Skip to main content
Occupational and Environmental Medicine logoLink to Occupational and Environmental Medicine
. 2003 Sep;60(9):e6. doi: 10.1136/oem.60.9.e6

Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review

S Hignett
PMCID: PMC1740617  PMID: 12937202

Abstract

Methods: A search strategy was devised to seek out research between 1960 and 2001. Inclusion/exclusion criteria limited the entry of papers into the review process. A checklist was selected and modified to include a wide range of study designs. Inter-rater reliability was established between six reviewers before the main review process commenced. Each paper was read by two reviewers and given a quality rating score, with any conflicts being resolved by a third reviewer. Papers were grouped by category: multifactor, single factor, and technique training based interventions.

Results: A total of 2796 papers were found, of which 880 were appraised. Sixty three papers relating to interventions are reported in this paper. The results are reported as summary statements with the associated evidence level (strong, moderate, limited, or poor).

Conclusion: There is strong evidence that interventions predominantly based on technique training have no impact on working practices or injury rates. Multifactor interventions, based on a risk assessment programme, are most likely to be successful in reducing risk factors related to patient handling activities. The seven most commonly used strategies are identified and it is suggested that these could be used to form the basis of a generic intervention programme, with additional local priorities identified through the risk assessment process. Health care providers should review their policies and procedures in light of these findings.

