December 21, 2022

Is the Study is clearly identified (qualitative or quantitative). For example, is this is a Qualitative Study and is considered Level VI evidence OR is it a Quantitative Randomized Control Study and would be considered Level I Level Evidence

Please answer the questions below regarding the article:

Larson, R. E., Murtagh, E. M., & Rice, M. S. (2018). Forces involved when sliding a patient up in bed. Work (Reading, Mass.), 59(3), 439-448

1. Is the Study is clearly identified (qualitative or quantitative). For example, is this is a Qualitative Study and is considered Level VI evidence OR is it a Quantitative Randomized Control Study and would be considered Level I Level Evidence?

2. what is the purpose or aim

3. What is the data theme or analysis of the study?

4. Based on what you learned. Would you implement the change? Why or why not?

5. What did you learn from review of the article?

Work 59 (2018) 439-448

DOI:10.3233/WOR-182688

IOS Press

Forces involved when sliding a patient up in bed

Robert E. Larsona,1,∗, Elise M. Murtaghb,1 and Martin S. Ricec aDepartment of Exercise Science, Brigham Young University, Provo, UT, USA bWestern Reserve Hospital, Cuyahoga Falls, OH, USA cSchool of Health Sciences, Indiana Wesleyan University, Marion, IN, USA

Received 11 October 2016 Accepted 22 May 2017

Abstract.

BACKGROUND: This study investigated the effects of 3 different types of slide sheets upon hand forces while sliding a patient up in bed.

METHODS: The sheets used included the reusable Arjo Maxislide, the McAuley disposable sheet, and a standard cotton sheet. Hand forces were measured from 38 male and female participants as they slid a ‘patient’ up in bed. A repeated measures ANOVA with 5 levels to the repeated factor (number of sheets and sheet type) was used, along with post-hoc repeated measures contrasts to compare differences between each condition.

RESULTS: A significant reduction in required force occurred when using the friction reducing sheets as compared to the cotton sheets when used according to manufacturer recommendations, as well as a reduction in one of the single friction reducing sheet categories compared to the cotton. However, it is important to note that there was still substantial force being placed on the participants.

CONCLUSIONS: This study illustrates the importance of using friction reducing slide sheets while engaging in manual patient handling. Future research should investigate the forces involved with other friction reducing materials and methods as well as the possibility of combining said materials and methods.

Keywords: Friction, nursing staff, hospital, body mechanics, sheets

1. Introduction

One large risk associated with patient care is the strain on the body while manually handling patients, which could result in a work related musculoskeletal disorder [1]. This danger is common among nurses, occupational therapists, and physical therapists, as well as other related professions. There is a current trend in the healthcare field to find ways to reduce

1This work was completed as partial fulfillment for the Occupational Therapy Doctoral Degree at the University of Toledo for the first two authors.

∗Address for correspondence: Robert E. Larson, OTD, OTR/L, Department of Exercise Science, Brigham Young University, 106 Smith Fieldhouse, Provo, UT 84663, USA. Tel.: +1 360 442 1304; Fax: +1 801 422 0555; E-mail: rob

the number of injuries that healthcare workers incur [2-4], which is particularly important as the demographics of the nation are changing to include older and larger individuals, which can both pose an even more substantial risk to these workers [5].

Although the overall numbers of work related injuries of employees across all fields were reduced in 2011 in the United States from the previous year, musculoskeletal injuries remained statistically unchanged [6]. Nursing assistants, registered nurses, construction workers, landscapers, and janitors account for the top five careers for musculoskeletal disorder claims in 2012. It has been reported that in an 8-hour shift, a member of the nursing staff typically cumulatively lifts up to 1.8 tons during patient handling responsibilities [7].

In 2011, a study by Rice, Dusseau, and Miller found that 5% of the 285 respondents (occupational therapists and occupational therapy assistants fromOhio)experiencedamusculoskeletalinjurysecondary to patient handling activities within the past yearoftheiremployment[8].Whenthestudyfocused in on those clinicians who were required to handle patients on a regular basis, the injury rate jumped to 8.3%. Overall, 21% of respondents had experienced regular pain within the last 5 years due to patient handling. Of these, 11% had missed work due to a patient handling related musculoskeletal injury.

