Participatory organizational intervention for improved use of assistive devices for patient transfer: study protocol for a single-blinded cluster randomized controlled trial

Markus D Jakobsen, Birgit Aust, Johnny Dyreborg, Pete Kines, Maja B Illum, Lars L Andersen, Markus D Jakobsen, Birgit Aust, Johnny Dyreborg, Pete Kines, Maja B Illum, Lars L Andersen

Abstract

Background: Epidemiological studies have shown that patient transfer is a risk factor for back pain, back injuries and long term sickness absence, whereas consistent use of assistive devices during patient transfer seems to be protective. While classical ergonomic interventions based on education and training in lifting and transferring techniques have not proven to be effective in preventing back pain, participatory ergonomics, that is meant to engage and motivate the involved parties while at the same time making the intervention maximally relevant, may represent a better solution. However, these findings are largely based on uncontrolled studies and thus lack to be confirmed by studies with better study designs. In this article, we present the design of a study which aims to evaluate the effect and process of a participatory organizational intervention for improved use of assistive devices.

Methods: The study was performed as a cluster randomized controlled trial. We recruited 27 departments (clusters) from five hospitals in Denmark to participate in the study. Prior to randomization, interviews, observations and questionnaire answers (baseline questionnaire) were collected to gain knowledge of barriers and potential solutions for better use of assistive devices. In April 2016, the 27 departments were randomly allocated using a random numbers table to a participatory intervention (14 clusters, 324 healthcare workers) or a control group (13 clusters, 318 healthcare workers). The participatory intervention will consist of workshops with leaders and selected healthcare workers of each department. Workshop participants will be asked to discuss the identified barriers, develop solutions for increasing the use of assistive devices and implement them in their department. Use of assistive devices (using digital counters -, primary outcome, and accelerometers and questionnaire - secondary outcome), perceived physical exertion during patient transfer, pain intensity in the lower back, occurrence of work-related back injuries during patient transfer, organizational readiness to change, knowledge on how to perform proper patient transfer, social capital and work ability (secondary outcomes) were assessed at baseline and will also be assessed at 1 year follow-up. Process evaluation will be based on qualitative and quantitative data to assess the implementation, the change process, and the impact of context aspects.

Discussion: The study will evaluate the effect and process of a participatory intervention on improving the use of assistive devices for patient transfer among hospital healthcare workers. By using cluster-randomization, as well as process- and effect evaluation based on objective measures we will contribute to the evidence base of a promising intervention approach.

Trial registration: ClinicalTrials.gov ( NCT02708550 ). March, 2016.

Keywords: Accidents at work; Back pain; Health care; Musculoskeletal disorders; Objective measure; Occupational health; Occupational injury; Patient lift; Process evaluation.

Figures

Fig. 1
Fig. 1
Flow-chart of the participants who received the baseline questionnaire
Fig. 2
Fig. 2
Elements, measurements and phases of the study