Full Text

The Full Text of this article is available as a PDF (143.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Addington C. All the right moves. A program to reduce back injuries in OR nurses. AORN J. 1994 Feb;59(2):483–488. doi: 10.1016/s0001-2092(07)70413-1. [DOI] [PubMed] [Google Scholar]
  2. Alavosius M. P., Sulzer-Azaroff B. The effects of performance feedback on the safety of client lifting and transfer. J Appl Behav Anal. 1986 Fall;19(3):261–267. doi: 10.1901/jaba.1986.19-261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Billin S. L. Moving and handling practice in neuro-disability nursing. 1998 May 28-Jun 10Br J Nurs. 7(10):571-4, 576 passim. doi: 10.12968/bjon.1998.7.10.5680. [DOI] [PubMed] [Google Scholar]
  4. Caska B. A., Patnode R. E., Clickner D. Feasibility of a nurse staffed lift team. AAOHN J. 1998 Jun;46(6):283–288. [PubMed] [Google Scholar]
  5. Charney W. The lift team method for reducing back injuries. A 10 hospital study. AAOHN J. 1997 Jun;45(6):300–304. [PubMed] [Google Scholar]
  6. Charney W., Zimmerman K., Walara E. The lifting team. A design method to reduce lost time back injury in nursing. AAOHN J. 1991 May;39(5):231–234. [PubMed] [Google Scholar]
  7. Daynard D., Yassi A., Cooper J. E., Tate R., Norman R., Wells R. Biomechanical analysis of peak and cumulative spinal loads during simulated patient-handling activities: a substudy of a randomized controlled trial to prevent lift and transfer injury of health care workers. Appl Ergon. 2001 Jun;32(3):199–214. doi: 10.1016/s0003-6870(00)00070-3. [DOI] [PubMed] [Google Scholar]
  8. Dixon R., Lloyd B., Coleman S. Defining and implementing a 'no lifting' standard. Nurs Stand. 1996 Jul 24;10(44):33–36. doi: 10.7748/ns.10.44.33.s54. [DOI] [PubMed] [Google Scholar]
  9. Downs S. H., Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998 Jun;52(6):377–384. doi: 10.1136/jech.52.6.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Engels J. A., van der Gulden J. W., Senden T. F., Kolk J. J., Binkhorst R. A. The effects of an ergonomic-educational course. Postural load, perceived physical exertion, and biomechanical errors in nursing. Int Arch Occup Environ Health. 1998 Jul;71(5):336–342. doi: 10.1007/s004200050289. [DOI] [PubMed] [Google Scholar]
  11. Evanoff B. A., Bohr P. C., Wolf L. D. Effects of a participatory ergonomics team among hospital orderlies. Am J Ind Med. 1999 Apr;35(4):358–365. doi: 10.1002/(sici)1097-0274(199904)35:4<358::aid-ajim6>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  12. Fanello S., Frampas-Chotard V., Roquelaure Y., Jousset N., Delbos V., Jarny J., Penneau-Fontbonne D. Evaluation of an educational low back pain prevention program for hospital employees. Rev Rhum Engl Ed. 1999 Dec;66(12):711–716. [PubMed] [Google Scholar]
  13. Feldstein A., Valanis B., Vollmer W., Stevens N., Overton C. The Back Injury Prevention Project pilot study. Assessing the effectiveness of back attack, an injury prevention program among nurses, aides, and orderlies. J Occup Med. 1993 Feb;35(2):114–120. [PubMed] [Google Scholar]
  14. Foster L., Whitaker S. Manual handling training and changes in work practices. Occup Health (Lond) 1996 Nov;48(11):402–406. [PubMed] [Google Scholar]
  15. Garg A., Owen B. Reducing back stress to nursing personnel: an ergonomic intervention in a nursing home. Ergonomics. 1992 Nov;35(11):1353–1375. doi: 10.1080/00140139208967398. [DOI] [PubMed] [Google Scholar]
  16. Goodridge D., Laurila B. Minimizing transfer injuries. Can Nurse. 1997 Aug;93(7):38–41. [PubMed] [Google Scholar]
  17. Harber P., Peña L., Hsu P., Billet E., Greer D., Kim K. Personal history, training, and worksite as predictors of back pain of nurses. Am J Ind Med. 1994 Apr;25(4):519–526. doi: 10.1002/ajim.4700250406. [DOI] [PubMed] [Google Scholar]
  18. Hellsing A. L., Linton S. J., Andershed B., Bergman C., Liew M. Ergonomic education for nursing students. Int J Nurs Stud. 1993 Dec;30(6):499–510. doi: 10.1016/0020-7489(93)90021-l. [DOI] [PubMed] [Google Scholar]
  19. Hignett S. Embedding ergonomics in hospital culture: top-down and bottom-up strategies. Appl Ergon. 2001 Feb;32(1):61–69. doi: 10.1016/s0003-6870(00)00029-6. [DOI] [PubMed] [Google Scholar]
  20. Hignett S., Richardson B. Manual handling human loads in a hospital: an exploratory study to identify nurses' perceptions. Appl Ergon. 1995 Jun;26(3):221–226. doi: 10.1016/0003-6870(95)00025-8. [DOI] [PubMed] [Google Scholar]
  21. Hignett S. Work-related back pain in nurses. J Adv Nurs. 1996 Jun;23(6):1238–1246. doi: 10.1046/j.1365-2648.1996.13423.x. [DOI] [PubMed] [Google Scholar]
  22. Holliday P. J., Fernie G. R., Plowman S. The impact of new lifting technology in long term care: a pilot study. AAOHN J. 1994 Dec;42(12):582–589. [PubMed] [Google Scholar]
  23. Lagerström M., Hagberg M. Evaluation of a 3 year education and training program. For nursing personnel at a Swedish hospital. AAOHN J. 1997 Feb;45(2):83–92. [PubMed] [Google Scholar]
  24. Ljungberg A. S., Kilbom A., Hägg G. M. Occupational lifting by nursing aides and warehouse workers. Ergonomics. 1989 Jan;32(1):59–78. doi: 10.1080/00140138908966068. [DOI] [PubMed] [Google Scholar]
  25. Lynch R. M., Freund A. Short-term efficacy of back injury intervention project for patient care providers at one hospital. AIHAJ. 2000 Mar-Apr;61(2):290–294. doi: 10.1080/15298660008984539. [DOI] [PubMed] [Google Scholar]
  26. Menckel E., Hagberg M., Engkvist I., Hjelm E. W. The prevention of back injuries in Swedish health care--a comparison between two models for action-oriented feedback. PROSA Study Group. Appl Ergon. 1997 Feb;28(1):1–7. doi: 10.1016/s0003-6870(96)00031-2. [DOI] [PubMed] [Google Scholar]
  27. Monaghan H., Robinson L., Steele Y. Implementing a no lift policy. Nurs Stand. 1998 Sep 2;12(50):35–37. doi: 10.7748/ns.12.50.35.s40. [DOI] [PubMed] [Google Scholar]
  28. Paternoster D., Salis M., Gisser G. V. Un'esperienza di formazione per operatori ospedalieri addetti alla movimentazione manuale di carichi (Ospedale di Bressanone): contenuti e verifica di efficacia. Med Lav. 1999 Mar-Apr;90(2):381–392. [PubMed] [Google Scholar]
  29. Scholey M. Back stress; the effects of training nurses to lift patients in a clinical situation. Int J Nurs Stud. 1983;20(1):1–13. doi: 10.1016/0020-7489(83)90034-2. [DOI] [PubMed] [Google Scholar]
  30. Scopa M. Comparison of classroom instruction and independent study in body mechanics. J Contin Educ Nurs. 1993 Jul-Aug;24(4):170–173. doi: 10.3928/0022-0124-19930701-08. [DOI] [PubMed] [Google Scholar]
  31. Smedley J., Egger P., Cooper C., Coggon D. Manual handling activities and risk of low back pain in nurses. Occup Environ Med. 1995 Mar;52(3):160–163. doi: 10.1136/oem.52.3.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. St-Vincent M., Tellier C., Lortie M. Training in handling: an evaluative study. Ergonomics. 1989 Feb;32(2):191–210. doi: 10.1080/00140138908966079. [DOI] [PubMed] [Google Scholar]
  33. Stubbs D. A., Buckle P. W., Hudson M. P., Rivers P. M. Back pain in the nursing profession. II. The effectiveness of training. Ergonomics. 1983 Aug;26(8):767–779. doi: 10.1080/00140138308963398. [DOI] [PubMed] [Google Scholar]
  34. Torri P., Liboni D., Milan F., Piccoli R. L'esperienza gestionale del rischio da movimentazione manuale di pazienti nelle realtà ospedaliere dell'Azienda ULSS 18 Regione Veneto. Med Lav. 1999 Mar-Apr;90(2):362–380. [PubMed] [Google Scholar]
  35. Tracz S., Rose I. Beating low back pain. Dimens Health Serv. 1982 Apr;59(4):20, 22-3. [PubMed] [Google Scholar]
  36. Troup J. D., Rauhala H. H. Ergonomics and training. Int J Nurs Stud. 1987;24(4):325–330. doi: 10.1016/0020-7489(87)90025-3. [DOI] [PubMed] [Google Scholar]
  37. Tuffnell C. Lightening the lifting load through education and quality assurance monitoring. Aust Clin Rev. 1989;9(3-4):123–126. [PubMed] [Google Scholar]
  38. Wood D. J. Design and evaluation of a back injury prevention program within a geriatric hospital. Spine (Phila Pa 1976) 1987 Mar;12(2):77–82. doi: 10.1097/00007632-198703000-00001. [DOI] [PubMed] [Google Scholar]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES