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Texas passes first law for safe patient handling in America: landmark legislation protects health-care workers and patients from injury related to manual patient lifting.

On June 17,2005, Texas Governor Rick Perry (R) signed into law Senate Bill 1525, making Texas the first state in the nation to require hospitals and nursing homes to implement safe patient handling and movement programs. Governor Perry is to be commended for this heroic first stand for safe patient handling in America. The landmark legislation will take effect January 1, 2006, requiring the establishment of policy to identify, assess, and develop methods of controlling the risk of injury to patients and nurses associated with lifting, transferring, repositioning, and movement of patients; evaluation of alternative methods from manual lifting to reduce the risk of injury from patient lifting, including equipment and patient care environment; restricting, to the extent feasible with existing equipment, manual handling of all or most of a patient's weight to emergency, life-threatening, or exceptional circumstances; and provision for refusal to perform patient handling tasks believed to involve unacceptable risks of injury to a patient or nurse. Manually lifting patients has been called deplorable, inefficient, dangerous to nurses, and painful and brutal to patients; manual lifting can cause needless suffering and injury to patients, with dangers including pain, bruising, skin tears, abrasions, tube dislodgement, dislocations, fractures, and being dropped by nursing staff during attempts to manually lift. Use of safe, secure, mechanical lift equipment and gentle friction-reducing devices for patient maneuvering tasks could eliminate such needless brutality. Research has proven that manual patient lifting is extremely hazardous to health-care workers, creating substantial risk of low-back injury, whether with one or two patient handlers. Studies on the use of mechanical patient lift equipment, by either nursing staff or lift teams, have proven repeatedly that most nursing staff back injury is preventable, leading to substantial savings to employers on medical and compensation costs. Because the health-care industry has relied on people to do the work of machines, nursing work remains the most dangerous occupation for disabling back injury. Back injury from patient lifting may be the single largest contributor to the nursing shortage, with perhaps 12% of nurses leaving or being terminated because of back injury. The US health-care industry has not kept pace with other industries, which provide mechanical lift equipment for lifting loads equivalent to the weight of patients, or with other countries, such as Australia and England, which are more advanced in their use of modern technology for patient lifting and with no-lifting practices in compliance with government regulations and nursing policies banning manual lifting. With Texas being the first state to succeed in passing legislation for safe patient handling, other states are working toward legislative protection against injury with manual patient lifting. California re-introduced safe patient handling legislation on February 17, 2005, with CA SB 363, Hospitals: Lift Teams, following the September 22, 2004, veto of CA AB 2532 by Governor Arnold Schwarzenegger, who said he believes existing statutory protection and workplace safety standards are sufficient to protect health care workers from injury. Massachusetts HB 2662, Relating to Safe Patient Handling in Certain Health Facilities, was introduced December 1, 2004. Ohio HB 67, signed March 21, 2005 by Governor Bob Taft (R), creates a program for interest-free loans to nursing homes for implementation of a no-manual-lift program. New York companion bills AB 7641 and SB 4029 were introduced in April, 2005, calling for creation of a 2-year study to establish safe patient handling programs and collect data on nursing staff and patient injury with manual patient handling versus lift equipment, to determine best practices for improving health and safety of health-care workers and patients during patient handling. Washington State is planning re-introduction of safe patient handling legislation, after WA HB 1672, Relating to reducing injuries among patients and health care workers, was stalled in committee in February, 2005. Language from these state initiatives may be used as models to assist other states with drafting safe patient handling legislation. Rapid enactment of a federal mandate for Safe Patient Handling No Manual Lift is essential and anticipated.

Back Injuries↗

Back muscle injury after posterior lumbar spine surgery. Part 1: Histologic and histochemical analyses in rats.

STUDY DESIGN: Back muscle injury caused by retractor application during posterior spine surgery in rats was examined histologically and histochemically according to the postoperative time with reference to the retraction time-pressure relationship. OBJECTIVES: The results were correlated to provide the risk factors for back muscle injury during posterior spine surgery. SUMMARY OF BACKGROUND DATA: Back muscles were examined histologically and histochemically after application of quantitative pressure and retraction time. No previous study has assessed this relationship. METHODS: Five groups were studied: Group 1, 1-hour low-pressure load group; Group 2, 1-hour high-pressure load group; Group 3, 3-hour low-pressure load group; Group 4, 3-hour high-pressure load group; and sham group. In each group, the multifidus muscle was evaluated 3 hours, 48 hours, 1 week, 3 weeks, and 6 weeks after surgery. RESULTS: In all groups except the sham group, degeneration of the muscle and neuromuscular junction was found at a very early postoperative time, but regeneration began at 1 week, and recovery was attained by 6 weeks. The extent of muscle fiber necrosis and the severity of degeneration of the neuromuscular junctions showed a parallelism with the magnitude of the pressure load and retraction time. As the duration and pressure load increased, the time required for regeneration also increased. The fiber type grouping in group 3 and 4 was consistent with the severity of degeneration of neuromuscular junctions. CONCLUSIONS: The muscular degeneration and the regeneration was largely dependent on the retraction pressure-time product. These results suggest that denervation muscle injuries are likely secondary responses to muscle retraction injury in any case of posterior spine surgery.

