2004

A psychophysical comparison of three patient handling methods, when assisting the geriatric patient to move from wheelchair to bed  

Leena TAMMINEN-PETER

Turku, Finland 

Topic classification: ergonomics, neck, low back 

Keywords: health care worker; musculoskeletal load; patient’s perception 

1.       Introduction

Working in long-term care involves a heavy physical load, as patients need a lot of help in moving. The most common and very straining part is assisting a patient to move from the wheelchair to the bed and vice versa. Back and other musculo-skeletal injuries and problems are very common in elderly care settings. Health care workers (HCWs) still use so-called traditional transferring techniques when assisting patients, that is, they lift a patient under the arms and from the clothing. They do not use the patient’s own resources, no needed time and space is allowed so the patient remains passive. There have been many studies on how to decrease the physical load by teaching HCWs how to perform the task in a more ergonomic way. However, they have had a poor impact on working practices and injury rates. One reason is that the instructed methods have often been more suitable for handling materials than human beings. We still have too little knowledge about the optimum ways to assist the patient as well as to utilize the patient’s own resources in such a way that he can participate. Manual patient handling situations are complex and a HCW needs versatile skills, for example, the ability to assess and utilize the patient’s remaining movement and function capacities, in order to both guide the patient and adapt to the patient’s movements, as well simultaneously use her own body in an ergonomic way. In a few training interventions, the didactic problems in skill training have been considered.

2.       Aim

The aim of this intervention study was to compare changes in the psychophysical load on the low back and shoulder muscles of HCWs, and in the patient’s perception of comfort, security and control when shifting from the traditional method to the new methods, Durewall and Kinaesthetics.

3.       Methods

The study included 12 female health care workers (HCWs), 43 (± 9) years old with body height of 165 (± 8) cm and a body weight 65 (± 10) kg. Their job experience in patient handling was 16 (± 7) years. They had no formal education in patient handling methods. None of the participants was experiencing musculoskeletal pain. The intervention took place in the neurological and orthopedic rehabilitation wards in Turku City Hospital. HCWs transferred, alone, two geriatric patients from the wheelchair to the bed and vice versa. The patients needed a lot of assistance, their functional independence measure (FIM) was low: one or two; they had been operated for collum fracture or suffered from hemiplegia. Altogether, there were 18 patients, 75 (± 7) years old with a body weight of 75 (± 8 kg). All subjects gave their written informed consent, and the Ethical Committee approved the study.

 The measurements were carried in three test sessions: 1) a traditional method before the training, 2) after learning one method and 3) after learning another method. HCWs were divided into two groups after the first measurements, the six HCWs were taught the Durewall method first, while the others were learning the Kinaesthetics. They were taught about the theory behind the method and had practical training during three days. They were given help in applying the method with the patients for one month. This was followed by a test session. A couple of months later the Durewall group received the Kinaesthetics training and vice versa, and the same procedure was repeated.

 The HCWs rated their perceived physical exertion in lower back and shoulders on Borg’s CR-10 – scale. The patients rated their feeling of security, control and comfort on a bipolar rating scale with the endpoints -4 and +4 immediately after the transfer. The HCWs' skill in assisting a patient to move was evaluated with a new observation method, which was developed on the basis of SOLO taxonomy. The aim was to measure individual performance and learning of nurses in patient transferring skills, as well as patient participation in moving.

4.       Results

The transferring skills of HCWs were evaluated at the baseline measurement at a 1, 2 and 2, 3 level. The first training sessions in both methods remarkably improved the skill level in both groups to about level four. After the second training sessions, only the Durewall-Kinaesthetics group could still improve their skills to close to level five. The Kinaesthetics-Durewall group stayed at about the same level. The mean rating of HCWs' lower back was 2. 53 and shoulders 1. 43 with the traditional way before the training (Table1). The first training session lowered the rating values and the second decreased them even further.

Table  SEQ Table \* ARABIC 1: The ratings of the HCWs shoulders and lower back physical exertion on Borg CR-10 scale before and after the first and second training sessions.

           

Ratings of perceived exertion of the HCWs

 

The measurement time

Lower back

Shoulders

 

 

Mean

Sd

Range

Mean

Sd

Range

Before training (n=54)

2,53

1,34

0-5

2,06

1,43

0-5

After first training (n=24)

1,33

1,01

0-3

1,27

1,06

0-3

After second training (n=48)

0,84

0,71

0-3

0,88

0,78

0-3

             

The patient ratings of comfort, security and control rose as the HCWs’ transfer skills improved (Table 2). Even after the first training session, the comfort ratings rose more than the security and control ratings. Only the security ratings showed some negative values after the first training.

Table 2: The patient ratings of feelings of comfort, security and control before and after the first and second training session.

           

Patient ratings of feelings of

The measurement time

Comfort

Security

Control

 

Mean

Sd

Range

Mean

Sd

Range

Mean

Sd

Range

Before training (n=27)

1,56

1,45

-2-+4

2,11

1,01

-1-+4

1,33

1,41

-3-+3

After first training (n=12)

3,08

0,79

+2-+4

2,83

1,27

-1-+4

2,58

0,51

+2-+3

After second training (n=24)

3,33

0,76

+2-+4

3,71

0,55

+2-+4

3,63

0,58

+2-+4

5.       Discussion and conclusions

The HCWs learned the new methods to transfer a geriatric patient well, reaching a high level of skill. As their skills improved they perceived less musculoskeletal strain in lower back and shoulders, and the patients experienced greater comfort and safety, as well as feeling more in control when being transferred.