In 1993, Waters, Putz-Anderson, Garg, and Fine submitted that a healthcare provider should not vertically lift more than 15.9 kilograms during the manual handling of patients during vertical lifting tasks, whichrecommendationwasreiteratedlaterbyWaters in 2007 [9, 10]. This guideline is known colloquially as the NIOSH equation. The compression limits are 6300 Newtons for maximum compression, and 3400 Newtons for the lower action limit for repetitive motions, with the Newton measurement being defined as kilograms multiplied by acceleration, which numbers are derived from force vectors such that 1 kilogram is equal to 9.81 Newtons [11-13]. McGill,Norman,Yingling,Wells,andNeumannsuggest a maximum shear limit for forces at the lumbar spine of 1000 Newtons [13]. They also recommend a lower action limit of 500 Newtons for repetitive shear tasks. Although tasks such as boosting a patient up in bed are more of a lateral sliding motion rather than a vertical lift, the compression and shear limits are still valid and need to be considered. These limits were based off of cadaver studies in conjunction with a review of factory work injury rates combined with the forces that were exerted by workers. Healthcare workers experience similar compression and shear forces during patient handling tasks.

Researchers have shown that low friction bed sheets effectively reduce the time that healthcare practitioner’s muscles are contracting as well as reducing the percentage of muscle involved in the transfer task [14]. These sheets have also been shown to reduce the amount of friction by 65% when a low friction sheet was used in conjunction with another low friction sheet underneath [15, 16]. While it was shown that the friction can be reduced significantly, there is tremendous variation on the spinal loads recorded.

The commonly accepted method of repositioning a patient in bed begins with two healthcare workers, one on each side of the patient. One of the workers counts to three and then they both lift the sheet upon which the patient is resting and slide the patient into the desired position. The bed height used for data collection for this study was set at 46% of the participant’s height, which is the height of the “high bed” condition in Lindbeck and Engkvist’s 1993 study, which height was also used in a study by Bartnik and Rice in 2013 [15, 17]. This technique for adjusting bed height is a standardized way to assure the force results can be appropriately compared between individuals.However,tallerbedheightsmaybebeneficial in a clinical setting.

In another study that investigated friction reducing devices for positioning patients, Bartnik and Rice, using uniaxial handheld force gauges, investigated the forces acting on the hands and lower back during the repositioning task of sliding a patient up in bed [17]. They found that although effective at reducing friction, the McAuleyTM disposable sheet and the Arjo MaxislideTM still required substantial force in the lower back in order to complete the task. In fact, the sum of the peak forces at the hand in this study came out to be 20.8 kilograms for the Arjo MaxislideTM,20.2kilogramsfortheMcAuleyTM disposable, and 22.6 kilograms for the standard cotton sheet. This shows that there is a decrease in required force when using a friction reducing device, but the levels are still too high for healthcare workers to be exerting and be considered safe.

Further analyzing the gathered data and using the University of Michigan’s 3D Static Strength Prediction Program which relies on joint position data and force data in order to calculate spinal forces, Bartnik and Rice also investigated compression and shear forces in the lumbar region [17]. They found that the compressive forces at the spinal levels of L5-S1 and L4-L5 varied depending on which type of sheet was used. Use of the McAuleyTMdisposable sheet resulted in the least amount of compressive force at both joints, whereas use of the Arjo MaxislideTM resulted in less compressive force than traditional cotton sheets at the L4-L5 joint, but not at the L5S1 joint. As far as shear forces are concerned, use of the McAuleyTM disposable sheet resulted in the least amount of L4-L5 sagittal shear force followed by the Arjo MaxislideTM and finally the traditional cotton sheet.

According to these results, the impact of lifting and repositioning tasks on the lower back is a concern, with the shear and compressive forces acting on the spine in a cumulative manner over time. There was the concern that since the Bartnik and Rice force gauges were uni-dimensional there may have been a significant amount of data lost during collection as they only collected force in the z plane and force was elicited in the x, y, and z planes [17].

The purpose of the current study was to investigate the forces acting on the hand and lower back while sliding a “patient” up in bed. A variety of slide sheets were used: the standard cotton sheet, as well as two types of friction reducing sheets, the Arjo MaxislideTM and the McAuleyTM disposable slide sheet. The researchers hypothesized that there would be significantly less force required when sliding a “patient” up in bed when using the friction reducing slide sheets compared to traditional cotton sheets, as well as having further reduced required forces when using a double friction reducing slide sheet approach compared to a single sheet approach.

