Changes needed to reduce risk of musculoskeletal disorders.

Musculoskeletal disorders (MSDs) are the main contributor to disability levels, which are rising as populations age. Workplace hazard exposures are a major source of this problem, and current workplace risk management practices require substantial changes to tackle it more effectively. Most importantly, the current focus of risk management on "manual handling" tasks must broaden to encompass the whole job. This is necessary because a wide range of psychosocial hazards, most of which operate across the whole job rather than particular tasks, are significant contributors to risk. To ensure that risk-control actions are effective, a recurring risk management cycle that includes worker participation and addresses risk from both biomechanical and psychosocial hazards will be essential. Legislation that mandates workplace management of psychosocial hazards would be helpful. Amendment by regulatory bodies of MSD-related guidance and codes of practice so that they reflect current research evidence would also be helpful in communicating the need for change to workplace stakeholders.

Investigating the Risk of Patient Manual Handling Using the Movement and Assistance of Hospital Patients Method among Hospital Nurses in Botswana.

BACKGROUND: Evidence on the prevalence of lower back pain (LBP) among nurses is widespread in the literature, with several risk factors being reported. These include manual handling of patients, repetitive bending and twisting movements, and long working hours. It is reported that LBP has negative health outcomes and causes poor work performance among healthcare workers (HCWs). The magnitude of ergonomic risks associated with these healthcare activities has not been adequately investigated in Botswana. Thus, this study aimed to investigate the ergonomic risk levels associated with the manual handling of patients and its association with the prevalence of LBP among nurses in Botswana. METHODS: This was an observational cross-sectional hospital-based study conducted in a Botswana public tertiary hospital from March to April 2023. The Movement and Assistance of Hospital Patients (MAPO) tool was used to collect data on ergonomic risk levels. Data on the demographic characteristics of participants were collected using a tool adapted from the Nordic Musculoskeletal Questionnaire (NMQ). Odds ratios and 95% confidence intervals were estimated to determine the association between ergonomic risk levels and the prevalence of LBP. RESULTS: A total of 256 nurses participated and completed the study. The self-reported prevalence of LBP in this study was 76.6%. The risk of acquiring LBP was high (90.5%) based on the MAPO index. Although the frequencies of self-reported LBP were high among nurses, these did not show any significant association with the MAPO index data. This could be partly due to the small sample size. CONCLUSIONS: There was a high prevalence of LBP in this study, which was corroborated by the MAPO index data. This has demonstrated the value of the MAPO index in forecasting the risk of patient manual handling. The findings might help Botswana formulate policies intended to address ergonomic preventive measures, directed towards reducing the MAPO index score by addressing the single risk determinants.

Manual rolling load and low back pain among workers in Japan: a cross-sectional study.

OBJECTIVES: Manual rolling of heavy objects remains in the workplace. The Health and Safety Executive (HSE) in the United Kingdom recommends load weights of <400 kg in the rolling task. However, the association of rolling weights <400 kg with work-related low back pain (LBP) has not been sufficiently investigated. This study examined the effect of rolling loads weighing <400 kg on LBP among Japanese workers. METHODS: A web-based survey gathered information from 15 158 workers in 2022. Among them, 15 035 did not handle loads, whereas 123 handled rolling weights <400 kg. Load weight was categorized into 4 groups: no-handling (0 kg) and rolling weights of ≤20, 20-40, and >40 kg. Multiple logistic regression analysis examined the association between the subdivided rolling weight and LBP. RESULTS: No significant differences in odds ratio (OR) of LBP were found for workers handling ≤40 kg rolling weights compared with that for no-handling workers. However, workers handling >40 kg rolling weights had a significantly greater OR of LBP than those not handling loads. CONCLUSIONS: Rolling weights between 40 and 400 kg could place a high stress on the lower back. Implementation in Japan of the HSE recommendations regarding rolling load should be carefully considered.

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.

The highs and lows of lifting loads: SPM analysis of multi-segmental spine angles in healthy adults during manual handling with increased load.

