Can the Use of Turn-Assist Surfaces Reduce the Physical Burden on Caregivers When Performing Patient Turning?

OBJECTIVE: To quantify differences in physical workload afforded by turn-assist surfaces relative to manual patient turns, and between nursing caregivers (turn-away vs. turn-toward) while performing partnered patient turning. BACKGROUND: Nurse caregivers experience an increased risk of musculoskeletal injuries at the back or shoulders when performing patient-handling activities. Use of turn-assist surfaces can reduce the physical burden and risk on caregivers. METHOD: Whole-body motion capture and hand force measures were collected from 25 caregivers (17 female) while performing partnered manual and technology-facilitated turns. Shoulder and low back angles and L4/L5 joint contact forces were calculated at the instant of peak hand force application for both caregivers. RESULTS: Hand force requirements for the turn-away caregiver were 93% of the estimated maximum acceptable force when performing a manual turn. Use of a turn-assist surface eliminated hand forces required to initiate the patient turn for the turn-away caregiver, where their role was reduced to inserting appropriate wedging behind the patient once the facilitated turn was complete. This reduced shoulder moments by 21.3 Nm for the turn-away caregiver, a reduction in exposure from 70% of maximum shoulder strength capacity to 15%. Spine compression exposures were reduced by 302.1 N for the turn-toward caregiver when using a turn-assist surface. CONCLUSION: Use of a turn-assist surface reduced peak hand force and shoulder-related exposures for turning away and reduced spine-related exposures for turning toward. APPLICATION: Turn-assist devices should be recommended to decrease the risk of musculoskeletal disorder hazards for both caregivers when performing a partnered patient turn.

Comparing the biomechanical and psychophysical demands imposed on paramedics when using manual and powered stretchers.

The aim of this investigation was to compare the effect of three different stretchers (two powered and one manual) on the biomechanical and psychophysical demands experienced by paramedics when performing routine stretcher handling activities. Eight experienced paramedics performed stretcher raising, lowering, unloading and loading tasks. Video data of task performance and static force requirements were recorded and input into a posture matching program with a quasi-static linked segment model (3DMatch) to compute peak and cumulative L4/L5 compression and shear forces and shoulder moments during each activity. Ratings of perceived exertion (RPE) were recorded from paramedics upon the completion of each task. Use of powered stretchers with load assist functionality reduced the demands on paramedics. Peak L4/L5 forces were reduced by 13-62% and 58-93% for compression and shear respectively when using powered stretchers to perform routine stretcher handling activities. Shoulder flexor moments and RPE scores were reduced by 16-95% and 29-60% respectively when using the powered stretchers compared to the manual stretcher. However, cumulative forces showed mixed results. Although powered stretcher use decreased peak forces, loading and unloading a powered stretcher took 1.5 to 3.4 times longer then when using the manual stretcher, which may explain the mixed results regarding cumulative forces. Based on the RPE scores, paramedics preferred power stretchers relative to the manual stretcher. This study demonstrates that powered stretchers can reduce peak biomechanical and psychophysical exposures associated with the development of musculoskeletal disorder (MSD) during routine stretcher handling activities with minimal increases in cumulative exposures.