Juliette Cooper

A randomized controlled trial to prevent patient lift and transfer injuries of health care workers.

Study Design. Randomized controlled trial (RCT). Objectives. To compare the effectiveness of training and equipment to reduce musculoskeletal injuries, increase comfort, and reduce physical demands on staff performing patient lifts and transfers at a large acute care hospital. Summary of Background Data. Back injury to nursing staff during patient handling tasks is a major issue in health care. The value of mechanical assistive devices in reducing injuries to these workers is unclear. Methods. This three-armed RCT consisted of a “control arm,” a “safe lifting” arm, and a “no strenuous lifting” arm. A medical, surgical, and rehabilitation ward were each randomly assigned to each arm. Both intervention arms received intensive training in back care, patient assessment, and handling techniques. Hence, the “safe lifting” arm used improved patient handling techniques using manual equipment, whereas the “no strenuous lifting” arm aimed to eliminate manual patient handling through use of additional mechanical and other assistive equipment. Results. Frequency of manual patient handling tasks was significantly decreased on the “no strenuous lifting” arm. Self-perceived work fatigue, back and shoulder pain, safety, and frequency and intensity of physical discomfort associated with patient handling tasks were improved on both intervention arms, but staff on the mechanical equipment arm showed greater improvements. Musculoskeletal injury rates were not significantly altered. Conclusions. The “no strenuous lifting” program, which combined training with assured availability of mechanical and other assistive patient handling equipment, most effectively improved comfort with patient handling, decreased staff fatigue, and decreased physical demands. The fact that injury rates were not statistically significantly reduced may reflect the less sensitive nature of this indicator compared with the subjective indicators.

Predictors of time loss after back injury in nurses.

STUDY DESIGN A 2-year prospective inception cohort study of back injury in nurses. OBJECTIVES To determine the extent to which characteristics of nurses, of the injury, and of the workplace predict occurrence and duration of time loss from work after back injury. SUMMARY OF BACKGROUND DATA During 2 years, 320 nurses incurred 416 back injuries at a large teaching hospital in Winnipeg, Canada. Nurses injured on preselected wards were targeted for early intervention, including provision of modified work, whereas nurses injured on other wards received the usual care. METHODS Time loss attributable to the back injury during the 6 months after injury was analyzed. Three statistical models were used to examine occurrence of time loss (logistic regression), duration of time loss (Tobit regression), and duration of time loss once an injury incurring time loss had been documented (least-squares regression). RESULTS In 218 of the 416 injuries, the injured nurse consented to interview. Whereas perceived disability was related to whether a time loss injury would ensue, self-reported pain was strongly related to the duration of time loss once an injury had become a time loss injury. Duration of time loss was reduced by participation in the return-to-work program. Mechanism of injury, specifically injury occurring while lifting patients, resulted in greater time loss. CONCLUSIONS Focusing on reducing the perception of disability at the time of injury is critical to preventing time loss, but once time loss has occurred, offer of modified work and attention to pain reduction are warranted. The findings add to the evidence that workplace-based intervention programs can be effective in reducing the morbidity resulting from back injury.

Elbow joint restriction: Effect on functional upper limb motion during performance of three feeding activities

This study was conducted to quantify and compare changes in upper limb joint motion during different feeding tasks when the elbow joint was restricted. Ten male and nine female volunteer subjects age 18 to 50 years participated; all were healthy, right dominant, with no upper limb pathology. A splint was used to restrict elbow joint motion. Three feeding tasks under both unrestricted and restricted conditions were randomly assigned; motion was recorded by a video-based three-dimensional motion analysis system. Elbow restriction resulted in significantly (p < .05) larger arcs of motion in shoulder flexion and internal rotation. Differences between feeding types were similar during both unrestricted and restricted conditions. Increased shoulder joint motion resulting from elbow joint restriction may require greater activity of shoulder girdle muscles increasing the risk of soft tissue problems and degenerative joint disease. Decisions regarding elbow immobilization should take into consideration potential effects upon total upper limb motion.

Effect of an early intervention program on the relationship between subjective pain and disability measures in nurses with low back injury.