Animals↗

Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans.

STUDY DESIGN: The histologic and histochemical changes in back muscle were studied in virgin surgery patients with lumbar spine disorders and in patients who underwent repeat posterior lumbar surgery. OBJECTIVES: The results were correlated to provide the evidences of histologic changes of back muscle after posterior lumbar surgery. SUMMARY OF BACKGROUND DATA: Back muscles were examined histologically and histochemically after posterior lumbar surgery. No previous study has assessed these changes. METHODS: Back muscles were obtained before and after retraction from 18 virgin surgery cases with lumbar spine disorders. In four patients, the retraction pressure was monitored and the retraction pressure-time products ([P][T]) were calculated. In 21 repeat lumbar surgery cases, muscle samples were obtained before muscle retraction. Samples were evaluated by histologic and histochemical methods. RESULTS: Abnormal findings were slight in virgin surgery cases. Early back muscle injury tended to depend on operation time and [P][T] products. Late back muscle injury in reoperated patients was marked. Various types of neurogenic changes were observed more than 10 months after the first operation. CONCLUSIONS: Histologic damages of back muscle due to previous surgical intervention were long-lasting. To avoid permanent muscle injury, the retraction time and pressure should be shortened or the pressure on the back muscle should be monitored during posterior surgery.

Adult↗

Benefits of a back care and light duty health promotion program in a hospital setting.

Back injuries are a common and expensive problem in industry in terms of both direct and indirect costs. A dramatic increase in the costs of workers' compensation for work-related back injuries occurred from 1981-1985 in a hospital setting. During this five-year period, costs of back injuries rose from $36,384 to $272,751, a 750% increase, and the incidence per thousand employees rose from 21 in 1981 to 33 in 1985. A back care education program was instituted by the Physical Therapy Department and Employee Health Service for all departments within the hospital, with content tailored to individual job requirements. Because employees who have had one back injury are at risk for reinjury, an "at risk" program was also developed. For those injured employees without time off work and without need for medical care, a private session with a physical therapist is required to assess musculoskeletal problems and to review posture and body mechanics directly related to specific job tasks. Those employees unable to work in their usual positions are assigned to temporary modified jobs as part of the Light Duty Program. In 1986, following the institution of these two programs in the hospital, the cost of back injuries dramatically decreased to $72,296, a $200,000 drop, and the incidence per thousand employees fell to fifteen. The efficacy of this health promotion intervention program was confirmed both in the cost benefit to the hospital as well as in reduction in incidence of low back injury.

Back Pain↗

Early intervention for back-injured nurses at a large Canadian tertiary care hospital: an evaluation of the effectiveness and cost benefits of a two-year pilot project.

This study evaluated a two-year multidisciplinary early intervention pilot programme for back-injured nurses employed at a large teaching hospital, using a pre- versus post-programme analysis. The purpose was to ascertain whether this programme could reduce the incidence, morbidity, time lost and cost due to back injuries in the 250 nurses employed on ten targeted high-risk wards. Injuries in the remaining 1395 nurses employed on the other 45 wards were monitored concurrently for comparison. The programme consisted of prompt assessment, treatment and rehabilitation through modified work. Evaluative data were gathered by one research nurse on standardized forms at the time of injury, weekly until return to work, and at a six-month follow-up. Time lost and cost data for up to one-year post-injury were derived from workers' compensation statements. Compared to the two years prior to introduction of the programme, the rates of back injuries and lost-time back injuries decreased by 23% and 43%, respectively, on the targeted wards, while these increased on the control wards. Combined expenditure was 32% lower per injury and 34% lower per lost-time injury for those in the targeted group who consented to take part in the programme compared to their counterparts on the control wards, as the increased assessment and treatment costs per case attributable to the programme were more than offset by the savings in lower compensation (wage loss) costs. This programme thus reduced the incidence and time lost due to back injuries and was cost-beneficial.

Back Injuries↗

Use of back belts in occupational settings.