Introduction: Manual handling personnel and those performing manual handling tasks in non-traditional manual handling industries continue to suffer debilitating and costly workplace injuries. Smart assistive devices are one solution to reducing musculoskeletal back injuries. Devices that provide targeted assistance need to be able to predict when and where to provide augmentation via predictive algorithms trained on functional datasets. The aim of this study was to describe how an increase in load impacts spine kinematics during a ground-to-platform manual handling task. Methods: Twenty-nine participants performed ground-to-platform lifts for six standardised loading conditions (50%, 60%, 70%, 80%, 90%, and 100% of maximum lift capacity). Six thoracic and lumbar spine segments were measured using inertial measurement units that were processed using an attitude-heading-reference filter and normalised to the duration of the lift. The lift was divided into four phases weight-acceptance, standing, lift-to-height and place-on-platform. Statistical significance of sagittal angles from the six spine segments were identified through statistical parametric mapping one-way analysis of variance with repeated measures and post hoc paired t-tests. Results: Two regions of interest were identified during a period of peak flexion and a period of peak extension. There was a significant increase in spine range of motion and peak extension angle for all spine segments when the load conditions were increased (p < 0.001). There was a decrease in spine angles (more flexion) during the weight acceptance to standing phase at the upper thoracic to upper lumbar spine segments for some condition comparisons. A significant increase in spine angles (more extension) during the place-on-platform phase was seen in all spine segments when comparing heavy loads (>80% maximum lift capacity, inclusive) to light loads (<80% maximum lift capacity) (p < 0.001). Discussion: The 50%-70% maximum lift capacity conditions being significantly different from heavier load conditions is representative that the kinematics of a lift do change consistently when a participant's load is increased. The understanding of how changes in loading are reflected in spine angles could inform the design of targeted assistance devices that can predict where and when in a task assistance may be needed, possibly reducing instances of back injuries in manual handling personnel.

Patient handling training interventions and musculoskeletal injuries in healthcare workers: Systematic review and meta-analysis.

Workplace injuries are a serious issue for the health and social care industry, with the sector accounting for 20 % of all serious claims reported. The aim of this systematic review was to determine whether patient handling training interventions that included instruction on patient transfer techniques are effective in preventing musculoskeletal injuries in healthcare workers. Methods: Electronic databases MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and Health and Safety Science Abstracts (ProQuest) were searched for controlled trials from January 1996-August 2022. Risk of bias was evaluated using the PEDro scale and overall certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluation for each meta-analysis. Results: A total of nine studies (3903 participants) were included. There is moderate certainty evidence that could not conclude whether patient handling training affects the 12-month incidence of lower back pain (OR = 0.83, 95 % CI [0.59, 1.16]). There is low certainty evidence that patient handing training does not prevent lower back pain in health professionals without pre-existing pain (MD = -0.06, 95 % CI [-0.63, 0.52]) but may reduce lower back pain in those with pre-existing pain (MD = -2.92, 95 % CI [-5.44, -0.41]). The results also suggest that there may be a positive effect of training incorporating risk assessment on musculoskeletal injury rates; however the evidence is of very low certainty. There is low certainty evidence from a single study that training may have a short-term effect on sickness absences.) Conclusions: There is a lack of evidence to support patient handling training when delivered to all healthcare staff. Training in its current form may be an ineffective strategy for reducing musculoskeletal injuries and pain. High quality disinvestment studies or trials incorporating risk assessment strategies are warranted. Practical Applications: This review suggests health service managers question the effectiveness of current patient handling training practices and consider evaluating current practices before allocating resources to meet employee risk reduction obligations.

Modeling heart rate of individual and team manual handling with one hand using generalized additive mixed models.

OBJECTIVES: Despite the fact that team manual handling is common in different working environments, the previous studies in this regard, particularly those with a physiological approach are quite limited. The present study is an attempt to model the heart rate (HR) of individual and team manual handling with one hand. METHODS: Twenty-five young men (aged 21.24±1.42 year) volunteered for this study. The experiments included individual and two-person handling of the load with three different weights with and without height difference. The participants' HR was registered at the end of the route by a chest-strap pulse monitor and a polar watch according to the manufacturer's recommendation. A multivariate Generalized Additive Mixed Model (MGAMM) was used for modeling heart rate based on explanatory variables of workload, carry method, HRrest, body weight, height, knee height, shoulder height, elbow height, and hand height. The significance level of the tests was considered as <0.05. RESULTS: Based on the MGAMM, the average HR (bpm) of participants increased as the workload increased (P<0.001). Handling the load with a taller person increased the HR compared to shorter partner (P<0.001). Moreover, the nonlinear associations of the resting HR (P<0.001), body weight (P<0.001), height (P<0.001), and the height of elbow, hand and knee (P<0.001) were statistically significant. The adjusted R2 of the model was 0.89 indicating that about 90 percent of the variations observed in HR could be explained by the variables in the model. This was greater than the model considering only linear effects (R2 =0.60). CONCLUSION: The model obtained in this study can predict the heart rate of individual and team one-handed handling with high validity. The MGAMM can be used in modeling heart rate in manual handling.

