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Evaluation of portable lift and transfer devices to reduce the risk of musculoskeletal injury (MSI) to home care workers
1150-20 B 1998
(98FS-47)
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Issue: |
Reduction of musculoskeletal injury to home care workers. |
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Agency: |
British Columbia Institute of Technology, Health Applied Research and Development Program |
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Representative: |
Nancy Paris-Seeley |
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Funding: |
$39,990 |
Context: Home care workers are at high risk of MSI, particularly to the lower back region, due to the nature of their job. They are often required to lift and transfer patient within small and confined spaces within homes, without assistance. The need for non-permanent home improvements or devices to reduce the risk of injury to home care workers is widely recognized.
Objectives: 1) Identify and assess factors that expose home care workers to MSI.
2) Evaluate existing portable client transfer aids in terms of reducing the risk of MSI to home care workers in a bathroom setting. 3) Develop a detailed set of performance requirements for an optimal device(s) for the bathroom setting.
Design: A biomechanical evaluation and a psychophysical assessment of a bathtub transfer board, a portable bathtub side-rail, a raised toilet seat, a walking transfer belt and a baseline manual method for bathtub and toilet transfers was conducted. A four-camera motion analysis system was used to measure the posture of home care workers during transfers. A three-dimensional biomechanical model was used to estimate the maximum potential external moment on the L5/S1 joint of the workers (see Note). Workers’ assessments of the devices were obtained using a perceived physical stress rating form and a device/client compatibility rating form.
Setting: A simulated bathroom setting, representative of a typical bathroom for middle to low income housing, was established at the Dr. Tong Louie Living Laboratory.
Subjects: Twenty home care workers with at least one year experience in client handling tasks and no history of cardiovascular disease or musculoskeletal problems.
Main Outcome Measures: External moments, particularly of the L5/S1 joint of the home care workers during transfers, perceived physical stress during transfers and perceived appropriateness of a device for various client types.
Results: The devices tested did not reduce the moment on the home care workers’ L5/S1 joint. The bathtub transfer board and walking transfer belt increased moment, however their perceived physical risk was low. Participants rated the performance of all devices as positive.
Home care workers identified three primary concerns regarding the devices: 1) transport of the devices to and from client residences, 2) hygiene if a device is used with multiple clients, and 3) liability if the home care worker introduces the device to a client’s home.
Conclusion: There is an identified need for affordable transfer devices for the home care setting. The devices must substantially reduce loads on the L5/S1 joint to safe limits under the highest risk conditions. Also, home care workers need to be trained to assess their clients’ ability to support themselves daily, and to think about their own safety. When a home care worker determines that they or their client are at risk of injury during a transfer, other options should be made available to the worker.
Note: Moment = Vertical Force x Horizontal Distance
The term 'moment' refers to the tendency to produce a rotating motion and is generally described in units of 'Newton * meters.' A numeric value of a moment is calculated by multiplying a force by its perpendicular distance from some significant related point. In the case of this project, the moment is determined by multiplying the weight (in Newtons) of the upper body by the horizontal distance of the centre of gravity of the upper body to the L5/S1 joint plus the weight of the object being lifted times the horizontal distance from the centre of gravity of the object to the L5/S1 joint. The higher the moment, the higher the load on the spine, increasing the risk of injury. For a full explanation of this topic please see reference:
Lindh, M., Biomechanics of the lumbar spine. In Basic biomechanics of the musculoskeletal system. Edited by Nordin, M. et al., Lea & Febiger, 1980, PP. 183-207.