Effects of training and experience on patient transfer biomechanics J.N. Hodder a, * , S.N. MacKinnon b , A. Ralhan c , P.J. Keir a a Department of Kinesiology, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada b School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada c Eastern Health Authority, 300 Prince Philip Drive, St. John’s, Newfoundland, Canada article info Article history: Received 7 October 2008 Received in revised form 7 December 2009 Accepted 14 January 2010 Available online 21 February 2010 Keywords: Nursing Low back disorder Patient handling Transfer techniques abstract Nursing is one of the professions at highest risk for the development of low back disorders, with patient handling identified as a leading contributor. The purpose of this study was to assess a component of the Back Injury Prevention Program (BIPP) that provided direct instruction on patient handling technique. Trunk kinematics and muscle activities were collected as indicators of low back loading. Novice participants (before and after instruction) and experienced nurses (previously trained) were monitored while they performed three selected patient transfers. Following BIPP instruction, muscle activity in novice participants was reduced by up to 18.1% MVE. Trained novices and nurses had generally smaller thoracolumbar spine angles by approximately 12  with lower variability in spine angle. Nurses had a smaller range of spine motion than novices combined with higher trapezius and deltoid activities, which may be a load reduction strategy for the back. The BIPP patient transfer instruction provided improved thoracolumbar biomechanics for new trainees and experienced nurses. Relevance to industry: Mechanical lifts are not viable in all hospital or home care settings, thus manual patient handling training is still a necessary and important facet of initial and continuing nursing education. Back education and patient handling instruction provides a cost effective prevention strategy in nursing. Ó 2010 Elsevier B.V. All rights reserved. 1. Introduction Nursing has been identified amongst the top professions at risk for development of occupationally-related low back disorders (LBDs) (Hignett et al., 2007; Karwowski et al., 2005; Yip, 2004; Retsas and Pinikahana, 2000; Marras et al., 1999). The American Nurses Association reported that of approximately 5000 nurses polled in 2001, 85% experienced back pain at work (Houle, 2001). In Canada, from 1996 to 2000, the incidence of back injuries in the healthcare sector was higher than all other industries combined (Engst et al., 2004). The etiology of LBD is complex, consisting of physical, psychosocial, individual, sociocultural and work organi- zational factors (Karwowski et al., 2005). Although many of these factors are present in nursing, the physical factors involved in patient handling have been frequently implicated as the origin of LBD (Cartledge, 2001; Yip, 2001; Retsas and Pinikahana, 2000; Marras et al., 1999). Patient handling activities identified as having a high risk of injury include: repositioning or adjusting a patient in bed, transferring a patient to/from the bed/chair/commode, assisting a patient while walking and assisting a patient rise from a sitting position (Skotte et al., 2002; Yip, 2001; Engvist et al., 1998; Owen and Garg, 1991). The use of retrofit ceiling lifts and portable mechanical lifts has been successful in reducing back compressive forces of these transfers by 60% (Santaguida et al., 2005; Owen and Garg, 1991). However, these are not always economically feasible and not all spaces can accommodate a lift, such as in homes and older institu- tions. Training patient transfer personnel in safe transfer techniques has been used in the past as a cost effective intervention (Hignett et al., 2007; Johnsson et al., 2002; Garg et al., 1991). Developing alternative ergonomic interventions for patient handling has proven difficult. Patients are asymmetrical, non-rigid bodies that impose awkward hand coupling with an element of unpredictability. Non-compliant patients or unanticipated actions from patients can lead to unexpected loading and increase the risk of injury. In addition, unlike many workplaces, workload is dependent on fulfilling the needs of the patients and, administra- tively, is unlikely to be reduced due to limited nursing resources. The need to educate nurses and patient handlers is intuitive, yet ‘‘back education’’ programs have not been successful in reducing injury incidence by themselves (Finch Guthrie et al., 2004; Hignett, 1996; Venning, 1988). Recently, Skotte and Fallentin (2008) found * Corresponding author. Tel.: þ1 905 525 9140x20175; fax: þ1 905 523 6011. E-mail address: hodderjn@mcmaster.ca (J.N. Hodder). Contents lists available at ScienceDirect International Journal of Industrial Ergonomics journal homepage: www.elsevier.com/locate/ergon 0169-8141/$ – see front matter Ó 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.ergon.2010.01.007 International Journal of Industrial Ergonomics 40 (2010) 282–288