Can we enable individuals to reach further down without rounding their backs before beginning a lift? Examining the influence of starting foot and trunk position on reach depth.

There is disagreement regarding the efficacy of 'safe' lifting recommendations for reducing low back disorder risk. These recommendations commonly focus on minimising lumbar spine flexion, which limits the range of allowable starting lift positions for that person. This study evaluated whether starting postural adaptations could allow a person to reach down further without rounding their lumbar spine before beginning a lift. Reach displacement was measured as participants performed a series of maximal reach tasks under different combinations of stance width, foot orientation and trunk inclination, with their lumbar spine motion restricted. There were no interactions between any of the three postural adaptations or any effect of stance width or trunk inclination. Seventy-nine percent of participants achieved their greatest reach displacement with their feet externally rotated, which contributed to a 4 cm greater reach displacement compared to a neutral foot orientation (p < 0.001).Practitioner summary: This study examined whether aspects of initial posture could influence the ability to adhere to 'safe' lifting recommendations across a range of lift heights. As a component of lifting (re)training interventions, practitioners should consider starting lift posture adaptations (e.g. manipulating foot external rotation) to improve capacity to adhere to recommendations.

Dynamic assessment for low back-support exoskeletons during manual handling tasks.

Exoskeletons can protect users' lumbar spine and reduce the risk of low back injury during manual lifting tasks. Although many exoskeletons have been developed, their adoptability is limited by their task- and movement-specific effects on reducing burden. Many studies have evaluated the safety and effectiveness of an exoskeleton using the peak/mean values of biomechanical variables, whereas the performance of the exoskeleton at other time points of the movement has not been investigated in detail. A functional analysis, which presents discrete time-series data as continuous functions, makes it possible to highlight the features of the movement waveform and determine the difference in each variable at each time point. This study investigated an assessment method for exoskeletons based on functional ANOVA, which made it possible to quantify the differences in the biomechanical variables throughout the movement when using an exoskeleton. Additionally, we developed a method based on the interpolation technique to estimate the assistive torque of an exoskeleton. Ten men lifted a 10-kg box under symmetric and asymmetric conditions five times each. Lumbar load was significantly reduced during all phases (flexion, lifting, and laying) under both conditions. Additionally, reductions in kinematic variables were observed, indicating the exoskeleton's impact on motion restrictions. Moreover, the overlap F-ratio curves of the lumbar load and kinematic variables imply that exoskeletons reduce the lumbar load by restricting the kinematic variables. The results suggested that at smaller trunk angles (<25°), an exoskeleton neither significantly reduces the lumbar load nor restricts trunk movement. Our findings will help increasing exoskeleton safety and designing effective products for reducing lumbar injury risks.

The Three-Dimensional Body Center of Mass at the Workplace under Hypogravity.

The center of mass dynamics of the seated posture of humans in a work environment under hypogravity (0 < g < 1) have rarely been investigated, and such research is yet to be carried out. The present study determined the difference in the body system of 32 participants working under simulated 1/6 g (Moon) and 1 g (Earth) for comparison using static and dynamic task measurements. This was based on a markerless motion capture method that analyzed participants' center of mass at the start, middle and end of the task when they began to get fatigued. According to this analysis, there is a positive relationship (p < 0.01) with a positive coefficient of correlation between the downward center of mass body shift along the proximodistal axis and gravity level for males and females. At the same time, the same positive relationship (p < 0.01) between the tilt of the body backward along the anterior-posterior axis and the level of gravity was found only in females. This offers fresh perspectives for comprehending hypogravity in a broader framework regarding its impact on musculoskeletal disorders. It can also improve workplace ergonomics, body stability, equipment design, and biomechanics.

The Effect of Corrective and Encouraging Accumulated Vibrotactile Feedback on Work Technique Training and Motivation-A Pilot Study.

