Summary of interventions and critical appraisal (QR) scores
| Author | Intervention subjects (n) | Outcome measures | Results | QR |
|---|---|---|---|---|
| Key Intervention strategy included: 1 = Risk assessment 2 = Equipment provision or/and purchase (including training in new equipment) 3 = Equipment design/evaluation 4 = Equipment maintenance 5 = Education and training 6 = Work environment redesign, space constraints addressed 7 = Work organisation/practices changed 8 = Feedback 9 = Group problem solving/team building 10 = Review and change of policies and procedures/safe systems of work 11 = Discussion of goals with clients 12 = Injury monitoring system with follow up. Return to work programme 13 = Change/introduction of patient assessment system 14 = Introduction of hazard register 15 = Audit of working practices/risk assessments 16 = Review of staffing levels. Increase in staffing level 17 = Introduction of lifting team programme 18 = Physical fitness training 19 = Stress management 20 = Medical examination and lifting skill assessment 21 = Task analysis, job design analysis 22 = Change in uniforms | ||||
| Addington (1994)63 USA | 5, 22 Operating room staff (n=?) | No. of reported back injuries Restricted working days | No decrease in injuries Reduction in restricted days | 37% |
| Aird (1988)31 Canada | Hospital: 2, 5, 9, 12, 18, 20, 21 Home for the Aged: 1, 3, 5, 13 (n=?) | Lost time injury claims (Workers Compensation Board) | Hospital: Back injuries reduced by (a) number (8.4%), (b) frequency (18.8%) Home for the Aged: No back injuries in 12 months following intervention | 44% |
| Alavosius and Sulzer-Azaroff (1986)71 USA | 5, 8 Direct care staff (n=6) | No. of safe transfers | Reduction in no. of unsafe transfers from 13 to 4 | 39% |
| Alexander (1996)13 UK | 1, 2, 6, 11, 13, 16 Community nurses (n=42) | Relationship between implementation of recommendations and level of sickness absence | Significant relationship between implementation of recommendations and reduction in sickness absence | 50% |
| Best (1997)67 Australia | 5 Nursing Home (n=55) | Postural analysis Back pain (severity and frequency) Rated Perceived Exertion (RPE) | All reduced but not significantly | 70% |
| Billin (1998)48 UK | 2, 5 Nurses, Occupational Therapists, Physiotherapists (n=?) | Moving and handling injuries | Increase in injuries over 5 year period | 54% |
| Caska et al (1998)39 USA | 17 Medical ward (n=4) | Effectiveness of lifting team Injury rate | Team completed 94% of scheduled and paged lifts No musculoskeletal discomfort reported by the team | 69% |
| Charney (1997)40 USA | 17 Hospital staff (n=10 units) | Incident rates Lost working time | Reduction in incident rates (by 63%) and lost work days (by 90%) | 72% |
| Charney et al (1993)41 USA | 17 Orderlies (n=2) | Accident rate Sickness absence | Year 2 data: No injuries or sick leave for lifting team Nursing sick leave was reduced | 61% |
| Charney et al (1991)42 USA | 17 Orderlies (n=2) | Accident rate | Year 1 data: Reduced from 39 to 2.4 cases (62%) with a projected saving of $65,000 per annum | 37% |
| Collins (1990)14 Australia | 1, 5, 12, 13, 14 Nurses (n=?) | Sickness absence | Reduced from 17 to 11 working days per claim | 52% |
| Daws (1981)64 UK | 5 Nurses (n=2000) | Injury rate | No change | 31% |
| Daynard et al (2001)27 Canada | 2, 5 Hospital staff (n=36) | Compliance with intervention Biomechanical evaluation of spinal loading | Increased compliance Reduced spinal loading | 50% |
| Dietz and Baumann (2000)56 France | 5 Nurses and physiotherapists (n=103) | Training impact | 76% felt they had not learned the basic positions at the end of the course | 33% |
| Dixon et al (1996)32 UK | 2, 5, 10 Ward staff (n=?) | Musculoskeletal sickness absence | No episodes of sickness absence after implementation | 20% |
| Duggan (1995)15 Ireland | 1, 2, 5, 6, 7 Nurses (n=24) | Postural analysis RPE | Significant reduction in harmful postures and RPE | 74% |
| Engels et al (1998)65 Netherlands | 5, 8, 10 Nurses (n=24) | Postural load Ergonomic and biomechanical errors RPE | Both postural load and errors decreased significantly RPE increased | 44% |
| Engkvist et al (2001)44 Sweden | 2, 5 Nursing staff (n=292) | Interaction between risk factors for back injuries and training | No association with decreased risk of injury | 100% |
| Entwhistle et al (1996)33 UK | 2, 5, 10, 13, 22 Nurses (n=900) | Lost working time | Reduction in certified illness from 35 to 8 episodes per annum | 35% |