2. Methods

2.1. Participants

Participants included 38 healthy adults, both male and female, between 20 and 57 years of age. Based on data from Bartnik and Rice, it was estimated that the L4-L5 lateral shear forces generated while using two different friction reducing slide sheets with this sample size was expected to generate enough statistical power to yield significant results [17]. These results were estimated to include a mean difference of approximately 29N, a standard deviation of 53.6N, an =0.05, and a =0.8. Participant recruitment was completed using university email, posting informational flyers in various areas around a public university, and through “word of mouth.” The “patient” throughout the entire data collection process was a 27-year-old male, weighing 68.0 kilograms.

2.2. Apparatus

A Motion Analysis system, using Cortex (version 3.1.0.1288) data acquisition software, coupled with eight Owl cameras provided 3D motion capture. This system was used in conjunction with two force plates (Amti Model# OR6-5-1, 176 Waltham Street, Watertown, MA 02472 and Bertec Model# 2060A, 6171 Huntley Road, Suite J, Columbus, OH 43229) and the Futek MTA 400 tri-axial load cells seen in Fig. 1, modified with handles and a coupler (Tri Axial Load Cell Model, 10 Thomas, Irvine CA 92618). The com-

image.jpeg

Fig. 1. Tri-dimensional hand gauges.

pressionandtensionforcesatthehandweremeasured using the Futek MTA 400 tri-axial load cells while sliding the “patient” up in bed. Data were collected at 120Hz. The sampling rate of 120 frames per second(Hz)assuredthatallchangesinbodypositioning, acceleration, and force were captured throughout the motion. The hospital bed in this study was manufactured by Linak (Model# CB9140AE-3+A011F, No. 106). The three types of sheets used were a traditional cotton draw sheet, the McAuleyTM disposable fabric slide sheet, and the Arjo MaxislideTM sheet, produced in Roselle, IL.

2.3. Dependent variables

This study analyzed the forces at the hands and the lower back. The data from the Futek load cell force gauges were analyzed to determine the hand forces involvedinslidingapatientupinbedgeneratedusing the three different types of slide sheets. Cortex was used to collect motion data and C-motion’s Visual 3D software was used to smooth the data using a dual pass Butterworth low pass filter using a 10Hz cutoff frequency and was used to determine body angles at the peak force moment during the transfers. Lastly, the University of Michigan’s 3DSSPP static strength prediction program was used to identify the lower back forces based on the joint angles.

2.4. Procedure

Approval from the Biomedical IRB from The University of Toledo occurred before study implementation. The researchers obtained informed consent from every participant prior to data collection, which occurred from August 2013 through

image.jpeg

Fig. 2. Research setup. Note that the transfer also included a second caregiver standing opposite of the pictured caregiver to help pull the

slide sheet.

February 2014. The participants in this study acted as the “caregivers,” and the investigator assistant (n=1) acted as the “patient.” Upon recruitment, each participant read and signed the informed consent form, then the participant’s height and weight was recorded, 37 reflective markers were placed on the individual’s body for motion detection by the Owl cameras, and a series of 33 patient transfers (3 for each of the 11 conditions) were performed. The “patient” participant also signed the informed consent, was weighed, and given instructions to lie supine in the hospital bed.

When the various sheets were used they were not used in conjunction with other sheet types. For instance, when the McCauley disposable sheet was used in the single sheet condition only one McCauley disposable sheet was placed on top of the fitted cotton sheet that was on the bed with nothing on top of it as in Fig. 2. In the double sheet condition, two of the friction reducing sheets were placed on top of each other with the “patient” lying directly on top of the top sheet.

The order of the presentation of the bed heights and sheet types were randomized into one of 11 possible combinations (41% of height with Sheet 1, 41% of height with Sheet 2, 41% of height with Sheet 3, 46% of height with Sheet 1, 46% of height with

Sheet 2, 46% of height with Sheet 3, 46% of height with double sheet 2, 46% of height with double sheet 3, 51% of height with Sheet 1, 51% of height with Sheet 2, or 51% of height with Sheet 3). These bed heights were based on Lindbeck and Engkvist’s as well as Bartnik and Rice’s works which used similar heightsforpatienthandlingtasks[15,17].Theparticular transfer technique used has been termed “pulling a patient up in bed” [18]. Note that the height factor was explored in a different study [19]. The current study addressed only the type of sheet at 46% of the participant’s height.