Studies of the biomechanical and physiological mechanisms of action concerning the prophylactic use of back belts to prevent occupational low back injuries are limited in number and present conflicting findings. The epidemiological data concerning the efficacy of back belts in the prevention of occupational low back injuries are not sufficient to warrant general use of back belts in the occupational setting for uninjured workers. There is actually a potential for increasing the degree of low back injury with general application of back belts in occupational settings. In sum, there are insufficient data in the scientific literature to indicate that general use of back belts in occupational settings is appropriate for uninjured workers. Because the increase in use of soft canvas back belts has been fairly recent, physical and epidemiological studies pertaining specifically to soft canvas back belts are extremely limited. The sample size of many physical investigations also is extremely limited. In many instances, studies concerning the role of back belts in preventing occupational low back injuries have examined conditions that do not apply directly to the use of soft canvas back belts. For these reasons, further studies in both the physical and epidemiological realms are necessary before it is appropriate to use commonly constructed back belts as personal protective equipment in occupational settings.

Biomechanical Phenomena↗

Spine: posture, mobility and pain. A longitudinal study from childhood to adolescence.

A longitudinal study was undertaken to analyse the development of posture and spinal mobility during growth and its relationship to low back pain and sports activities. A total of 90 children were examined at 5-6 years of age and re-examined at 15-16. Sagittal configuration and mobility were measured using Debrunner's kyphometer. Information about pain and activities was acquired by interview with the parents of the 5- to 6-year-olds and by a questionnaire to the 15- to 16-year-olds. Posture changed significantly during the study period: thoracic kyphosis increased by 6 degrees and lumbar lordosis increased by 6 degrees. The relationship between kyphosis and lordosis was independent of gender at age 5-6, but kyphosis in relation to lordosis was significantly lower in girls among the 15- to 16-year-olds. The total sagittal mobility of the spine decreased significantly during the 10-year study period: in the thoracic spine by as much as 27 degrees and in the lumbar spine by 4 degrees. About one-third of the children at the age of 15-16 years stated that they had occasional low back pain. This complaint was more frequent in those stating they had suffered some type of back injury, but low back pain was not related to gender, regular physical training, posture or spinal mobility. The results of the study showed that kyphosis and lordosis increased and mobility decreased in the 90 children who were examined both at age 5-6 and 15-16 years. The relationship between kyphosis and lordosis decreased in girls but not in boys. Occasional low back pain was reported by 38% of the children at the age of 15-16 years, but back pain was not related to posture, spinal mobility or physical activity.

Adolescent↗

Anthropometric measurements and ejection injuries.

BACKGROUND: A previous study examined anthropometric variables to determine possible ejection seat risk factors. It concluded that individuals who weighed below the average body weight or who met the criteria of having a tall, thin physique as measured by body mass index (BMI = kg.m-2) were significantly more at risk for acceleration induced back injuries. HYPOTHESIS: Because of the increased number of female pilots and the potential need to modify ejection seats for lighter aviators, this retrospective analysis of Naval Safety Center data attempted to reproduce and confirm the same results with more current data, covering a 5-yr period from Jan 1989-Dec 1993. METHODS: In this study, the same criteria were used to define back injury, including thoracic or lumbar vertebral fractures and soft tissue injuries, and the same anthropometric variables were used, including weight, height, BMI, and below average weight. Additional categories of injury were examined, including all spinal fractures alone without soft tissue back injuries, all injuries combined, and severity of injury. Sitting height and trunk height were added to the variables. RESULTS: Out of 810 aircrew involved in mishaps, 199 ejected. Of all the ejections, 111 (56%) had some type of injury as a result of the ejection. Severe injuries occurred in 8 (4%) including 4 (2%) fatalities. Back injuries occurred in 44 (22%), and 8 (4%) involved spinal fractures. Although there were no significant risk factors for ejection back injury, weight and height were statistically significant risk factors for severe injury and spinal fracture, respectively. CONCLUSIONS: Aircrew with severe injury were heavier (average weight 88 kg. vs. 79 kg.). In addition, taller aircrew (185 vs. 180 cm.) were at increased risk for any spinal fracture.

Acceleration↗

Preventing injuries using an ergonomic approach.

The risk of back injury is a continuing problem for nurses. Patient-handling tasks (e.g., transferring patients on and off stretchers, repositioning patients on OR beds) are a major precipitating factor to this problem. Educating nurses about body mechanics has not been the answer to preventing back injuries; however, changing the physical demands of the job (i.e., using an ergonomic approach) by using assistive devices (e.g., friction reducers) has been proven to decrease perceived stress and injury rates and increase patient comfort. This article focuses on the problem of nurses' back and shoulder overexertion injuries and explores the application of ergonomics in the perioperative setting.