Encouraging feedback is shown to increase motivation and facilitate learning in different settings, though there is a lack of knowledge of applying it in work technique training. This pilot study aimed to evaluate two accumulated vibrotactile feedback strategies for work technique training using a smart workwear system. Eight women and two men participated in the study. They were divided into two groups, receiving the corrective feedback or the combined corrective and encouraging feedback while doing simulated manual handling tasks in a lab environment. Questionnaires and semi-structured interviews were used to evaluate the motivation, learning, and user experiences. In this small sample size, we saw that both groups significantly improved their work technique of upper arm and trunk postures, and no significant difference between groups was seen. In addition, both groups reported increased ergonomic awareness, were satisfied with the feedback training, and considered the system useful. However, the combined feedback group had slightly lower ratings of motivation and more negative experiences of the corrective feedback itself compared to the corrective feedback group. Both groups had positive experiences with the encouraging feedback. Future research should consider investigating the long-term learning effects of using solely corrective or encouraging accumulated feedback for work technique training with such systems.

Effects of Slide Sheet Use and Bed Position on Muscle Activities in the Low Back and Extremities: A Pilot Experimental Simulation Study.

BACKGROUND: Low-friction slide sheets (SS) are designed to reduce compression loads on the body during manual handling tasks, such as boosting patients. Using SS has been shown to decrease muscle activity in the lower back and upper extremities. However, it is unclear if this effect varies with different bed positions. To investigate this, we studied the effects of SS use, bed height, and their combination on muscle activity during a simulated patient boost. METHODS: Thirty-three Japanese undergraduate students (age 21.0 ± 1.1 years; 14 men, 19 women) participated. Participants were asked to boost a dummy figure on the bed three times each using four conditions. During the repositioning task, electromyography of eight muscles of the lower back and upper and lower extremities, hip and knee joint flexion angles, pelvic forward tilt angle, and position of the center of mass based on the posterior superior iliac spine were evaluated. FINDINGS: Electrophysiological activities of muscles of lower back and upper extremities were significantly lower with SS than without it in both bed positions (30% and 40% of body height); the reduction in muscle activities with SS use was 20% to 40%. Lowering the bed did not affect the SS effect magnitude on reducing muscle activities, although postural changes, including hip and knee joint flexion, were observed. CONCLUSIONS/APPLICATION TO PRACTICE: SS reduced muscle activities in the back, upper, and lower extremities when the bed was in the low position, and this effect persisted at a bed height of ≥30% of the participant's height.

Optimizing aged care environments to promote resident functional mobility and reduce staff injury risk.

Introduction: This study aimed to evaluate the suitability and usability of the Pro-Mobility patient/person handling assessment tool (ProMob) within residential aged care. Physiological changes associated with ageing influence an older person's ability to perform functional mobility tasks such as transferring from furniture and walking. Strategies that improve capability and/or reduce the physical demands of the task have the potential to promote an older person's mobility, independence and wellbeing. Environment-related strategies in Manual Handling of People (MHP), such as optimum seated heights, in part address this challenge, as they can promote resident functional mobility while also protecting staff from injury. The ProMob tool was developed to address this issue through systematic evaluation of these environmental factors. Methods: The participants in this study were seven (7) residential aged care facilities (RACFs) operated by a not-for-profit aged care organization. A qualified assessor evaluated MHP risk management with the ProMob tool at each RACF through collection of data for a random sample of residents (n = 67) regarding their living environments and available mobility information. Data was transferred to an SPSS-22 statistical software database for analysis which involved descriptive statistics and cross tabulations. Results: Application of the ProMob tool provided effective quantification of the nature and extent of environment-related MHP interventions that may influence resident mobility. Areas for improvement with MHP risk management were identified, with variation evident across RACF's within the same organisation, which was not consistent with levels of care (e.g., lack of clear space to facilitate mobility). Low level care facilities were observed to have fewer adaptive environmental features that could potentially slow decline in independence. Discussion: Features of the aged care environment can be used to facilitate the functional mobility of aged care residents, and simultaneously reduce injury risk for staff in MHP interactions. The ProMob tool can be used for auditing care facilities, planning re-development, and continual improvement in provision of care and management of staff injury risk exposure.

Feasibility of implementing an innovative manual handling risk assessment training program for staff working in long-term care.

