RE: use of back supports

[Guest guest]

This link is to an abstract of a large meta study that found, basically, there

is little to no gain from lumbar supports in terms of pain, or work days lost to

injury. The study is out of the Netherlands.

http://www.cochrane.org/reviews/en/ab001823.html

More important would be to investigate the Safe Patient Handling & Mobility

(SPH & M) movement, although that will inevitably open a huge can of worms for

you, since the research in this area is quite conclusive that patient handling

is far more dangerous than we often suspect, and cannot be made more safe by

mere education in techniques.

The following is long, but worth the read. It's adapted from a letter written in

2006 by Kathleen L. Dunn, MS, RN, Clinical Nurse Specialist at the VA San Diego

Healthcare System in San Diego.<?xml:namespace prefix = o ns =

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++++++++++

There is NO WAY to do traditional transfers such as quad pivots, 2-person lifts,

hook and toss, or totally dependent slide board transfers safely! It is a

fallacy that one need merely " teach staff better " to make these safe. Over 25

years of research in numerous papers show conclusively that even extensive

traditional body mechanics and transfer training does NOTHING to prevent injury

in nurses, and may in fact INCREASE injuries. Most institutions, with their all

to typical patient care expectations regarding lifting, foster the notion that

nurses are disposable and replaceable!

OSHA does not allow construction workers to lift over 50 lb. Neither should they

allow patient care staff to do so! Recent studies show that, with the shear

forces on the back occurring with traditional transfers, no more than 35 lb.

should be allowed for nurses and other direct care providers.

I used to teach these transfers, and do the transfers myself. I also thought

that if only staff would do transfers as I taught them (what arrogance!) they

would not get injured. I was SO WRONG! Even with 2-person transfers, the first

person has been shown to be doing 80% of the work in transfers like quad pivot,

2-person slide board, or plain lift. I regret having set so many staff up for

injuries over the years. I have seen the light, and now our body mechanics class

is primarily a class on what is not safe and not allowed at our center, how to

use lifting algorithms for decision making, how to use lifting equipment, and

how to do moderate to minimal assist transfers (which we still do) safely.

Therapy staff DO GET INJURED! We did not have good numbers on this until lately

because OSHA and NIOSH were grouping therapists into a group called " other

health care workers " which included many non-direct care staff. We now know that

the injury rate in PTs is nearly as high as in nurses. Nurses remain in the top

10 of on the job injuries in the USA, with nurses, aides, and orderlies

remaining in the top 3. Those who are not practicing evidence-based care in this

area are setting themselves up for major potential liability and workers comp

costs.

Please know that you can practice a Safe Patient Handling and Movement model in

a rehab setting. It is not " anti-rehab " . And, by the way, not only should we not

expect staff to lift 50-100 lb., neither should we expect family caregivers to

do so. We need to be advocating for insurance coverage (including Medicare) for

the costs of lifts in the home. This is MUCH cheaper than placing patients in

nursing homes!

The NIOSH standards for nursing homes do NOT allow the kind of lifting I am

discussing here. Texas and Washington have passed legislation outlawing this for

nurses too, and other states are following their lead.

I suggest you look into the writings of Audrey , RN, PhD, FAAN. She is a

long-time ARN member and rehab nurse, and the leading guru on this subject in

the USA. Ms. advocates " Safe Patient Handling and Mobility " (SPH & M) as

the preferred method for patient mobility in rehab settings. (Both the ARN and

APTA have signed a white paper endorsing this as well.) Get up to date on this!

(Our European, Canadian and Australian colleagues implemented these

evidence-based changes in practice 15 years ago.)

Nursing is often accused of " eating their young " . Job descriptions containing

unsafe and unrealistic lifting expectations is one way to do just that. We need

to move forward and start paying attention to the very clear evidence on this

subject.

+++++++++++++

Dave Milano, PT, Director of Rehab Services

Laurel Health System

use of back supports

I have recently been contacted by the DON of our attached LTC, stating that

she has been ordered by a physician and administration to require all CNAs

to wear back supports. She is wanting each individual measured and fitted

for these. The last I had heard, the research did not show conclusive

evidence that back supports would reduce the risk of back related injury.

OSHAs stand on this in regards to PPE is not particularly in support of or

against back supports.

Does anyone have and research/literature/information on the effectiveness or

ineffectiveness of back supports?

Thanks!

le Bohl, PT

Rehab Manager

County Health Systems

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please notify me immediately at

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[Guest guest]

le:

Chapter nine in McGill's Book Low Back Disorders, 2nd edition, has an

informational chapter on back belts:

http://www.humankinetics.com/products/showproduct.cfm?isbn=9780736066921<http://\

www.humankinetics.com/products/showproduct.cfm?isbn=9780736066921>

Mike

use of back supports

I have recently been contacted by the DON of our attached LTC, stating that

she has been ordered by a physician and administration to require all CNAs

to wear back supports. She is wanting each individual measured and fitted

for these. The last I had heard, the research did not show conclusive

evidence that back supports would reduce the risk of back related injury.

OSHAs stand on this in regards to PPE is not particularly in support of or

against back supports.

Does anyone have and research/literature/information on the effectiveness or

ineffectiveness of back supports?

Thanks!

le Bohl, PT

Rehab Manager

County Health Systems

This email and any files transmitted with it are confidential and are

intended solely for the use of the individual or entity to which they are

addressed. This communication may contain materials protected by copyright,

or confidentiality and non-disclosure agreements. Be advised that the

unauthorized dissemination, forwarding, printing, or copying of this email

is strictly prohibited. If you are not the intended recipient of this email,

please notify me immediately at

dbohl@...<mailto:dbohl%40phillipshospital.org>.

[Guest guest]

Hi le,

The link is to the abstract from the journal " Occupational Medicine " It is

a 2004 article by Mireille and van Poppel that is " An update of a systematic

review of controlled clinical trials on the primary prevention of back pain

in the workplace " . This updates their frequently cited 1997 study. They

once again found that recent studies showed no positive effect from the use

of back supports. Be careful, however, because they also found the quality

of the latest studies to be very poor.

The link is:

http://occmed.oxfordjournals.org/cgi/content/abstract/54/5/345

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

howellpt@...

_____

From: PTManager [mailto:PTManager ] On Behalf

Of le Bohl

Sent: Monday, May 19, 2008 1:28 PM

To: PTManager

Subject: use of back supports

I have recently been contacted by the DON of our attached LTC, stating that

she has been ordered by a physician and administration to require all CNAs

to wear back supports. She is wanting each individual measured and fitted

for these. The last I had heard, the research did not show conclusive

evidence that back supports would reduce the risk of back related injury.

OSHAs stand on this in regards to PPE is not particularly in support of or

against back supports.

Does anyone have and research/literature/information on the effectiveness or

ineffectiveness of back supports?

Thanks!

le Bohl, PT

Rehab Manager

County Health Systems

This email and any files transmitted with it are confidential and are

intended solely for the use of the individual or entity to which they are

addressed. This communication may contain materials protected by copyright,

or confidentiality and non-disclosure agreements. Be advised that the

unauthorized dissemination, forwarding, printing, or copying of this email

is strictly prohibited. If you are not the intended recipient of this email,

please notify me immediately at dbohl@phillipshospi

<mailto:dbohl%40phillipshospital.org> tal.org.