Back Injuries↗

Acute backpack injuries in children.

OBJECTIVE: To identify the most common mechanisms and sites of injury associated with book backpacks in school-aged children, who present to the emergency department. This should help with the development of backpack injury prevention strategies. DESIGN: A descriptive analysis of The National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission (CPSC) National Injury Information Clearinghouse data on backpacks. SETTING: One hundred emergency department departments throughout the United States that participate in NEISS data collection served as the setting. PARTICIPANTS: All children between 6 and 18 years old who were recorded in the NEISS database with a backpack-related injury were studied. METHODS: Patients were identified by review of the NEISS data from 1999-2000. We separated patient data by age, sex, location of injury, and mechanism of injury. RESULTS: There were 247 children with backpack injuries. The mean age was 11.8 years, and 50% were male. The most common injury location was the head/face (22%) followed by the hand (14%), wrist/elbow (13%), shoulder (12%), and foot/ankle (12%). The back ranked sixth (11%). Of these back injuries, 59% were associated with carrying a backpack. The most common mechanism for injury was tripping over the backpack (28%), followed by wearing (13%), and getting hit by the backpack (13%). CONCLUSIONS: Although the CPSC data on backpack injuries is frequently quoted in articles relating backpacks with back injury, 89% of backpack injuries in our study do not involve the back. Our study does not support the hypothesis that back injury is the major problem with book backpacks in the emergency department setting.

Accidental Falls↗

Biopsychosocial multivariate predictive model of occupational low back disability.

STUDY DESIGN: To establish outcome, 253 workers with subacute and chronic low back conditions were assessed with a comprehensive multimethod biopsychosocial protocol at baseline, 3 days after the initial examination, and 3 months later. OBJECTIVE: To validate empirically a biopsychosocial model for prediction of occupational low back disability. SUMMARY OF BACKGROUND DATA: Costs of low back occupational disability continue to spiral despite stabilization of low back injury rates. An empirically based model to predict occupational disability in workers with low back injuries is required. METHODS: Workers with subacute low back injuries (4-6 weeks after injury, n = 192) and those with chronic back pain (6-12 months after injury, n = 61) were the study participants. The biopsychosocial protocol included five groups of variables: 1) sociodemographic, 2) medical, 3) psychosocial, 4) pain behavior, and 5) workplace-related factors. Predictive validity was investigated through a 3-month follow-up assessment, at which time the return to work outcome was determined. Stepwise logistic regression models were developed to predict work status. RESULTS: The final integrated model consisted of variables from a wide biopsychosocial spectrum: vitality, health transition, feeling that job is threatened due to injury, expectations of recovery, guarding behavior, perception of severity of disability, time to complete walk, and right leg typical sciatica. CONCLUSIONS: The "winning" variables identified in the integrated model are dominated by cognitions, which are accompanied by disability behaviors. A cognitive-behavioral model with an adaptation-oriented rather than a pathology-oriented focus is favored for early intervention with high-risk workers since cognitions are amenable to change.

Adult↗

Magnitude and distribution of trunk stresses in telecommunications engineers.

The incidence of back injuries has been shown to be greater in occupations as heavy manual work than light manual work. To plan a programme aimed at reducing the incidence of back injuries in industry those workers at high risk of incurring handling accidents and back injuries need to be identified and a knowledge of the specific occupational factors causing such injuries sought. This has been achieved for telecommunications engineers using epidemiological and radio pressure pill methodologies. The results verify the correlation between the back injury rates and physical work stresses of different occupational groups. The magnitude and relative frequency of trunk stresses in hazardous tasks has been determined and compared with those with lower incidences of back disorders. The study has confirmed that in examining manual handling hazards in industrial male populations a critical value of truncal stress can be applied and used to determine the safety of occupational factors in relation to their potential causing or contributing to degenerative back diseases.

Accidents, Occupational↗

Postconcussion symptoms.

Research pertaining to the self-report of symptoms after traumatic brain injury was reviewed. Cognitive, emotional, and motivational factors have more relevance than demographic (except for female sex) and personality factors. Specific neuropsychological deficits in attention and memory have been found in the early stages after head injury of even mild severity. This is unlikely to be the only factor affecting symptom persistence. Exaggeration of cognitive dysfunction occurs in some cases, but appears unrelated to symptom overreport. Increased emotional distress typically accompanies symptom persistence. The psychological reaction of preoccupation with symptoms and emotional distress is not unique to concussion, but also occurs after severe head injury and back injury and relates more to the personal interpretation of the effect of the trauma than to objective indicators of brain injury severity.