| Evanoff et al (1999)16 USA | 1, 3, 4, 6, 7, 9, 10 Hospital orderlies (n=67) | Reportable injuries (OSHA 200 log) Workers compensation insurance records Self-administered survey | Reduction in injury rate from 32.5 per 100 FTE to 16.3 per 100 FTE Relative risk reduced by 50% No significant findings for workers compensation records Significant reduction in proportion of employees with musculoskeletal symptoms | 58% |
| Fanello et al (1999)45 France | 5 Non-clerical hospital staff (n=272) | Injury rate (musculoskeletal disorders) Amount of patient handling Postural analysis | No significant difference for all three measures | 80% |
| Feldstein et al (1993)68 USA | 5, 18 Nurses, aids and orderlies (n=55) | Back pain Quality of patient transfers | Reduction (not significant) 19% improvement in transfers | 68% |
| Paternoster et al (1999)73 Italy | 5, 18 Hospital workers (n=80) | Postural analysis | Incorrect postures reduced from 68% to 38% | 31% |
| Foster (1996)69 UK | 5 Nurses (n=100) | Change in practice Use of equipment | 74% change in practice 77% improved use of equipment | 57% |
| Garg and Owen (1992)17 USA | 1, 2, 5 Nursing Homes (n=57) | Incidence of back injuries | Reduced from 83 to 47 per 200,000 work hours | 63% |
| Garrett and Perry (1996)66 USA | 1, 5, 10, 12, 15 Nursing and therapy staff (n=700) | Lost working time cases | Reduced from 42 to 23 per annum | 46% |
| Goodridge and Laurila (1997)23 Canada | 2, 13 Nurses (n=?) | Injury rate | Reduction in injury rate from 6.7 to 4.1 patient handling injuries per staff member per month | 44% |
| Gray et al (1996)72 Canada | 5 Nurses (n=14 units) | Knowledge of procedures | Significant improvement | 43% |
| Griffith and McArthur (1999)57 UK | 5 Health care assistants (n=502) | Impact of training using questionnaire | No acquisition of transferable skills with respect to applying the techniques in different environments | 42% |
| Harber et al (1994)49 USA | 5 Newly qualified nurses (n=179) | Association between training and future back pain | No association | 73% |
| Head and Levick (1996)24 Australia | 1, 2, 3, 5 Nurses and ambulance workers (n=?) | No. of back injury claims | Reduction in number (by 23%), lost time (by 38%) and average cost (by 56%) of back injury claims | 28% |
| Hellsing et al (1993)61 Sweden | 5, 18, 19 Nursing students (n=51) | Nordic Questionnaire Observation of standardised work tasks | No short term effects on musculoskeletal problems Reduction of lifts (and shorter times) in extreme positions | 58% |
| Hignett and Richardson (1995)18 UK | 1, 3, 5, 6, 7, 9, 10 Nurses (n=26) | Qualitative | Risk assessment model | 81% |
| Holliday et al (1994)37 Canada | 2 Nursing staff (n=22) | No. of staff for a task RPE Comfort Time taken | Fewer staff needed and significant reduction in RPE No change in comfort or time taken | 50% |
| Johnston (1987)58 UK | 5 Student nurses (n=7) | Application of training principles | Only 28% of lifts were planned Assistance was used for 50% of lifts | 43% |
| Kilbom et al (1985)34 Sweden | 2, 6, 7 Home care nurses (n=12) | Vertical force and duration of lift, weight distribution and no. of steps while carrying | The modern ward showed a reduction in: total weight (43%); no. of lifts per hour (53%); asymmetric lifts (60%); and no. of steps while carrying (73%); | 27% |
| Knibbe and Friele (1999)38 Netherlands | 2 Home care nurses (n=378) | Prevalence of back pain (12 months) Lift Counter (self-administered log) | Significant reduction in back pain (from 74 to 64%) Reduction in total no. of transfers from 35 to 21 per nurse per week | 83% |
| Lagerström and Hagberg (1997)46 Sweden | 2, 5, 18, 19 Nurses (n=348) | Questionnaire on musculoskeletal symptoms, physical fitness and physical workload | No reduction in neck, shoulder and back symptoms, increase in hip and upper back problems. Reduction in physical fitness. Increase in perception of work as physically strenuous | 76% |
| Ljungberg et al (1989)28 Sweden | 2, 6, 7 Nursing staff (n=24) | Lifting rates, cumulative force; total lifting time, and no. of steps while carrying | Modern ward showed a reduction in: lifting rates (50%); cumulative force (57%); total lifting time (78%); no. of steps while carrying (72%) | 65% |
| Lynch and Freund (2000)62 USA | 5 Nursing staff (n=374) | Knowledge about back injury risk factors Change in work practices Lost time back injuries | No change in level of knowledge Repositioning in-bed tasks reduced 30% reduction in lost time back injuries over previous 3 years | 50% |
| Menckel et al (1997)19 Sweden | 1, 2, 5, 8 Health care staff (n=122) | Implementation of feedback | 42% of measures were implemented | 63% |
| Miller and Johnson (1992)20 UK | 1, 5, 10 Home care staff (n=10) | Questionnaire | Increase in qualitative measures of carer confidence and feeling of control of situation | 50% |
| Monoghan et al (1998)25 UK | 1, 2, 5, 10, 13 Nurses (n=28) | Training attendance Patient assessment plans | 59% attendance 75% of patients had mobility plans | 31% |
| Nussbaum and Torres (2001)50 USA | 5 Nurses (n=24) | RPE Postural analysis Biomechanical analysis | No significant change | 59% |
| Nyran (1991)21 Canada | 1, 2, 4, 5 Nursing Homes (n=48) | Cost effectiveness Lost time claims (Compensation Board) | Net saving of $57,439 | 65% |
| Oddy (1993)29 UK | 3, 6, 10, 13 Continuing care ward (n=24) | Elimination of drag lift | Reduction over 6 months, with alternative techniques used | 50% |
| Paternoster et al (1999)73 Italy | 5, 18 Hospital workers (n=80) | Postural analysis | Incorrect postures reduced from 68% to 38% | 31% |
| Peers (1998)26 Canada | 5, 10, 13, 15, 20 Nursing home staff (n=131) | Lost time and modified work duties | Lost time reduced from 249 to 30 days Modified work days reduced from 246 to 184 | 37% |
| Pohjonen et al (1998)22 Finland | 1, 2, 3, 7, 9, 10, 11 Home care staff (n=70) | Postural analysis Heart rate Psychosocial questionnaire (Work Ability Index) | Significant increase in proportion of straight back positions (from 59 to 75%) No change in heart rate data or psychosocial data for intervention group | 58% |
| Rodgers (1985)59 UK | 5 Ward staff (n=4 wards) | Use of taught lifting techniques | Shoulder lift not used 30% of 2-person lifts carried out by one person | 38% |
| Santoro (1994)43 USA | 17 Neurology staff (n=65) | Effectiveness of lifting team | 90% of lifts achieved | 35% |
| Scholey (1983)70 UK | 5 Nurses (n=4) | Intra abdominal pressure (IAP) | Significant reduction in IAP | 78% |
| Scopa (1993)51 USA | 5 Nurses (n=49) | Evaluation of body mechanics | No significant difference | 65% |
| Stubbs et al (1983)52 UK | 5 Student nurses (n=2) | Intra abdominal pressure | Minimal reduction in IAP at best, deterioration at worst | 55% |
| St Vincent et al (1989)53 UK | 5 Orderlies (n=33) | Use of taught handling methods (6 principles) | Application of all 6 principles only in 1% of sample. Frequency of use of individual principles ranged between 11–33% | 70% |
| Torri et al (1999)30 Italy | 2, 5 Hospital staff (n=approx. 900) | Sickness absence Use of hoists (lifters) | Reduction in sickness absence (39%) 71% used hoists regularly and correctly | 50% |
| Tracz and Rose (1982)35 Canada | 2, 5 Rehabilitation ward staff (n=?) | Reported injuries Lost time for back injuries | Little change | 33% |
| Trevelyan (2001)36 UK | 2, 5, 7, 10 Nurses (n=48) | Self-reported well-being questionnaire Task and postural analysis | No significant difference for any of the measures | 78% |
| Troup and Rauhala 198754 UK and Finland | 5 Student nurses (n=4 groups) | Use of taught techniques Back injuries | New skills were acquired and increased use of equipment No significant difference in prevalence or incidence of back pain and injuries | 54% |
| Tuffnell (1989)74 New Zealand | 5, 10 Nurses (n=?) | Type of lifts | Increase in use of shoulder lift from 6 to 50% | 30% |
| Videman et al (1989)60 Finland | 5 Student nurses (n=200) | Skill assessment Prevalence and incidence of back pain and injuries | Improvement in skills for techniques (63%) and lifting aids (53%) used No significant difference in prevalence or incidence of back pain and injuries | 41% |
| Wachs and Parker (1987)47 USA | 5 Nursing staff (n=178) | 13 point skills checklist (environmental factors and postural assessment) | Low level of prescribed lifting behaviours (17%), only 2% completed all 13 prescribed behaviours. 23% of postures were labelled ‘at risk’ | 86% |
| Wood et al (2000)75 USA | 5 Nursing assistants (n=90) | Evaluation of transfer skills Audit of bedside information | Prescribed techniques were performed 68% of the time 37% of bedside information was accurate | 46% |
| Wood (1987)55 Canada | 5, 8 Nursing staff (n=3 units) | No. of wage loss claims for back injuries caused by interactions with residents | No significant difference between expt. and control groups (both reduced) | 56% |