BACKGROUND: The Risk Assessment for moving Individuals SafEly (RAISE) program is a hospital-based manual handling nursing training program. RAISE involves upskilling on continual risk assessment during patient-assisted movements. RAISE aims to optimise staff and patient safety while providing the patient with movement and rehabilitation opportunities. Implementation of RAISE in the hospital setting has been established. The aim of this study was to explore the feasibility of implementing RAISE in the long-term care setting. METHODS: We examined three feasibility domains: acceptability, practicality, and limited efficacy (observed nursing behaviour change which has the potential to reduce nursing injuries), using a prospective pilot pre-post design in the long-term care setting. Staff completed a 4-hour training session on RAISE delivered by two physiotherapists, followed by 8 h of supported behaviour change in the workplace. Staff acceptability and practicality of incorporating risk assessment strategies into manual handling approaches were explored through pre- and post-training staff surveys and a semi-structured interview. Resident acceptability of manual handling practices was explored via survey data collected after the RAISE training. Pre to post-training changes in staff knowledge and behaviour were examined through the pre- and post-training staff survey, and observation of staff assisting resident movement. RESULTS: Two enrolled nurses and five residents participated. Staff reported the RAISE program was acceptable and practical to implement in the long-term care setting. There were no adverse events or safety concerns. Staff reported the RAISE program provided guidance and enhanced staff empowerment to make decisions during assisted resident movement. There were 26 observed resident-staff manual handling interactions recorded, with 13 pre-training and 13 post-training. Post-training, RAISE skills had improved and were completed 100% of the time, except for completing a physical risk assessment which improved from 46 to 85%, demonstrating limited efficacy. Residents reported it's important for staff to be trained on how to assist them to mobilise and they found the concept of the RAISE program acceptable. CONCLUSIONS: This pilot study supports the feasibility of long-term care facilities participating in future studies testing the effectiveness and cost-effectiveness of the Risk Assessment for moving Individuals SafEly (RAISE) patient and resident manual handling program.

An Exploration of the Influence of Non-Biomechanical Factors on Lifting-Related LBP.

Objective: The primary objective was to compare non-biomechanical factors between manual workers with and without a history of LBP related to lifting. A secondary objective was to investigate associations between the change in pain intensity during repeated lifting (termed pain ramp) and non-biomechanical factors tested in the LBP group. Methods: Manual workers currently in lifting occupations with and without a history of lifting-related LBP were recruited (21 LBP and 20 noLBP) and took part in a repeated (100) lift task. A series of non-biomechanical factors, including psychological, work-related, lifestyle, whole health and psychophysical factors, were collected. Psychophysical factors (pressure pain thresholds (PPTs) and fatigue) were also measured at different time points. Associations between pain ramp during lifting and non-biomechanical factors were investigated with linear regression. Results: The LBP group reported worse perceived sleep quality, more musculoskeletal pain sites other than LBP and greater symptoms related to gastrointestinal complaints and pseudo-neurology compared to the group with no history of LBP. The group with LBP were also slightly more worried about the lifting task and felt more fatigued at the end of the lifting task. The feeling of fatigue during lifting was positively associated with pain ramp in the LBP group. Anxiety and gastrointestinal complaints were weakly negatively associated with pain ramp during lifting. Conclusions: The group differences of poorer perceived sleep, greater non-specific health complaints, slightly more worry about the lifting task and more perceived fatigue in the LBP group highlight the complex and multi-factorial nature of LBP related to lifting. The feeling of fatigue was positively associated with pain ramp in the LBP group, suggesting a close relationship with pain and fatigue during lifting that requires further exploration.

Manual handling amongst physiotherapists: Analysis of intra-shift variations in pain, fatigue and movement.