Affective Symptoms↗

Prognosis for people with back pain under a No-fault 24-hour-cover compensation scheme.

STUDY DESIGN: A retrospective descriptive casenote review of consecutive back pain claimants assessing claim outcome at 12 months from onset. OBJECTIVE: To assess prognosis for back pain claimants in a no-fault 24-hour-cover accident compensation system. BACKGROUND: New Zealand has a unique accident compensation system that may provide incentives for health professionals to classify people with backache as having a back injury and incentives for back pain claimants to continue claims longer than would be the case in other compensation systems. METHODS: One hundred consecutive back pain claimants were identified from a single office of New Zealand's sole accident compensation insurer (Accident Rehabilitation and Compensation Insurance Corporation; ACC), who were still receiving compensation payments 4 weeks after the initial date of the claim. The study end point was case closure in the subsequent 12 months. Case closure rate was analyzed in relation to several potential prognostic variables. RESULTS: Of the 100 cases identified in which the claimant was receiving compensation 4 weeks from the initial date of the claim, 43 cases were not closed by 6 months, and 30 cases were not closed at 12 months. The variable most strongly associated with case nonclosure was whether the claimant was receiving earnings-related compensation (equal to 80% of previous income), with 41% of this group still receiving compensation at 12 months versus 16% of the group not receiving earnings-related compensation (chi2 = 8.55, P = 0.003). These results compare unfavorably with those from previous published studies from The Netherlands and Jersey in the United Kingdom. CONCLUSION: New Zealand's unique accident compensation environment may discourage return to work for people with back pain. New Zealand legislators should assess the impact of the ACC scheme on people with back pain, particularly in light of the recent recommendations of the International Association for the Study of Pain Task Force on Back Pain in the Workplace, that compensation cover for workers with back pain be limited to 6 weeks.

Adolescent↗

Emotional, cognitive, and motivational deficits in compensation-seeking, suspected brain injury cases.

Emotional distress, neuropsychological impairment, and motivation were measured in a consecutive series of 38 individuals with suspected brain injury who are seeking compensation. Participants had no neurological or neuroradiographic abnormalities, but reported persisting symptoms. One quarter of the participants had significant neuropsychiatric histories. Poor motivation was found in 18% of participants. High rates of neuropsychological impairment (68%) in delayed verbal memory and information-processing capacity and of emotional distress (86%) were found in the remainder. Neuropsychological test scores were not correlated with measures of emotional distress. It is argued that preoccupation with symptomatology and emotional distress are not unique to mild brain trauma but also occur after severe head injury and back injury and relate more to personal interpretation than to objective indicators of injury severity or the injury to the brain itself.

Journal Article↗

The Multidisciplinary Approach to Occupational Low Back Pain and Disability.

Chronic disability generates most of the growing costs of occupational low back injuries. When back problems persist for more than a few months, traditional diagnostic and therapeutic approaches are rarely curative. Beyond the challenges of physical impairment, disabling back pain is commonly complicated by psychosocial issues, including depression, fear of reinjury, family discord, and vocational dissatisfaction. The biopsychosocial complexity of chronic disability often demands integrated care from physicians, physical and occupational therapists, psychologists, and vocational counselors. In the past decade, the care of back-injured workers has shifted emphasis from symptom palliation toward functional restoration. This evolution has been possible, in part, through improved quantification of physical capacities. Repeated objective measurements of function guide rehabilitation and recommendations for return to work and other activities. Published results of function-oriented multidisciplinary care depend on the outcome variables reported and the particular socioeconomic setting.

Journal Article↗

Factors affecting the organizational responses of employers to workers with injuries.

The organizational responses of employers to work-related injuries is one of several significant influences on return-to-work outcomes. Thus, understanding the factors that lead to better or worse organizational responses to work injuries may ultimately help to improve success in this area. The purpose of this study was to systematically explore factors that might influence the organizational responses of employers to injured workers, based on employee perceptions. Cross-sectional survey data were collected from 2,943 subjects with work-related injuries which had occurred less than eight weeks prior to survey completion. Measured variables included pre-injury demographic and job factors, injury circumstances, and a measure of post-injury events that comprised the organizational response. Multivariate linear regression results show that age, gender, job dissatisfaction before injury, prior difficulty performing job tasks, injury severity, back injury and lost time were all associated with negative organizational responses, suggesting potential opportunities for intervention.

Adolescent↗