Thehospitalbedwashorizontal,andthetwo”caregivers” stood on either side of the bed throughout the transfers as in Fig. 2. The height of the bed was adjusted to either 41%, 46%, or 51% (based on the outcome of the randomization) of the height of the participant “caregiver” [15, 17, 19]. The “patient” began in a supine position with his arms across his chest and his legs straight. Two marks were placed on the bed, 12 inches apart, in order to identify the distance of the repositioning based on the position of the “patient’s” head. The “caregiver” participants stood on the Bertec force plate and were instructed that they could move their feet if desired as long as theyremainedwithintheareaoftheforceplates.They were also instructed to grasp the handles in a forearm supinatedpositionandtopreparetoslidethe”patient” upinthebed.The”caregiver”thenmovedtotheforce plates and communicated to the co-investigator by counting up to three, at which point the “caregiver” and co-investigator slid the “patient” 12 inches up toward the head of the bed.

2.5. Statistical analysis

This study used a repeated measures design with a focus on sheet type, as well as number of sheets (e.g., Arjo-Single, Arjo-Double, McAuley-Single, McAuley-Double, and Cotton-Single). A repeated measures analysis of variance (ANOVA) with 5 levels to the repeated factor (number of sheets and sheet type) was used, along with a post-hoc repeated measures contrasts analysis for the data at the hands. Similar statistics were used for the lower back data with 3 levels to the repeated factor. A paired t-test was also employed to analyze the single sheet versus the double sheet hand force categories.

3. Results

Data were collected and analyzed from 5 males and 33 females from August 2013 through February 2014. Data from one participant’s Arjo single sheet condition was discarded due to protocol breach. Overall, there was a significant difference among the 5 repeated hand force conditions. F(4,144)=66.83, p<0.001. The repeated measures contrasts analysis (Tables 1 and 2) revealed no significant difference between the forces generated when using the Single Arjo Maxislide and the standard Cotton Sheet as seen in Table 3. There were, however, significant differences between other conditions as seen in Tables 3 and 4. The use of Double Arjo, Single McAuley, and Double McAuley all resulted in less force from the participants than the Cotton Sheet. There were also differences between single sheet and double sheet conditions as seen in Tables 5 and 6 such that the double sheet conditions both resulted in significantly lower force generation than the single sheet conditions. The forces at the lower back can be found in Table 7. An important item of note is that there was no statistically significant difference between compression forces in any of the conditions either for the L4-L5 or L5-S1 joints, as seen in Table 8, so these were excluded from further analysis. As can be seen in Table 9, use of the the McAuley resulted in less shear force than the cotton sheets in every category and less L4-L5 forward shear and less L5-S1 sagittal shear than the Arjo. The Arjo resulted in less force than the cotton in the L4-L5 forward shear category only.

4. Discussion

4.1. Relationship to current literature

The purpose of this study was to investigate the forces acting on the hands and lower back while sliding a “patient” up in bed using a variety of slide sheets.Theresearchershypothesizedthattherewould be significantly less force required when sliding a “patient” up in bed when using the single friction reducing slide sheets compared to traditional cotton sheets, as well as having a further reduction in required forces when using a doubled up friction reducing slide sheet approach than a single sheet approach per manufacturer’s recommendations with both Arjo MaxislideTM and McAuleyTM disposable slide sheets.

There was not a significant difference between using a standard cotton sheet versus the single Arjo MaxislideTM as shown in Tables 1 and 3 and Fig. 3, which is curious as the Arjo MaxislideTM is designed and marketed as a friction reducing slide sheet, and it was expected that even a single Arjo MaxislideTM sheet would outperform the cotton sheet, but that was not the case in this study. It is also interesting in light of the study by Bartnik and Rice where the results of the same two sheets did result in a reduction of required force [17]. One reason this could be is that the data in the Bartnik and Rice study were collected by uni-dimensional hand gauges and some force could have been lost in the process as the unidimensional hand gauges only recorded data in the z-axis, which is parallel to the line of pull. The triaxial hand gauges used in the current study included orthogonalforcesinthex-,y-,andz-axes.Eitherway, the manufacturer’s recommended method of using the slide sheets is to have one on top and one on bottom, or if that is not possible, then fold one in half in order to still have a double layer of the friction reducing material [20]. See Fig. 4 for a comparison of the single versus double sheet conditions. Even in light of the double sheet recommendation, there was a significant difference between the standard cotton sheet and the single McAuleyTM friction reducing sheet, which was expected and was evident in the Bartnik and Rice article. Therefore, the single Arjo MaxislideTM not resulting in a reduction of required force and the single McAuleyTM disposable sheet

