Lifting Patients Poses High Risk For Back Injuries, Study Shows

January 20, 1998

COLUMBUS, Ohio -- Caregivers in hospitals and nursing homes risk serious back injuries when they lift patients, according to a new study at Ohio State University. Researchers estimate that when caregivers lift patients by themselves, their movements appear about 98 percent similar to those of workers at high risk for developing lower back disorders.

But even using two people to lift patients poses a significant risk of back injury, said William Marras, professor of industrial, welding and systems engineering, and physical medicine and rehabilitation at Ohio State. The solution may be to use mechanical devices to lift patients.

“We explored the different ways that people normally lift patients in hospitals and nursing homes,” said Marras. “And we found that no matter what method was used, lifting patients seems to impose an excessive amount of stress on the spine.”

The study will help the Occupational Safety and Health Administration (OSHA) set new safety guidelines for hospitals and nursing homes and other environments in which employees must move patients. Marras and his colleagues published their results in a report for the state of Washington Safety and Health Achievement Recognition Program (SHARP), which sponsored the study. SHARP is an OSHA service that helps small companies develop safety and health strategies for their workers.

Researchers monitored 12 professional patient handlers and 5 students as they moved a volunteer who acted as a patient around Ohio State’s Biodynamics Laboratory. The researchers measured the electrical activity generated in the lifters’ muscles. From this information the researchers were able to estimate the load on the spine of each lifter and approximate the similarity of the movements to those of jobs where employees risk developing a lower back disorder over time.

“What makes patient lifting really difficult is that employees can’t use their leg muscles because they’re leaning over the edge of a bed. They have to use their back muscles to haul the patients up, and that’s not easy,” said Marras.

The researchers found that each person experienced the most stress when they worked alone to reposition the patient on the bed. This activity resembled the movements of high-risk jobs the most, by about 98 percent.

The second highest level of stress resulted when one person worked alone to lift the patient out of bed. This resembled high-risk jobs by about 90 percent.

“Lifting patients is not a trivial task,” Marras continued. “This activity presents very significant risks, and anything we can do to sidestep those risks is worthwhile, because one of the problems with back injuries is that you don’t get much early warning. Typically, by the time you feel the pain, it’s too late.”

The study yielded some surprising results. For instance, when two people shared the work of lifting and moving the patient, they didn’t lessen their load very much. Two people repositioning the patient together still mirrored high-risk movements by about 88 percent; two people lifting the patient together still maintained a similarity above 78 percent.

Two people working together generated the least amount of stress when they repositioned the patient on the bed by pulling on a draw sheet. This task resembled high-risk movements by only 68 percent, which Marras said is still cause for concern.

“I was surprised that having two people work together did not significantly lower their similarity to high-risk jobs,” said Marras. “We think that when two people are doing the lifting they may actually be fighting each other somewhat.”

One of the other tasks the researchers examined was that of lifting the patient from the bed into a wheelchair. This yielded surprising results as well.

“Removing the arms of the wheelchair didn’t help,” said Marras. “Originally we thought that the difficulty with loading people into wheelchairs was that you have to position them carefully between the arms, so the workers have to hold on longer and contract their muscles longer to get the patient in there. We thought it would be easier to just put the patient on a chair with no armrests. And that turned out not to be the case.”

Marras also pointed out that the study took as its “standard” patient a student volunteer who weighed only 120 pounds. For the purposes of the experiment, she was not to make use of her legs, but she was able to support herself with her arms.

“This is probably the best case scenario you’re ever going to see in a hospital or nursing home, and even this small person produced loads on the spines of the patient handlers that were excessive,” said Marras.

In the future, Marras may perform further research in actual hospitals and nursing homes. In the meantime, he and the other researchers recommended in their report that health care companies should invest in mechanical lifting devices to aid workers.

“The moral of the story is, changing the way people lift doesn’t seem to control the risk in these situations, so we’re going to have to get lifting devices to help workers transfer patients. That way, the workers help, but they’re using a machine, not moving the patient directly. Those will be the kinds of measures that will significantly lower risk of back injury.”

Marras said such machines suspend patients by a strap from the end of a mechanical arm to move them around the room. While the devices are not inexpensive, Marras feels that they will be necessary to mitigate the high cost of back injuries.

“The question is, what does it cost not to buy this equipment? A back injury can cost as much as $50,000, and that’s not even including all the indirect costs. If a nursing home can buy these lifting devices for $1,000 to $2,000, and eliminate a back injury that costs tens of thousands of dollars, that’s a good deal,” said Marras.

Ohio State University

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