References

    1. Bureau of Labor Statistics . Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work, 2014. Washington (DC): US: Department of Labor; 2015.
    1. Lipscomb HJ, Schoenfisch AL, Myers DJ, Pompeii LA, Dement JM. Evaluation of direct workers’ compensation costs for musculoskeletal injuries surrounding interventions to reduce patient lifting. Occup Environ Med. 2012;69(5):367–72. doi: 10.1136/oemed-2011-100107.
    1. Davis KG, Kotowski SE. Prevalence of Musculoskeletal Disorders for Nurses in Hospitals, Long-Term Care Facilities, and Home Health Care: A Comprehensive Review. Hum Factors. 2015;57(5):754–92. doi: 10.1177/0018720815581933.
    1. Andersen LL, Clausen T, Mortensen OS, Burr H, Holtermann A. A prospective cohort study on musculoskeletal risk factors for long-term sickness absence among healthcare workers in eldercare. Int Arch Occup Environ Health. 2012;85(6):615–22. doi:10.1007/s00420-011-0709-5.
    1. Koppelaar E, Knibbe JJ, Miedema HS, Burdorf A. Individual and organisational determinants of use of ergonomic devices in healthcare. Occup Environ Med. 2011;68(9):659–65. doi: 10.1136/oem.2010.055939.
    1. Yassi A, Lockhart K. Work-relatedness of low back pain in nursing personnel: a systematic review. Int J Occup Environ Health. 2013;19(3):223–44. doi: 10.1179/2049396713Y.0000000027.
    1. Skotte J, Fallentin N. Low back injury risk during repositioning of patients in bed: the influence of handling technique, patient weight and disability. Ergonomics. 2008;51(7):1042–52. doi: 10.1080/00140130801915253.
    1. Skotte JH, Essendrop M, Hansen AF, Schibye B. A dynamic 3D biomechanical evaluation of the load on the low back during different patient-handling tasks. J Biomech. 2002;35(10):1357–66. doi: 10.1016/S0021-9290(02)00181-1.
    1. Burdorf A, Sorock G. Positive and negative evidence of risk factors for back disorders. Scand J Work Environ Health. 1997;23(4):243–56. doi: 10.5271/sjweh.217.
    1. Smedley J, Egger P, Cooper C, Coggon D. Manual handling activities and risk of low back pain in nurses. Occup Environ Med. 1995;52(3):160–3. doi: 10.1136/oem.52.3.160.
    1. Owen BD. The magnitude of low-back problem in nursing. West J Nurs Res. 1989;11(2):234–42. doi: 10.1177/019394598901100208.
    1. Pompeii LA, Lipscomb HJ, Schoenfisch AL, Dement JM. Musculoskeletal injuries resulting from patient handling tasks among hospital workers. Am J Ind Med. 2009;52(7):571–8. doi: 10.1002/ajim.20704.
    1. Andersen LL, Burdorf A, Fallentin N, Persson R, Jakobsen MD, Mortensen OS. Patient transfers and assistive devices: prospective cohort study on the risk for occupational back injury among healthcare workers. Scand J Work Environ Health. 2014;40(1):74–81. doi: 10.5271/sjweh.3382.
    1. Yassi A, Cooper JE, Tate RB, Gerlach S, Muir M, Trottier J. A randomized controlled trial to prevent patient lift and transfer injuries of health care workers. Spine. 2001;26(16):1739–46. doi: 10.1097/00007632-200108150-00002.
    1. Garg A, Kapellusch JM. Long-term efficacy of an ergonomics program that includes patient-handling devices on reducing musculoskeletal injuries to nursing personnel. Hum Factors. 2012;54(4):608–25. doi: 10.1177/0018720812438614.
    1. Verbeek JH, Martimo K-P, Kuijer PPFM, Karppinen J, Viikari-Juntura E, Takala E-P. Proper manual handling techniques to prevent low back pain, a Cochrane systematic review. Work. 2012;41(Suppl 1):2299–301.
    1. Martin PJ, Harvey JT, Culvenor JF, Payne WR. Effect of a nurse back injury prevention intervention on the rate of injury compensation claims. J Safety Res. 2009;40(1):13–9. doi: 10.1016/j.jsr.2008.10.013.
    1. Rivilis I, Van Eerd D, Cullen K, Cole DC, Irvin E, Tyson J. Effectiveness of participatory ergonomic interventions on health outcomes: a systematic review. Appl Ergon. 2008;39(3):342–58. doi: 10.1016/j.apergo.2007.08.006.
    1. van Eerd D, Cole D, Irvin E, Mahood Q, Keown K, Theberge N. Process and implementation of participatory ergonomic interventions: a systematic review. Ergonomics. 2010;53(10):1153–66. doi: 10.1080/00140139.2010.513452.
    1. Wilson J, Haines H. Participatory Ergonomics. In: Salvendy G, editor. Handbook of Human Factors and Ergonomics. New York: Wiley; 1997. pp. 490–513.
    1. Kuorinka I. Tools and means of implementing participatory ergonomics. Int J Ind Ergon. 1997;19:267–270. doi: 10.1016/S0169-8141(96)00035-2.
    1. Haines H, Wilson JR, Vink P, Koningsveld E. Validating a framework for participatory ergonomics (the PEF) Ergonomics. 2002;45(4):309–27. doi: 10.1080/00140130210123516.
    1. D’Arcy LP, Sasai Y, Stearns SC. Do assistive devices, training, and workload affect injury incidence? Prevention efforts by nursing homes and back injuries among nursing assistants. J Adv Nurs. 2012;68(4):836–45. doi: 10.1111/j.1365-2648.2011.05785.x.
    1. Park RM, Bushnell PT, Bailer AJ, Collins JW, Stayner LT. Impact of publicly sponsored interventions on musculoskeletal injury claims in nursing homes. Am J Ind Med. 2009;52(9):683–97. doi: 10.1002/ajim.20731.
