METHODS: Two serial cross-sectional surveys were conducted using postal and online questionnaires in statewide random samples of California registered nurses in 2013 and 2016. Analysis included hospital nurses who performed patient handling (n = 254 and n = 281, respectively). RESULTS: In 2016, there were significant improvements in nurses' knowledge of a SPH policy in their hospital (87%), receipt of annual SPH training (73%), and availability of lift equipment (80%); 33% perceived their hospital's SPH programs as excellent or very good. Significant prevalence reduction was observed for work-related musculoskeletal symptoms (61% vs 52%; Adjusted Prevalence Ratio = 0.78, 95% CI 0.66-0.91). CONCLUSIONS: Our findings indicate the significant role of SPH legislation with positive impacts on SPH policies and programs at the hospital level and on musculoskeletal health outcomes at the worker level.

Commercially Available Friction-Reducing Patient-Transfer Devices Reduce Biomechanical Stresses on Caregivers' Upper Extremities and Low Back.

OBJECTIVE: The aim of this study was to evaluate the efficacy of commercially available friction-reducing patient-transfer devices in reducing biomechanical stresses on caregivers and patients. BACKGROUND: Caregivers suffer from high prevalence of work-related musculoskeletal disorders, which is associated with manual patient handling. However, there is not enough information available on the efficacy of various friction-reducing devices in reducing biomechanical stresses in the upper extremities and low back. METHOD: During patient-transfer tasks performed by 20 caregivers, we measured hand force; shoulder and trunk posture; shoulder moment; muscle activity in the flexor digitorum superficialis, extensor digitorum communis, biceps, triceps, trapezius, and erector spinae; and usability ratings from four devices: a draw sheet, a repositioning sheet, a slide board, and an air-assisted device. In addition, triaxial head acceleration of mock patients was measured to evaluate patients' head acceleration. RESULTS: The slide board and air-assisted device significantly reduced hand force (p < .001), shoulder flexion (p < .001), shoulder moment (p < .001), muscle activities of caregivers (p < .004), and patients' head acceleration (p < .023) compared with the draw sheet. However, no significant differences in biomechanical measures were found between the repositioning and draw sheets. The air-assisted device consistently showed the lowest biomechanical stresses and was most preferred by participants. CONCLUSION: Reduction in caregivers' biomechanical stresses and mock patients' head acceleration indicates that a slide board and an air-assisted device can be effective engineering controls to reduce risk of injury. APPLICATION: The study results can provide a recommendation for engineering controls to reduce biomechanical stresses for both caregivers and patients.

To what extent do paramedics apply safe handling principles when transferring patients from stair chairs to stretchers?

The efficiency of training programmes in handling designed to prevent injuries has rarely been demonstrated by studies in the workplace. This study aimed to identify factors that may favour or inhibit the application of safe handling principles by paramedics performing full-body transfers of patients from a stair chair to a stretcher. In an observational field study, handling methods used in 45 patient transfers from a stair chair to stretcher were characterised. Principles concerning the physical environment seem to be applied frequently, but those applicable during the transfer are neglected. Principles taught during training may not be applied due to the physical constraints of the workplace and the underestimation of risk exposure. The results suggest that training should be enhanced, not by focussing on handling techniques but by focussing on compromise and the capacity to adapt work techniques based on the working context and the team-mate.

Nurses and nursing assistants decision-making regarding use of safe patient handling and mobility technology: A qualitative study.

AIM: This study explored decision-making regarding use of safe patient handling and mobility (SPHM) technology among registered nurses (RN) and nursing assistants (NA). BACKGROUND: Lifting injuries are common among healthcare workers. Despite development of standards for SPHM, the introduction of regulation for monitoring access to SPHM technology, and implementation of education programs and process improvements, threat of injury remains a concern. Although access to SPHM equipment is associated with decreased workplace injuries, access alone does not guarantee use. Questions remain concerning how healthcare workers make decisions to use SPHM equipment, and how they weigh decisions against personal safety. METHODS: A qualitative descriptive study was conducted. Data collection consisted of four 60min focus groups. Two focus groups consisted of all RNs (n=14) and two consisted of all NAs (n=11). Each focus group was audiotaped and transcribed verbatim. Transcripts were coded, repeating concepts identified, and codes collapsed into themes and subthemes. RESULTS: Qualitative analysis revealed three major themes: barriers to use, perceived risk, and coordination of care. Barriers to use include subthemes of physical barriers, knowledge and skill, and unit culture. Perceived risk includes patient risk and perceived risk to self. Coordination of care includes patient factors and characteristics, assessment of patient needs and abilities, and interprofessional collaboration. CONCLUSIONS: These findings provide new knowledge about the complexity of decision making among care providers in the use of SPHM technology. Interprofessional team approaches to patient assessment and care are important components of confident decision making in use of SPHM technology.

[Manual handling, job fitness, and musculoskeletal disorders in the Sondrio hospital (Italy) healthcare workers.] / Movimentazione manuale, idoneità alla mansione e disturbi muscolo-scheletrici negli operatori sanitari dell'Ospedale di Sondrio.

OBJECTIVES: Musculo-skeletal disorders (MSD) are a large group of locomotor system pathologies with multifactorial etiology. Healthcare professionals are often exposed to biomechanical overload of the spine and upper limb, for example during patient handling, and represent a working population at risk. METHODS: In order to acquire further knowledge on this subject, we conducted a cross-sectional study (year 2016) among healthcare workers (excluding physicians) of the Sondrio Hospital (Italy), investigating the correlations between manual handling, MDS and job fitness. RESULTS: The sample examined included 667 subjects (74 males and 593 females, mean age: 50 years): 557 (83.5%) certified fully "fit for the job", 109 (16.3%) "partially fit" (with limitations and/or prescriptions), and one "not fit" female worker. Eighty-seven of the 109 partial fitnesses (79.8%) were related to manual handling. In turn, 76 of the 87 limitations/prescriptions for manual handling (87.4%) were due to the presence of musculo-skeletal disorders (accompanied by instrumental diagnosis, and often associated with each other), especially of the lumbo-sacral tract, to a lesser extent of the cervical spine, shoulder or other body districts. Associations between partial job fitness and worker operative units have not been observed. CONCLUSIONS: The data indicate that, among healthcare workers, the biomechanical overload of the limbs and the spine, and the related MSD, are the health problems that most often come to the attention of the occupational physician, posing delicate problems for the "fitness to job" certification. The observed lack of correlation with the operative unit is an expression of the tendency to relocate staff with MSD in tasks at lower biomechanical risk.

Factors affecting pain relief in response to physical exercise interventions among healthcare workers.

The aim of this study is to identify factors associated with musculo-skeletal pain reduction during workplace-based or home-based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0-10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed alone during leisure-time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi-adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure-time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home-based exercise in reducing musculo-skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo-skeletal pain.