BACKGROUND: Manual handling injuries amongst physiotherapists are common and the need to improve our understanding of causal influences is imperative. OBJECTIVE: The objective was to determine whether intra-shift variations in manual handling task performance occurred in our cohort, which may inform mechanisms underpinning related injuries. METHODS: We used motion capture, force plate dynamics and electromyography to identify variations in task performance, loading forces and muscle activity, during the performance of one static and one dynamic standardized manual handling task, pre- and post-shift, by 40 physiotherapists. Participants also rated their pain and fatigue on a visual analogue scale (VAS). Statistical analysis utilised paired samples Student's t tests. RESULTS: Significant differences were seen in the EMG activity in the quadriceps during the static task only. No significant differences were seen for any of the kinematic variables. Significant differences in fatigue (p < 0.005) were seen between the pre- and post-shift sessions. Notably, there were significant differences in pain between the pre- and post-shift sessions in the static (p < 0.01) and dynamic tasks (p < 0.05). This increase in pain was at a level which impacted on function. CONCLUSION: Whilst significant variations in task performance were not observed, our findings indicate that physiotherapists frequently experience task-related pain towards the end of their shift. Contemporary research indicates that frequent transient low back pain may transition to a chronic disabling condition, as such we posit that the effects of intra-shift pain, and its causative factors, should be more widely considered in a 'whole-of-job' approach to mitigating risk in this demographic.

A systematic literature review of evidence for the use of assistive exoskeletons in defence and security use cases.

Advances in assistive exoskeleton technology, and a boom in related scientific literature, prompted a need to review the potential use of exoskeletons in defence and security. A systematic review examined the evidence for successful augmentation of human performance in activities deemed most relevant to military tasks. Categories of activities were determined a priori through literature scoping and Human Factors workshops with military stakeholders. Workshops identified promising opportunities and risks for integration of exoskeletons into military use cases. The review revealed promising evidence for exoskeletons' capacity to assist with load carriage, manual lifting, and working with tools. However, the review also revealed significant gaps in exoskeleton capabilities and likely performance levels required in the use case scenarios. Consequently, it was recommended that a future roadmap for introducing exoskeletons to military environments requires development of performance criteria for exoskeletons that can be used to implement a human-centred approach to research and development.

We assessed the state-of-the-art for the use of wearable assistive exoskeletons in UK defence and security use cases. A full systematic review of the literature was undertaken, informed by use cases developed in military stakeholder workshops. Clear gaps in exoskeleton capability and use case requirements were identified, leading to recommendations for future work.

Biomechanical assessment of a passive back-support exoskeleton during repetitive lifting and carrying: Muscle activity, kinematics, and physical capacity.

INTRODUCTION: Most people have experienced low back pain (LBP) more or less in their lifetime. Heavier load weight could increase the risk of LBP, especially in repetitive lifting and carrying tasks. The risk could also increase with the frequency of lifting. This study aims to investigate the effects of a passive back-support exoskeleton (PBSE) on trunk muscle activation, kinematics, and physical capacity in a repetitive lifting task and a carrying task in consideration of load weights in a laboratory setting. RESULTS: Results showed that using the PBSE, the activities of the thoracic erector spinae and lumbar erector spinae muscles were reduced significantly by nearly 7% MVC and 3% MVC in the repetitive lifting task and the carrying task, respectively. There was no significant effect of the PBSE on the spine kinematics and physical capacity. PRACTICAL APPLICATIONS: This study supports the use of the PBSE to reduce trunk muscle activity in repetitive lifting and carrying tasks.

[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.

Kinematic adaptations to restricting spine motion during symmetrical lifting.

When lifting an object from the ground a person has many possible whole-body movement solutions to accomplish the task. It is unclear why lifters use most of their available lumbar spine flexion range-of-motion despite many ergonomic guidelines advising against doing so. Experimentally restricting spine motion and observing compensatory movement strategies is one approach to address this knowledge gap. A kinematic analysis was performed on 16 participants who completed symmetrical lifting tasks with and without wearing a spine motion-restricting device. Sagittal trunk, lumbar spine, and lower extremity kinematics, along with stance width and foot orientation in the transverse plane were evaluated between restricted and unrestricted lifting conditions. Restricting spine motion required greater ankle dorsiflexion (p < 0.001), knee flexion (p < 0.001), and hip flexion (p < 0.001) motion in comparison to unrestricted lifting. Motion was reallocated such that hip flexion showed the largest increase in restricted lifting, followed by ankle dorsiflexion, then knee flexion compared to unrestricted lifting. Trunk inclination decreased (i.e., more upright) in restricted compared to unrestricted lifting (p < 0.001). Neither stance width (p = 0.163) nor foot orientation (p = 0.228) were affected by restricting spine motion. These adaptive movements observed indicate lower extremity joint motion must be available and controlled to minimize lumbar spine flexion during lifting.