Table 1

Pairwise comparisons of the single sheet conditions against each other

Sheet Type 1

Sheet Type 2

Type III Sum

Mean

p-value

Effect

of Squares

Square

Size

Arjo

Cotton

11.04

0.18

0.680

0.05

McAuley

5346.20

85.76

<0.000

1.05

Error

Cotton

2233.80

62.05

McAuley

2244.34

62.34

Cotton

Arjo

11.04

0.18

0.680

0.05

McAuley

4871.41

106.69

<0.000

1.01

Error

Arjo

2233.80

62.05

McAuley

1643.72

45.66

McAuley

Arjo

5346.20

85.76

<0.000

1.05

Cotton

4871.41

106.69

<0.000

1.01

Error

Arjo

2244.34

62.34

Cotton

1643.72

45.66

Pairwise compa

risons of the doubl

Table 2 e sheet co

nditions agains

t each other

Sheet Type 1

Sheet Type 2

Type III Sum

Mean

p-value

Effect

of Squares

Square

Size

Arjo

Cotton

3369.41

51.93

<0.000

0.89

McAuley

704.85

18.43

<0.000

0.47

Error

Cotton

2400.71

64.88

McAuley

1415.10

38.25

Cotton

Arjo

3369.41

51.93

<0.000

0.89

McAuley

7156.42

139.29

<0.000

1.31

Error

Arjo

2400.71

64.88

McAuley

1900.92

51.38

McAuley

Arjo

704.85

18.43

<0.000

0.47

Cotton

7156.42

139.29

<0.000

1.31

Error

Arjo

1415.10

38.25

Cotton

1900.92

51.38

Table 3

Total force in kilograms at hands while boosting a patient in bed using three different sheet types in the single sheet condition

Sheet Type

Mean

Standard

(kg)

Deviation

Arjo

30.29

5.29

Cotton

30.14

5.13

McAuley

24.84

5.14

Table 4

Total force in kilograms at hands while boosting a patient in bed using three different sheet types in the double sheet condition

Sheet Type

Mean

Standard

(kg)

Deviation

Arjo

25.87

4.19

Cotton

30.14

5.13

McAuley

23.91

4.16

resulting in a reduction of required force partially supports the current study’s first hypothesis.

More importantly, there was a significant difference between the standard cotton sheet and both of the double sheet conditions as in Tables 2 and 4.

Table 5

Mean force at the hands in the single and double sheet conditions compared

Sheet

Number

Mean (kg)

Standard Deviation

Arjo

Single

30.29

5.29

Double

25.87

4.19

McAuley

Single

24.92

5.09

Double

23.91

4.11

Table 6

Paired t-test of single versus double sheet conditions by sheet type

Sheet Number and

p-value

Effect Size

Type 1

Type 2

Single Arjo

Double Arjo

175.88

<0.000

0.93

Single McAuley

Double McAuley

8.89

0.005

0.22

This is important because this is the use for which these sheets are marketed, and it shows that if used as advised, these sheets have the potential to reduce strain on the human body. This is also enlightening as cotton sheets are typically used in healthcare facilities for patient repositioning tasks, and this shows that using the cotton sheets is not the most effective way to avoid contracting an injury throughout the process of handling and repositioning patients. That being said, the double friction reducing sheet condition only reduced the overall hand force required by the caregivers by 15% for the double Arjo Maxislide sheet and 22% for the double McAuley sheet, thus still requiring a minimum average of 23.9 kilograms of hand force per transfer as shown in Table 4. This is a higher resulting force than the friction reducing slide sheet conditions in the Bartnik and Rice article, which reported 20.0-20.9 kilograms of force being generated at the hands. This highlights the probability that some forces were lost to the uni-dimensional hand gauges that were used in that study, but more alarmingly, it shows that even with the “best” methods that we investigated resulted in the forces being far above the limits recommended by Waters et al. [9]. So even if healthcare workers are following the “safe” methodologies outlined in this article, there is still a risk that they will contract a musculoskeletal disorder due to patient handling.