Study Design The effect of a workplace‐based early intervention program on perceptions of pain and disability in nurses with low back injury was studied using a preintervention versus postintervention design with concurrent control group. Objectives To examine the relationship and changes over time between pain and disability measures in two groups of back‐injured nurses‐those who received the early intervention program (study) and those who were not offered the program (control). Summary of Background Data The relationship between back pain and disability is not straightforward. The effects of an intervention program on changes in perceptions of pain and disability over time have not been widely reported. Methods The Oswestry Low Back Disability Questionnaire and a visual analog pain scale were administered to 46 study nurses and 137 control nurses at time of injury and at 6 months after injury. Correlation and regression analyses were used to explore the relationships between the two measures. Changes over time were compared with analyses of variance. Results Pain and disability were positively correlated in both groups at time of injury and at follow‐up evaluation. Mean scores for pain and disability were lower at follow‐up evaluation than at initial injury in both groups; study nurses had significantly (P < 0.01) lower scores at 6 months than nurses in the control group. Disability at time of injury predicted disability at 6 months only for nurses in the control group. Conclusions This workplace‐based early intervention program decreased levels of pain and disability in back‐injured nurses and altered the relationship between these two variables over a 6‐month time interval.

Determination of inter-rater reliability in pediatric burn scar assessment using a modified version of the Vancouver Scar Scale.

The Vancouver Scar Scale is too subjective for our needs and is not culturally sensitive to our Aboriginal clients. The VSS was modified by developing a color scale to aid with vascularity rating. This study was designed to measure the inter-rater reliability of the modified Vancouver Scar Scale (MVSS). Three raters assessed 14 pediatric patients, resulting in a total of 32 scars. Data were analyzed using a Spearman Rank Order Correlation, intraclass correlation coefficient, and the kappa statistic. All subtests were shown to have significant (P < .05) correlations except for the pigmentation subtest. Because the pigmentation subtest has poor reliability, its inclusion in scar assessment should be questioned. Results indicate that only total scores of the MVSS should be used when determining burn scar outcomes because individual subtest scores appear to have little reliability. Further modifications to the MVSS followed by additional research with greater numbers of subjects are warranted.

Components of initial and residual disability after back injury in nurses.

Study Design. A pre‐ versus postintervention with concurrent control group design was used to investigate the effect of a workplace‐based early intervention program on perception of disability in nurses with low back injury. Objectives. This report examines changes over time in the components of the Oswestry Low Back Pain and Disability Questionnaire in two groups of back‐injured nurses‐those who received the early intervention program (study) and those who were not offered the program (control). Summary of Background Data. Early intervention programs can decrease morbidity, time lost from work, and compensation costs. Although perception of disability decreases, some residual disability remains, the nature of which is not clear. Methods. The Oswestry Low Back Pain and Disability Questionnaire scores of 40 study nurses and 118 control nurses at time of injury and at 6 months after injury were examined. Analysis of variance was used to compare changes in mean overall scores over time. The proportion of nurses reporting disability on individual components of the Oswestry Low Back Pain and Disability Questionnaire at each time period was compared with the results of a chi‐square test. Results. Overall Oswestry Low Back Pain and Disability Questionnaire scores were similar between study and control nurses at time of injury, but were significantly lower in study nurses at 6 months after injury. However, scores of individual Oswestry Low Back Pain and Disability Questionnaire components that related to job demands increased over time; this was most apparent in lifting, particularly in study nurses. Conclusions. Although overall perception of disability decreased 6 months after injury, particularly in study nurses, disability in job‐related activities persisted. Residual disability after back injury should be addressed in workplace‐based prevention programs.

Antagonist cocontraction of knee flexors during constant velocity muscle shortening and lengthening.

Electromyography (EMG) was used to study the role of antagonist cocontration of the hamstring muscles of 24 normal subjects during constant velocity muscle performance tests on a KIN COM (™) dynamometer. The hypothesis tests whether antagonist cocontraction varies dependent on joint angle, limb velocity, and type of contraction. Seated subjects performed two dynamic tests of resisted quadriceps muscle shortening and lengthening through a 65° range of knee motion under two constant velocity conditions in a single session. Each test consisted of four repetitions of maximum effort constant velocity muscle shortening and lengthening of the knee extensors; one test performed at 30° s(-1), the other at 90° s(-1). The sequence of velocity testing was randomized. Normalized values of peak amplitude EMG of knee flexors were measured every 5° in the constant velocity phase of each test and compared in a paired manner between each angle, contraction type, and velocity, by split-plot 2-way ANOVA. Antagonist hamstrings cocontraction was found to be contraction type, and velocity dependent. Cocontraction was greater at larger angles of knee flexion and at higher velocity. These results do not support the hypothesis that such activity is a function of muscle moment-arm, but are consistent with the idea that antagonist muscle function is controlled by muscle spindles and perhaps Golgi tendon organs. Because antagonist cocontraction ranged up to a mean of 32% of maximum agonist activity in normal individuals, it should be taken into consideration when interpreting clinical muscle performance tests.

Participation in community-based activities of daily living: Comparison of a pushrim-activated, power-assisted wheelchair and a power wheelchair

Purpose. The purpose of this study was to evaluate pushrim-activated, power-assisted wheelchair (PPW) performance among dual-users in their natural environment to determine whether the PPW would serve as a satisfactory alternative to a power wheelchair for community-based activities. Methods. A concurrent mixed methods research design using a cross-over trial was used. The outcome measures used were number of hours reported using the different wheelchairs, Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), Functioning Everyday with a Wheelchair (FEW), Psychosocial Impact of Assistive Devices Scale (PIADS) and Canadian Occupational Performance Measure (COPM). Results. The number of hours spent participating in self-identified activities was not significantly different. Only the Self-Esteem subscale of the PIADS identified a statistically significant difference between the PPW and power wheelchair conditions (p = 0.016). A clinically important difference for Performance and Satisfaction was suggested by the COPM, in favour of the power wheelchair. Conclusions. Additional knowledge was gained about the benefits of PPW technology. Participants were able to continue participating independently in their self-identified community activities using the PPW, and identified comparable ratings of satisfaction and performance with the PPW and the power wheelchair. For some individuals requiring power mobility, the PPW may provide an alternative to the power wheelchair.

Burn Therapists' Opinion on the Application and Essential Characteristics of a Burn Scar Outcome Measure

Comprehensive burn rehabilitation requires the use of an appropriate burn scar outcome measure (BSOM). The literature reports many BSOMs; however, an objective, practical, inexpensive, valid, reliable, and responsive instrument eludes us. A problem in the development of such a measure is disagreement in which scar properties to include. The objective of this study was to determine the burn scar variables that therapists believe should be included in a BSOM. An Internet survey was administered to burn occupational and physical therapists. The response rate was 38.6% (105 surveys). Of the respondents, 38.1% use a BSOM; of those, 75% use the Vancouver Scar Scale. Reasons why respondents do not use a BSOM (61.9%) are because they are not familiar with available measures, have not found one that is clinically practical, or need more training. The majority (95%) believes that using a BSOM is important, and the following BSOM characteristics were reported as important: reliable, valid, quick, easy, and noninvasive. Respondents indicated that the following properties should be included in a BSOM: pliability (96.2%), vascularity (92.4%), height (87.6%), appearance (75.2%), skin breakdown (74.3%), itch (73.3%), surface texture (70.5%), pigmentation (68.6%), and pain (67.6%). This study suggests that using a BSOM is important despite its inconsistent use, and BSOM education may be valuable. The top three agreed-upon properties for inclusion are already incorporated into the most commonly used BSOM—the Vancouver Scar Scale—suggesting that modifications may be reasonable.

Causes of staff abuse in health care facilities. Implications for prevention.

Verbal and physical abuse of health care workers (HCWs) is prevalent and costly. A 3 month prospective study was conducted to characterize precipitating conditions and the perpetrators of abusive incidents reported by HCWs at a large inner city hospital. Sixty-six HCWs reporting 102 incidents were interviewed by a research nurse within 48 hours of the incident. Abusive incidents resulted from 55 different patients and 11 visitors. Verbal abuse accounted for 42 incidents (41%) and 60 (59%) involved physical abuse. Two thirds of the abuse occurred on psychiatric wards, 20% on inpatient wards, and 13% in other settings. Overall, twice as many abusive incidents were inflicted by males as females. Cognitive impairment accounted for 19% of the incidents and one abuser was intoxicated at the time. Rule enforcement precipitated abuse in 70% of incidents. Researchers concluded that reviewing rules that apply to patients, how HCWs are trained to enforce rules, how to respond when service requested cannot be provided promptly, and how HCWs can protect themselves when performing a service were important elements in the prevention of staff abuse.