Biomechanical Evaluation of a Patient-Handling Technology Prototype
Corresponding email: hiridias@vt.edu
Published at : 29 Jan 2020
Volume : IJtech
Vol 11, No 1 (2020)
DOI : https://doi.org/10.14716/ijtech.v11i1.1332
Iridiastadi, H., Vani, T., Yamin, P.A.R. 2020. Biomechanical Evaluation of a Patient-Handling Technology Prototype. International Journal of Technology. Volume 11(1), pp. 180-189
| Hardianto Iridiastadi | Industrial Engineering, Faculty of Industrial Technology, Institut Teknologi Bandung (ITB), Indonesia, Ganesa 10, Bandung 40132, Indonesia |
| Theodora Vani | Industrial Engineering, Faculty of Industrial Technology, Institut Teknologi Bandung (ITB), Indonesia, Ganesa 10, Bandung 40132, Indonesia |
| Putra Alif Ramdhani Yamin | Industrial Engineering, Faculty of Industrial Technology, Institut Teknologi Bandung (ITB), Indonesia, Ganesa 10, Bandung 40132, Indonesia |
Nursing jobs have generally been associated with poor posture and heavy
exertion, particularly during patient-handling activities. Such working conditions are known to increase
the risk of musculoskeletal disorders, and the use of patient-handling aids has
been proposed to alleviate the problem. This study was conducted with the
purpose of evaluating a patient-handling technology (PHT) prototype that was
developed by the researchers for use in Indonesia. An experiment was conducted
involving 12 nurse participants, who were asked to move a patient, either manually
or by using the prototype. Postural analyses were performed using 3DSSPP
software, Rapid Upper Limb Assessment (RULA), and Rapid Entire Body Assessment
(REBA). A Borg scale was employed to
determine the participants’ perceptions of the levels of exertion required
during the experiment. The findings
demonstrated that using the PHT prototype resulted in a substantial reduction
in the compression force at the lumbar (L5/S1) joint. However, there was a marginal increase in
shear force at this joint due to the push/pull activities involved in using the
technology while handling the patient. This increase, however, was still within
accepted biomechanical limits. Postural analyses based on the RULA and REBA
demonstrated a great reduction in ergonomic risks when using the
prototype. The nurses also reported
reduced physical workload when using the PHT technology. Across all measures,
there were reductions in the biomechanical risks of between 30% and nearly 70%.
While the PHT prototype still needs design refinements, its use in medical
settings has the potential to ameliorate musculoskeletal problems among nurses
and caregivers.
Caregivers; Musculoskeletal disorders; Patient handling; Patient-handling technology prototype;
The patient-handling
activities performed by hospital nurses are often associated with increased
risk of musculoskeletal disorders or MSDs (Waters
et al., 2007; Nelson et al., 2007; Iridiastadi et al., 2019). These are a
group of disorders affecting the muscles, joints, tendons, ligaments, nerves,
and bones, which are caused by strenuous physical activity in combination with
poor posture (Batubara and Dharmastiti, 2017;
Ribeiro et al., 2017). According
to the US Bureau of Labor Statistics (2008), caregivers are subject to a relatively
high rate of non-fatal occupational injuries.
Caregivers include nurses, health workers, and nursing assistants. Nursing has been identified as a profession
carrying a high risk of lower back or spinal injury. Every year, 10,000
nurses in the United States suffer MSDs and roughly
30–65% of these injuries are caused by manual patient-handling activities.
One
of the methods for reducing the risk of MSDs is to use lifting or moving aids (Nelson et al., 2006). In the United States, for instance,
many medical settings have introduced patient-handling technology to reduce the
risk of musculoskeletal injury.
Hospitals employ floor lifts and ceiling lifts with patients. The floor
lift is a portable tool that can be maneuvered on the floor so that, when
handling a patient, the nurse only needs to push and control the device. The
ceiling lift is usually installed on the ceiling of the room, and the nurse can
move the patient by using a controller or a remote control.
Although
these ideas are not new in many industrialized countries, the concept and
availability of patient-handling aids is generally lacking in many developing
nations. In Indonesia, such apparatus is generally only available in the larger
hospitals, or it is available for rent at a high price. In recent years, the
researchers have developed a patient-handling technology (PHT) prototype in the
expectation that this will prove to be low-cost technology that will help
reduce the risk of MSDs in Indonesian nurses and caregivers. This prototype can
be used to help maneuver a patient from a bed to a wheelchair and vice versa.
Two types of lifting mat are available—for the sitting and supine positions.
The tool is activated through a pneumatic system; and the nurse or caregiver
controls the height and position of the tool through a remote control. The PHT
prototype is also equipped with wheels and a braking pedal.
Despite
its potential benefits, the prototype had not yet been evaluated from the
biomechanical perspective. Its effectiveness had not been proven, and it was
not clear if nurses would accept the technology in the hospital setting. The
major research question was whether the technology would result in lower
biomechanical loads and thus, potentially, reduce the risk of MSDs. Even if it
did result in lower loads, there was also a need to determine whether the loads
were indeed below the acceptable ergonomic limit. If the technology was accepted by the users,
and shown to perform as intended, the prototype could be manufactured and made
widely available in a large number of hospitals in Indonesia.
This
study was conducted based on the premise that nurses and caregivers suffer
musculoskeletal problems as a result of their manual patient-handling
activities. A mechanical aid (i.e., the
PHT) had been designed and manufactured previously by the researchers, but it
had not yet been evaluated from the biomechanical perspective. This study demonstrated that the use of this
technology was ergonomically better than manual handling. The PHT greatly reduced the spinal load (at
the L5/S1 joint), improved work postures, and minimized the amount of physical
effort during patient handling tasks.
Further research is needed to refine the design. It is expected that this technology will help
reduce musculoskeletal problems among hospital nurses and caregivers in
general, and in particular, among those with regular duties in handling
patients.
This research was made possible by a
grant provided by the Indonesian Ministry of Research, Technology, and Higher
Education (Grant#: 255/SP2H/LT/DRPM/II/2016).
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