It was seen that with the friction reducing slide sheets, the lowest mean amount of force exhibited was 23.9 kilograms. It is important to note, that this was with participants that were cooperative and presumablyunderstoodalloftheinstructionsgiven.It was also with a constant “patient” who was relatively light compared to many people who are receiving healthcare services, and who was very cooperative. All factors considered, this was an ideal and atypical situation. Even in this carefully controlled situation, the force being elicited was significantly greater than is advisable [9].

When considering the lower back forces, it can be seen that all of the forces elicited when using the McAuleyTM disposable slide sheet ended up being

Table 7

Mean compression, forward sheer, and sagittal sheer forces at L4-L5 and L5-S1 in the double sheet condition

Location and Force

Sheet

Mean (N)

Standard Deviation

L4-L5 Compression

Arjo

1456.51

765.61

Cotton

1420.09

652.72

McAuley

1367.32

582.39

L4-L5 Sagittal (A-P) Shear

Arjo

328.77

73.91

Cotton

332.08

87.66

McAuley

301.67

65.66

L4-L5 Frontal (Lateral) Shear

Arjo

122.44

77.14

Cotton

145.14

122.85

McAuley

113.70

92.87

L5-S1 Compression

Arjo

756.60

427.28

Cotton

686.51

291.67

McAuley

741.85

455.08

L5-S1 Sagittal (A-P) Shear

Arjo

392.54

67.07

Cotton

406.45

75.05

McAuley

370.91

66.84

L5-S1 Frontal (Lateral) Shear

Arjo

119.53

38.24

Cotton

150.57

58.81

McAuley

115.99

47.25

significantly lower than those elicited from the cotton sheet which can be seen in Tables 7, 8, and 9 as well as Fig. 5. Use of the McAuleyTM sheets also elicited less force than the ArjoTM at the L4-L5 joint in the forward shear direction and at the L5-S1 sagittal shear direction. Use of the ArjoTM, however, only elicited less force than the cotton at the L4-L5 joint in the forward shear direction. This shows a benefit to healthcare workers should they choose to use the friction reducing slide sheets. These results are