    1. Fujishiro K, Weaver JL, Heaney CA, Hamrick CA, Marras WS. The effect of ergonomic interventions in healthcare facilities on musculoskeletal disorders. Am J Ind Med. 2005;48(5):338–47. doi: 10.1002/ajim.20225.
    1. Koppelaar E, Knibbe JJ, Miedema HS, Burdorf A. Determinants of implementation of primary preventive interventions on patient handling in healthcare: a systematic review. Occup Environ Med. 2009;66(6):353–60. doi: 10.1136/oem.2008.042481.
    1. Garg A, Owen B. Reducing back stress to nursing personnel: an ergonomic intervention in a nursing home. Ergonomics. 1992;35(11):1353–75. doi: 10.1080/00140139208967398.
    1. Collins JW, Wolf L, Bell J, Evanoff B. An evaluation of a “best practices” musculoskeletal injury prevention program in nursing homes. Inj Prev. 2004;10(4):206–11. doi: 10.1136/ip.2004.005595.
    1. Nelson A, Baptiste AS. Evidence-based practices for safe patient handling and movement. Orthop Nurs. 2006;25(6):366–79.
    1. Koppelaar E, Knibbe JJ, Miedema HS, Burdorf A. The influence of individual and organisational factors on nurses’ behaviour to use lifting devices in healthcare. Appl Ergon. 2013;44(4):532–7. doi: 10.1016/j.apergo.2012.11.005.
    1. Campbell MK, Piaggio G, Elbourne DR, Altman DG, CONSORT Group Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012;345:e5661. doi: 10.1136/bmj.e5661.
    1. Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586. doi: 10.1136/bmj.e7586.
    1. Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–7. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Thaler RH, Sunstein CR. Nudge: improving decisions about health, wealth and happiness. London: Penguin; 2009. p. 305 s.
    1. Saunders RP, Evans MH, Joshi P. Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promot Pract. 2005;6(2):134–47. doi: 10.1177/1524839904273387.
    1. Nielsen K, Randall R. Opening the black box: Presenting a model for evaluating organizational-level interventions. Eur J Work Organ Psychol. 2013;22(5):601–17. doi: 10.1080/1359432X.2012.690556.
    1. Fridrich A, Jenny GJ, Bauer GF. The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions. Biomed Res Int. 2015;2015:414832. doi: 10.1155/2015/414832.
    1. Nielsen KA, Nielsen BS. Methodologies in Action Research : Action Research and Critical Theory. I: Action Research and Interactive Research: Beyond practice and theory ed Kurt Aagaard Nielsen; Lennart Svensson. Maastricht: Shaker Publishing; 2006. s. 63–87.
    1. Pincus T, Bergman M, Sokka T, Roth J, Swearingen C, Yazici Y. Visual analog scales in formats other than a 10 centimeter horizontal line to assess pain and other clinical data. J Rheumatol. 2008;35(8):1550–8.
    1. Andersen LL, Saervoll CA, Mortensen OS, Poulsen OM, Hannerz H, Zebis MK. Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain. 2011;152(2):440–6. doi: 10.1016/j.pain.2010.11.016.
    1. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233–7. doi: 10.1016/0003-6870(87)90010-X.
    1. Borg G. Psychophysical scaling with applications in physical work and the perception of exertion. Scand J Work Environ Health. 1990;16:55–8. doi: 10.5271/sjweh.1815.
    1. Jakobsen MD, Sundstrup E, Persson R, Andersen CH, Andersen LL. Is Borg’s perceived exertion scale a useful indicator of muscular and cardiovascular load in blue-collar workers with lifting tasks? A cross-sectional workplace study. Eur J Appl Physiol. 2014;114(2):425–34. doi: 10.1007/s00421-013-2782-9.
    1. Jakobsen MD, Sundstrup E, Brandt M, Jay K, Aagaard P, Andersen LL. Physical exercise at the workplace reduces perceived physical exertion during healthcare work: cluster randomized controlled trial. Scand J Public Health. 2015;43(7):713–20. doi: 10.1177/1403494815590936.
    1. Ilmarinen J. The Work Ability Index (WAI) Occup Med (Lond) 2007;57(2):160. doi: 10.1093/occmed/kqm008.
    1. Jakobsen MD, Sundstrup E, Brandt M, Jay K, Aagaard P, Andersen LL. Physical exercise at the workplace prevents deterioration of work ability among healthcare workers: cluster randomized controlled trial. BMC Public Health. 2015;15:1174. doi: 10.1186/s12889-015-2448-0.
    1. Andersen LL, Poulsen OM, Sundstrup E, Brandt M, Jay K, Clausen T. Effect of physical exercise on workplace social capital: Cluster randomized controlled trial. Scand J Public Health. 2015;43(8):810–8. doi: 10.1177/1403494815598404.
    1. Borg V, Mateu N, Clausen T. Udvikling af en ny metode til undersøgelse af social kapital på arbejdspladsen. 2014
    1. Shea CM, Jacobs SR, Esserman DA, Bruce K, Weiner BJ. Organizational readiness for implementing change: a psychometric assessment of a new measure. Implement Sci. 2014;9(1):7. doi:10.1186/1748-5908-9-7.
    1. Evanoff B, Wolf L, Aton E, Canos J, Collins J. Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace. Am J Ind Med. 2003;44(5):451–7. doi: 10.1002/ajim.10294.
    1. Burdorf A, Koppelaar E, Evanoff B. Assessment of the impact of lifting device use on low back pain and musculoskeletal injury claims among nurses. Occup Environ Med. 2013;70(7):491–7. doi: 10.1136/oemed-2012-101210.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera