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Abstract
Remote area staff performing manual patient handling tasks in the absence of patient lifting hoists available in most health care settings are at an elevated risk of musculoskeletal injuries. The objective of this project was to identify the patient handling methods that have the lowest risk of injury. The patient handling task of lifting a patient from floor to a chair or wheelchair is a common task performed in a remote health care setting. The task was performed utilising three methods, these being: (1) heads/tails lift, (2) use of two Blue MEDesign® slings and (3) use of a drawsheet. The task of the heads/tails lift was broken down into two distinctly separate subtasks: lifting from the (1) head and (2) tail ends of the patient load. These techniques were selected based on criteria including current practice, durability, portability, accessibility, ease of storage and cost to supply.
Postural data were obtained using a Vicon 370 three - dimensional motion measurement and analysis system in the Biomechanics & Gait laboratory at the University of New South Wales. Forty reflective markers were placed on the subject to obtain the following joint angles: ankle, knee, hip, torso, shoulder, elbow, and wrist. The raw data were converted into the respective joint angles (Y, X, Z) for further analysis.
The postural data was analysed using the University of Michigan’s Three-Dimensional Static Strength Prediction Program (3D SSPP) and the relative risk of injury was based on the following three values: (1) a threshold value of 3,400 N for compression force, (2) a threshold value of 500 N for shear force, and (3) population strength capability data.
The effects on changes to the anthropometric data was estimated and analysed using the in-built anthropometric data contained within the 3D SSPP program for 6 separate lifter scenarios, these being male and female 5th, 50th and 95th percentiles. Changes to the patient load were estimated and analysed using the same computer software.
Estimated compressive and shear forces were found to be lower with the drawsheet and tail component of the heads/tails lift in comparison to the use of the Blue MEDesign® straps and head component of the heads/tails lift. The results obtained for the strength capability aspect of each of the lifts indicated a higher percentage of the population capable of both the drawsheet and tail end of the heads/tails lift. The relative risk of back injury for the lifters is distributed more evenly with the drawsheet lift as opposed to the heads/tails (tail) lift where risk is disproportionate with the heavier end being lifted.
The use of lifter anthropometrics does not appear to be a realistic variable to base assumptions on which group of the population are capable of safely performing this task in a remote setting.
This study advocates the use of the drawsheet lift in a remote setting based on the author’s experience and the biomechanical results obtained in this study.
The drawsheet lift is both more accessible and provides a more acceptable risk when more than two patient handlers are involved, in comparison to the other lifts utilised lifting patients from floor to a chair.