Table 8

Pairwise comparisons of low back forces against sheet type

Force and Location

Type III Sum

Mean

p-value

of Squares

Squares

L4-L5 Compression

7519.12

2.00

3759.91

0.33

0.721

Error

824944.50

72.00

11457.56

L4-L5 Sagittal (A-P) Shear

1041.30

1.43

727.56

5.42

0.014

Error

6921.20

72.00

96.13

L4-L5 Frontal (Lateral) Shear

984.92

1.53

644.73

4.78

0.019

Error

7413.87

72.00

102.97

L5-S1 Compression

5105.63

2.00

2552.82

1.19

0.310

Error

154398.02

72.00

2144.42

L5-S1 Sagittal (A-P) Shear

1198.88

1.55

775.71

11.66

<0.000

Error

3702.66

55.64

66.55

L5-S1 Frontal (Lateral) Shear

1353.96

1.71

794.23

20.67

<0.000

Error

2357.65

61.37

38.42

Table 9

Post hoc analysis of significant low back force differences

Force and

Sheet Type

Type III Sum

Mean

p-value

Effect

Location

of Squares

Squares

Size

L4-L5 Sagittal

Cotton vs Arjo

20.44

0.07

0.796

0.04

(A-P) Shear

Arjo vs McAuley

1373.93

14.62

0.001

0.39

Cotton vs McAuley

1729.54

9.61

0.004

0.39

Error

Cotton vs Arjo

10901.36

302.82

Arjo vs McAuley

3383.06

93.97

Cotton vs McAuley

6479.16

179.98

L4-L5 Frontal

Cotton vs Arjo

963.36

3.00

0.091

0.22

(Lateral) Shear

Arjo vs McAuley

142.94

0.94

0.339

0.10

Cotton vs McAuley

1848.45

12.72

0.001

0.29

Error

Cotton vs Arjo

11533.97

320.39

Arjo vs McAuley

5477.56

152.15

Cotton vs McAuley

5230.08

145.28

L5-S1 Sagittal

Cotton vs Arjo

361.82

2.39

0.131

0.195

(A-P) Shear

Arjo vs McAuley

874.12

16.04

<0.000

0.32

Cotton vs McAuley

2360.70

22.94

<0.000

0.50

Error

Cotton vs Arjo

5440.24

151.12

Arjo vs McAuley

1962.51

54.51

Cotton vs McAuley

3705.24

102.92

L5-S1 Frontal

Cotton vs Arjo

1802.14

20.75

<0.000

0.63

(Lateral) Shear

Arjo vs McAuley

23.41

0.58

0.450

0.08

Cotton vs McAuley

2236.34

32.19

<0.000

0.65

Error

Cotton vs Arjo

3126.55

86.85

Arjo vs McAuley

1445.35

40.15

Cotton vs McAuley

2501.06

69.47

image.jpeg

Fig. 3. Mean and standard deviation of total force at the hands while boosting a patient up in bed using three different sheet types.

similar to what Bartnik and Rice found for the lower back forces in their study [17]. The lower back forces only exceeded the action limit under one condition in that study, but in the current study none were ever surpassed. However, even with these benefits, it is important to note that none of the forces measured here exceeded the recommended action limits put forth by McGill of 3400 Newtons for compressive force and that proposed by McGill et al. of 500 Newtons of shear force at the lower back [11, 13]. Even though the forces elicited in this study were all below the recommended action limits, it is important to note that this study was completed under ideal circumstances with a willing participant, and that forces elicited in an acute care setting are likely to be greater than those found in this study. It is also important to note that even with lower forces, repetitive strain injuries are possible.

image.jpeg

Image transcription text

400 350 300 250 Mean Hand Force [Newtons) 200 150 100 50 Single Double Single Double Arjo

Mcauley

Fig. 4. Mean and standard deviation of hand force comparing single and double sheet categories.

image.jpeg

Image transcription text

Mean Forge at Lower Back [Newtons) 2000 1500 1000 500 Arjo Collon L4-45 Compression Mcauley

Arjo L4-15 Sagittal Cotton Arjo 14 15 Frontal Cotton Mcauley Arjo Cotton 15:51 Compression Mcauley

Arja LS-51 Sap cum Cotton Mcauley Arjo 15 51 Fromcal Cotton Mcauley

Fig. 5. Mean and standard deviation of total force at various back locations and directions while boosting a patient up in bed using three

different sheet types.

4.2. Limitations

Using a bed height that was only 46% of the participant’sheightisalimitationastheremaybebenefitto using taller bed heights. However, the only standardized method of bed height determination found by the authors was in the study by Lindbeck and Enkvist and was thus used [15].

This study was performed in a laboratory setting, so the results are not necessarily indicative of what would be found in the clinic. Also, the sample population predominately consisted of students instead of healthcare professionals, so the results are not necessarily indicative of what healthcare workers would elicit in a similar situation.

The “patient” was standardized and was 68.0 kilograms throughout the course of the study. The population of the United States of America is currently on the rise, and in addition to the extra weight they come with many obesity related diseases and conditions. With this in mind, it is likely that many of the patients with whom healthcare workers will be dealingwillweighmorethan68.0kilograms[5].This will lead to added stress on the bodies of healthcare workers and will lead to increases in the numbers of work-related musculoskeletal injuries.

Another important note is that the University of Michigan’s 3D Static Strength Prediction Program is, as its title states, static, whereas the task at hand is dynamic.

Future research should include different friction reducing devices including air assisted devices, healthcare professionals performing the transfers, patients of different weights, real patients, taller bed heights, and hospital settings. Another aspect that

would be intriguing would be convening research related to discovering the forces involved for caregivers when using mechanical lifts and further research related to the impact of zero lift policies in various settings. It would also be illuminating to investigate one method of patient handling combined with another such as with tilting the head of the bed down in conjunction with a friction reducing device.

