Reducing Occupational Hazards for Occupational Therapy Practitioners: Forces Involved When Sliding a Patient Up in Bed Using a Variety of Draw Sheets

PURPOSE: Work-related musculoskeletal injuries are prevalent among occupational therapy practitioners (Rice et al., 2011). The physically demanding nature of patient handling contributes to high injury rates because of unsafe techniques and loads. Safe patient handling techniques have been successful in reducing the prevalence of musculoskeletal injuries among health care workers while still allowing for appropriate care and positioning of patients. Occupational therapy practitioners need to shift their standards of practice from traditional manual patient handling to emphasize safe patient handling. Methods purported to reduce the potential for musculoskeletal injury and keep practitioners safe include use of friction-reducing devices, which influence the amount of force required during patient handling tasks (Darragh et al., 2013; Larson & Rice, 2015).

This study used a variety of slide sheets to investigate the forces required by caregivers during a repositioning task. It sought to provide evidence for using certain slide sheets over others when performing this task. It was hypothesized that significantly less force would be required by the caregiver to slide a patient up in bed using friction-reducing draw sheets compared with a traditional cotton draw sheet.

METHOD: This study used an experimental repeated measures design. Participants were recruited by word of mouth and fliers hung around a university campus. Participants included 38 healthy adults, male and female, aged 20–57 who did not have previous musculoskeletal injury.

Data were gathered via a 3D movement analysis system (Cortex Version 3.1.0.1288 [Cortex Software, Toronto, Ontario, Canada] coupled with eight Owl motion capture cameras [Motion Analysis Corp., Santa Rosa, CA]) along with handheld force gauges (Futek MTA 400 triaxial load cells [Futek, Irvine, CA]). The system collected kinematic and force data.

This research was completed in a lab setting at the University of Toledo. The “patient” for this project was a 150-lb man aged 27. A repeated measures analysis of variance with five levels to the repeated factor—number of sheets (single or double) and sheet type (Arjo, McAuley, or cotton)—was used, along with a post hoc Bonferroni multiple comparison analysis.

RESULTS: Significant differences were found among the five repeated conditions. There were significant differences between the double Arjo condition and the cotton sheet condition as well as the double McAuley condition and the cotton sheet condition. The Arjo and McAuley sheets both elicited less force from participants than the cotton sheet. The peak force with the cotton sheet was 66.2 lb, with the double Arjo 57.0 lb, and with the double McAuley 52.7 lb. Low back shear forces when using the McCauley sheet were lower in every category compared with the cotton sheet, whereas the forces when using the Arjo sheet were lower only in the L4–L5 forward shear category.

CONCLUSION: The Arjo and McAuley friction-reducing slide sheets were effective at reducing the hand force required to boost a patient up in bed when doubled. This lower friction can help reduce injuries experienced by occupational therapy practitioners if used appropriately. Limitations include the lab setting, the relatively light 150-lb patient, and the largely student population of participants.

IMPACT STATEMENT: Using friction-reducing devices is a simple way to reduce the risk manual patient handling poses to occupational therapy practitioners. The more practitioners understand this and implement these methods, the fewer musculoskeletal injuries they will experience throughout their careers.

References

Darragh, A. R., Campo, M. A., Frost, L., Miller, M., Pentico, M., & Margulis, H. (2013). Safe-patient-handling equipment in therapy practice: Implications for rehabilitation. American Journal of Occupational Therapy, 67, 45–53. https://doi.org/10.5014/ajot.2013.005389

Larson, R. E., & Rice, M. S. (2015). Hand forces involved when completing a lateral bed to plinth transfer. International Journal of Safe Patient Handling and Movement, 5, 117–121.

Rice, M. S., Dusseau, J. M., & Miller, B. K. (2011). A questionnaire of musculoskeletal injuries associated with manual patient lifting in occupational therapy practitioners in the State of Ohio. Occupational Therapy in Health Care, 25, 95–107. https://doi.org/10.3109/07380577.2011.566308