Table 2 Studies with barriers and facilitators in the implementation of engineering interventions aimed at patient handling in health care
StudyDesign (duration)Population (setting)InterventionOutcomesType of barrier (B) or facilitator (F)
Chhokar et al (2005)19OBS (3 years)All staff who handle patients (nursing home)65 ceiling lifts and education on useSignificant reduction in MSI claims, claims costs and days lostTime required to fully implement intervention (B-2B) Time required to alter work culture (B-2B)
Engst et al (2005)20CT (1 year)34 care staff INT, 16 care staff CON (hospital)(1) Ceiling lifts and training session to introduce lifts; (2) no interventionDecreased total claim costs, but increased claim costs associated with repositioning patientsCeiling lifts require more time than manually repositioning residents (B-2B)
Evanoff et al (2003)12OBS (2–3 years)36 nursing units (hospital and nursing home)25 full-body and 22 stand-up lifts and instructional course on lift operationSignificant decrease in MSI, lost workday injuries and total lost days due to injuryThink they do not need lifting devices (B-1A) Lack of knowledge (B-1B) Too time consuming (B-2B) Devices misplaced or not enough available (B-2B) Patients in isolation/connected to too many lines (B-2B) Aides or patient care technicians use lifting devices (F-2B) Policy of mandatory lift usage (F-2D) Patients do not like lifting devices/feels unstable (B-2G) Established care activities and patient characteristics (F-2G)
Fujishiro et al (2005)21OBS (2 years)100 work units (nursing home and hospital)Financial support and ergonomic consultation for installing ergonomic devicesSignificant decrease in MSDLower employee-to-ergonomic device ratio (F-2B)
Garg and Owen (1992)22OBS (1–10 months)57 nursing assistants in 2 units (nursing home)Hoist, walking belt, shower chairs and training in use of devicesReduction in back injuriesAdequate staffing (F-2B) Saves time to perform transfer with 1 nursing assistant (F-2B) Reduction in number of patient transfers compensated for longer transfer times associated with devices (F-2B)
Li et al (2004)18OBS (7 months)138 nurses in 3 nursing units (hospital)1 portable full-body sling lift, 2 stand-up sling lifts and a single hands-on training session on lift usageNumber of injuries and lost-day injuries decreasedLack of perceived need (B-1A) Inexperience in lift use (B1B) Lack of time (B-2B) Lack of manoeuvring space (B-2B) Staff turnover (B-2B)
Miller et al (2006)23CT (1 year)45 nurses INT and 29 nurses CON (nursing home)(1) Portable ceiling lifts and training with regard to the ceiling lift; (2) no interventionDecreased MSI claims and claim costsCeiling lifts preferred method for lifting and transferring (F-1B)
Owen et al (2002)24CT (5 years)37 nurses INT and 20 nurses CON (hospital)(1) 5 assistive devices and training in use; (2) traditionally scheduled in-service trainingDecreased number of back injuries, lost work and restricted daysPatient more comfortable and secure when assistive devices used (F-2G)
Ronald et al (2002)13OBS (5 years)34 RNs and 95 aides (hospital)62 ceiling lifts and training in useNo significant reduction in total MSI. Significant decline in MSI due to lifting and transferringPreference by staff for mechanical options (F-1B) Ceiling lifts not used for repositioning due to problems with slings (B-2B) Incompatibility with pre-existing structures of older building (B-2B)
Yassi et al (2001)25RCT (1 year)103 nurses INT, 116 nurses INT and 127 nurses CON (hospital)(1) Training in back care, patient assessment, and handling techniques using manual equipment; (2) training in back care, patient assessment, and handling techniques using mechanical and other assistive equipment; (3) no interventionNumber of injuries did not change significantlyIncreased perception of safety among staff (F-1A) More comfortable performing patient-handling tasks (F-1B) Increasing demand by staff for mechanical equipment (F-2A) Other workplace dynamics than patient population (B-2D) Changing patient population (B-2G)
  • CON, control group; CT, controlled trial; INT, intervention group; MSD, musculoskeletal disorders; MSI, musculoskeletal injuries; OBS observational study; RCT, randomised controlled trial. Type of barrier: B-2B represents a barrier (B), within environment (2), category B (convenience and easy accessibility).