* Corresponding author. Tel.: #46-8-730 9922; fax: #46-8-730 1967. E-mail address: katak@niwl.se (K. Kjellberg) Applied Ergonomics 31 (2000) 139}150 An observation instrument for assessment of work technique in patient transfer tasks Katarina Kjellberg*, Christina Johnsson, Karin Proper, Elisabeth Olsson, Mats Hagberg National Institute for Working Life, S-11279 Stockholm, Sweden Department of Occupational Medicine, Go ( teborg University, Sahlgrenska University Hospital, S-412 66 Go ( teborg, Sweden Department of Development and Education, Stockholm County Council, South Stockholm Medical Area, Box 17 531, S-118 91 Stockholm, Sweden TNO Work and Employment, P.O. Box 718, NL-2130 AS Hoofddorp, The Netherlands Department of Physical Therapy, Karolinska Institute, S-141 57 Huddinge, Sweden Received 21 April 1998; accepted 28 June 1999 Abstract The aim of the study was to construct an observation instrument for description and assessment of nursing personnel's work technique in patient transfer tasks with regard to musculoskeletal health and safety, and to evaluate the validity and reliability of the instrument. The instrument consists of 24 items arranged in three phases of a transfer: the preparation phase, the starting position and the actual performance. Observations are made from video recordings. A detailed description of the individual's work technique, including actions taken to prepare the transfer, the interaction with the patient and any assistant co-worker, and the motor performance of the nurse, is provided. An attempt was made to quantify the assessments, by calculating an overall score of the work technique with regard to the level of musculoskeletal hazard and safety. The validity and reliability of the instrument were evaluated on 35 video-recorded patient transfers from hospital wards. The validity and reliability were mostly satisfactory, both when evaluating the agreements between the observations of each item (i.e.  values '0.40), and when evaluating the agreements between the overall scores (i.e. intraclass correlation coe$cients 0.71}0.90). Further improvements to enhance the agreements are suggested.  2000 Elsevier Science Ltd. All rights reserved. Keywords: Nurses; Observation method; Patient handling; Musculoskeletal hazards 1. Introduction Di!erent aspects of work technique and its relation to musculoskeletal disorders have been discussed by several authors (Feuerstein, 1996; Kilbom, 1997). For nursing personnel, work technique when transferring patients is probably of importance for the musculoskeletal health (Owen, 1986; Videman et al., 1989). In comparison with the general working population, the prevalence and inci- dence of back pain and back injuries among nursing personnel is considerably higher (Buckle, 1987; Engkvist et al., 1992; Jensen, 1987; Ono et al., 1995). There is an association between the work task of transferring pa- tients and back disorders and injuries (Hignett, 1996b; Jensen, 1990; Lagerstro K m et al., 1998; Wigaeus Hjelm et al., 1995; Yassi et al., 1995). However, the exact mecha- nisms behind these back injuries have not been fully clari"ed. The frequency of transfer tasks during a work shift is a crude measure of exposure often used in epi- demiological studies (Jensen, 1990). Presumably a nurse's individual work technique during a transfer task may modify the musculoskeletal load. It has been suggested that the concept work technique comprises two basic elements: the method to carry out a work task and the individual performance of a work task (Kjellberg et al., 1998). The "rst element, the method, represents general established work methods taught to workers: in the present study, patient transfer methods taught to nursing personnel during training programmes. The individual performance focuses on individual vari- ations when executing a given transfer task, or using 0003-6870/00/$ - see front matter  2000 Elsevier Science Ltd. All rights reserved. PII: S 0 0 0 3 - 6 8 7 0 ( 9 9 ) 0 0 0 4 6 - 0