Tuesday, February 12, 2019 From PTJ: PT, PTA Injuries Related to Patient Handling Still Common in LTC Settings Despite efforts by APTA and others to emphasize safety and the use of lifting devices, physical therapists (PTs) and physical therapist assistants (PTAs) working in long-term care (LTC) facilities continue to experience musculoskeletal disorders (MSDs) linked to patient handling incidents, say authors of a new study. Areas of injury most frequently cited by PTs, PTAs, and other "therapy personnel"—occupational therapists (OTs) and occupational therapy assistants (OTAs)—were the lower back, shoulder, and neck. For the study, published in the February issue of PTJ (Physical Therapy), researchers looked at a year's worth of workers compensation claims (WCCs) from a long-term care company with 202 skilled nursing facilities and 20 assisted living facilities, and compared those data with the results of confidential surveys completed by 2,642 employees of the company. While the primary aim of the study was to get a sense of the magnitude of musculoskeletal injuries experienced by employees, authors also were interested in how those injuries correlate to workers' perceptions of their job demands and whether they routinely used resident-lifting equipment. For the analysis, the authors divided the WCC claims into 4 categories related to the cause of injury: ergonomic (manual or patient handling, bodily reaction, repetition), workplace violence, acute incident (fall, slips, trips, being struck by an object), and other. The nature of the injury—acute, subacute, nonspecific, nonmusculoskeletal—and body region affected also were grouped into major areas. Employees were grouped into larger categories: therapy personnel, nursing aide, licensed practical nurse (LPN), registered nurse (RN), social/speech/respiratory service, technician, housekeeping/dietary maintenance, and office/administrative service. Among the findings: According to WCC data, the most commonly injured body regions among all employees were upper extremities (37%), lower back/back and trunk (20%), and lower extremities (17%). Therapy personnel had the lowest rate of claims for acute injury, at 2 claims per 1,000, but their average per-claim cost were the highest. In terms of ergonomic injury among clinical staff, nursing aides reported the highest rate of injury, at 36 claims per 1,000. Therapy personnel were next, at 16 per 1,000—a rate similar to those of LPNs and RNs. About 43% of subacute injuries (defined by the authors as "sprains, spasms, muscle contusions, carpal tunnel, tendinitis, disc hernias, and similar injuries") were related to patient handling incidents across all jobs, with nursing aides once again reporting the highest claims rate, at 58 per 1,000. Therapy personnel were next highest at 15 per 1,000. Therapy personnel, RNs, and nursing aides reported low back pain at a similar rate—48.1%, 44%, and 47.5%, respectively. Therapy personnel registered higher rates of neck pain (24.4%) and shoulder pain (34.6%) than nursing personnel (14%-22% for neck pain and 25%-30% for shoulder pain). In analyzing survey results among employee categories, researchers found that therapy personnel recorded the third highest "psychological demand score" (5.87 on a 2- to 8-point scale, behind RNs and LPNs), and the highest "physical demand score"(14.6 on a 5- to 20-point scale), followed by nursing aides (12.6). Just over half of therapy personnel—53%—reported that they "never" or "rarely" use resident-lifting equipment. When asked to explain the use rates, "a majority of therapy personnel stated that treatment did not involve lifting because the goal was to make residents independent," authors write. "It is concerning that MSD symptoms and costs…for therapy personnel were higher than for nurses," the authors write. "Our finding on the low use of resident-handling equipment by therapy staff, and the rationale that equipment use interferes with therapy goals, are consistent with prior studies." This use pattern is common despite evidence of similar patient outcomes with and without the use of patient-handling equipment and safe patient-handling protocols, they add. APTA's Safe Patient Handling webpage offers resources for avoiding injury, including links to online courses, US Food and Drug Administration guidelines on proper use of patient lifts, and a bibliography of journal articles from multiple disciplines. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.