A biomechanical assessment of selected patient transfers: the effects of instruction and experience for improving thoracolumbar motions and electromyographic muscle activities

Billions of dollars are being spent each year in North America alone on the treatment and compensation of low back disorders (LBD) related to work processes. Nursing characterizes one of those professions at high risk for the development of LBD. Previous research has identified that patient handling has been the leading cause of occupationally-related LBD for nurses. In response to a need for ergonomic intervention, the Back Injury Prevention Program (BIPP) was introduced in Newfoundland in 1989. While there was some anecdotal evidence that this macro-ergonomic approach was successful in reducing risk of injury, there has been no reported biomechanical evidence that the patient transfer techniques prescribed by BIPP were related to these reductions. The purpose of this study was to examine whether instruction in BIPP transfer techniques is related to beneficial changes in biomechanics metrics thought to be associated with risk for developing LPB. Two comparisons were considered in this model. First, novice subjects were compared prior to and following a standardized BIPP training session, specific to three patient transfer techniques. Secondly, an experienced group of active institutional nurses were measured while performing the same tasks. These transfers were selected based on their history of high incidence of injury and included repositioning a patient to the head of the bed from a side-on position and a position superior to the patient's head and a transfer from a sitting bed position to a wheelchair. Bilateral electromyography (EMG) and a Lumbar Motion Monitor (LMM) were employed to monitor each subject during the execution of a task. Results suggest that BIPP principles for patient transfers reflect sound biomechanical principle, as participant experience increased, the biomechanical demands decreased. Further investigations should consider the administrative controls involved in the implementation of this program in the workplace