5. Conclusion

TheArjoMaxislideandMcAuleyfrictionreducing slide sheets, when doubled, were effective at reducing the hand force required to boost a patient up in bed when compared to using a cotton sheet. While thisreductionwasstatisticallysignificant,theelicited hand forces still pose a sizeable risk to healthcare workers. Healthcare workers need to be aware of the impact that the handling of patients has on their bodies. In light of these risks, they need to take precautions against injury. Currently, the most effective and efficient way to do this is to utilize the various equipment that is available. Manual lifts should be used, and when those are not available, it is important to incorporate the use of friction reducing devices.

Conflict of interest None to report.

References

Safe patient handling: Occupational Safety and Health Administration[OSHA].2011[cited2013].Availablefrom: http://www.osha.gov/SLTC/healthcarefacilities/safepatienthandling.html.

Li J, Wolf L, Evanoff B. Use of mechanical patient lifts decreased musculoskeletal symptoms and injuries among health care workers. Injury Prevention. 2004;10(4):212-6.

Owen BD, Keene K, Olson S. An ergonomic approach to reducing back/shoulder stress in hospital nursing personnel: A five year follow up. International Journal of Nursing Studies. 2002;39(3):295-302.

Waters T, Collins J, Galinsky T, Caruso C. NIOSH research efforts to prevent musculoskeletal disorders in the healthcare industry. Orthopaedic Nursing. 2006;25(6):380-9.

Adult obesity facts: Centers for Disease Control and Prevention [CDC]; 2013 [cited 2013]. Available from: http://www.cdc.gov/obesity/data/adult.html.

Nonfatal injuries and illnesses requiring days away from work, 2012: Bureau of Labor Statistics [BLS]; 2013 [cited 2013]. Available from: http://www.bls.gov/news.release/ archives/osh2 11262013.pdf.

Tuohy-Main K. Why manual handling should be eliminated for resident and career safety. Geriaction. 1997;15(1):10-4.

Rice MS, Dusseau JM, Miller BK. A questionnaire of musculoskeletalinjuriesassociatedwithmanualpatientlifting in occupational therapy practitioners in the state of Ohio. Occupational Therapy in Health Care. 2011;25(2-3): 95-107.

Waters TR, Putz-Anderson V, Garg A, Fine LJ. Revised NIOSH equation for the design and evaluation of manual lifting tasks. Ergonomics. 1993;36(7):749-76.

Waters TR. When is it safe to manually lift a patient? AJN The American Journal of Nursing. 2007;107(8):53-8.

McGill S. Low back disorders: Evidence-based prevention and rehabilitation. Human Kinetics; 2007.

Marras WS, Davis KG, Kirking BC, Bertsche PK. A comprehensive analysis of low-back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques. Ergonomics. 1999;42(7): 904-26.

McGill S, Norman R, Yingling V, Wells R, Neumann P, editors. Shear happens! Suggested guidelines for ergonomists to reduce the risk of low back injury from shear loading. Proceedings of the 30th annual conference of the human factors association of Canada; 1998.

McGill S, Kavcic N. Transfer of the horizontal patient: The effect of a friction reducing assistive device on low back mechanics. Ergonomics. 2005;48(8):915-29.

Lindbeck L, Engkvist I-L. Biomechanical analysis of two patient handling tasks. International Journal of Industrial Ergonomics. 1993;12(1):117-25.

Theou O, Soon Z, Filek S, Brims M, Leach-MacLeod K, Binsted G, et al. Changing the sheets: A new system to reduce strain during patient repositioning. Nursing Research. 2011;60(5):302-8.

Bartnik LM, Rice MS. Comparison of Caregiver Forces Required for Sliding a Patient Up in Bed Using an Array of Slide Sheets. Workplace Health Saf. 2013;61(9):393-400.

FragalaG.FacilitatingRepositioninginBed.AAOHNJournal. 2011;59(2):63-8.

Murtagh EM. Required caregiver forces while sliding a patient up in bed using a variety of bed heights. 2015. Locatedat:TheUniversityofToledo,OccupationalTherapy Program, Toledo, OH, USA.

Arjo International A. Maxi slide: Versatile repositioning sheets. Sweden: Arjo Huntleigh Getinge Group; 2010 [cited 2014]. Available from: http://www.rochestermexico.com/ PDF/20100723162630.pdf.

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Is the Study is clearly identified (qualitative or quantitative). For example, is this is a Qualitative Study and is considered Level VI evidence OR is it a Quantitative Randomized Control Study and would be considered Level I Level Evidence

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