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STUDY #2The Ergo Stat Program:Pilot study of an ergonomic intervention to reduce static loads for caregivers

By: Amelieke Brinkoff and Nico E.Knibbe, M.Sc.

May 2003

See Professional Safety: Journal of the American Society of Safety Engineers, May 2003www.asse.org

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32 PROFESSIONAL SAFETY MAY 2003 www.asse.org

ErgonomicsErgonomics

The ErgoStatProgramPilot study of an ergonomic intervention

to reduce static loads for caregiversBy Amelieke Brinkhoff and Nico Knibbe

ONE IN 10 SERIOUS WORK-RELATED BACKinjuries in the U.S. involves nursing personnel, andabout 12 percent of caregivers leave the professionbecause of back injuries. Workers’ compensation(WC) costs for back injuries among healthcare work-ers are an estimated $1.7 billion annually (U.S. DOL,BLS). According to scientific studies, the primary con-tributors to back injuries are 1) lifting patients and2) static (positional) stress (Estryn-Behar 47).

To reduce these injuries, healthcare facilities arepaying greater attention to physical loads for care-givers. Actions include reduction of dynamic loadscaused primarily by lifting and repositioningpatients. The use of lifting aids, lifting specialists andtraining based on a nonlifting strategy that assumeshealth-based standards for lifting will lead to areduction in overloading of nursing staff and care-givers (Fragala 23). A study in three British nursinghomes showed that an integrated approach to theprevention of musculoskeletal pain among nursinghome staff can be effective in the sense that staff

exposure to manual han-dling risks decreases signifi-cantly as more tasks areperformed safely (Crump-ton, et al). Longitudinal con-trolled research in Dutchhomecare facilities subse-quently showed that such aprogram can reduce thenumber of back complaintsand sick leave (Knibbe andFriele 445). Five years later,this reduction has beenmaintained [Knibbe andKnibbe(c)].

This does not mean thatthe exposure to physicaloverload and associated

musculoskeletal pain complaints have been reducedto a level that is acceptable from a health perspective,however. Little attention is being paid in typical anti-lifting programs to positional or static loads. Theseloads are also called covert loads because the load isnot visible (nothing is being lifted or pushed), butthere is an actual load. These loads can be heavy fortwo reasons:

1) The weight of the lifter’s own trunk, arms andhead places a strain on the back, neck and shoulderarea; these parts of the body make up about two-thirds of one’s total body weight. The more the lifterbends forward, the greater these loads become.

2) Muscles must hold the position assumed bystabilizing the weight of the trunk, head and arms.This requires a great deal of muscle power, whichrapidly increases the more the lifter bends forward.If the position must be maintained for any length oftime, muscle fatigue can occur quickly. This causes anagging pain in the back or neck.

Research on static loads in three Dutch geriatriccare facilities has shown that caregivers spend 21 per-cent of their eight-hour working day standing in abent-forward, twisted position or a bent-forward-and-twisted position (Engels, et al 338). This researchalso showed that patient bathing and showeringtasks, in particular, caused peaks in static loads.

Research has also shown that the type of aid usedin bathing and showering patients has a major effecton the eventual static load on the caregiver [Knibbeand Knibbe(b) 37]. The height-adjustable showerchair, still relatively little-used in the healthcareindustry, was shown to cause the least physical over-load compared to a high-low shower stretcher, a high-low bath or a high-low bed. Using correct lifting aidsdoes not mean, however, that caregivers will auto-matically use them in the correct manner and that thiswill, in turn, lead to fewer complaints. In addition,despite the fact that peak loads are experienced dur-

Amelieke Brinkhoff is a research associate withCorpus B.V. Research, Consultancy, Training and

Interim-Management in Amsterdam, TheNetherlands. Corpus specializes in reducing

physical loads in healthcare. She is a physiothera-pist and holds a master’s degree in general social

sciences from the University of Utrecht.

Nico Knibbe, M.Sc., is a research associatewith LOCOmotion Research and Health

Consultancy in Bennekom, The Netherlands.He holds an M.Sc. in Human Movement Sciences

from the Free University of Amsterdam.LOCOmotion has been consulting and

conducting research in the field of occupationalhealth since 1988, specializing in the field ofpreventing musculoskeletal disorders in the

healthcare environment.

Brinkhoff Knibbe Feature.qxd 4/15/03 1:19 PM Page 32

www.asse.org MAY 2003 PROFESSIONAL SAFETY 33

(Kahru 77). The method is based on multimomentsampling at fixed intervals. In this study, observa-tions consisting of a back score, an arm score, a legscore and an external-weight score were made every30 seconds. Scores gathered by two observers werefed into a handheld computer. Data were eventuallyconverted into four action categories (AC); each cat-egory comprises a particular degree of load on theentire body and makes recommendations for themeasures to be taken (Table 1).

During the before measurements, the twoobservers watched five different caregivers during allof their activities. During the second set of measure-ments, three of these caregivers were observed again,along with three new caregivers. In total, nine shiftswere observed, with each shift divided into three peri-ods (Table 2). This procedure produced a picture of thestatic loads on caregivers during the entire shift, peakloads and differences in loads among caregivers.

OWAS scores were linked to 10 different groupsof activities the caregivers performed during adayshift; these included “assisting while using thetoilet,” “patient care” and “social activities” (Table3). To enable comparison with Engels’ 1998 research,groups of activities were defined as similarly as pos-

ing hygiene activities, static loads arenot confined to washing, bathing andshowering patients. They can also occurwhen bending over a table to update anursing file, making beds or talking to apatient in a wheelchair. Static loads alsooccur during tasks not directly related topatients. Such tasks cannot always beimproved via an ergonomic interven-tion and, therefore, require knowledge,awareness, and the correct attitude andskill, which requires training.

Statistics are not available at thistime to show the effectiveness of anintervention policy specifically directedat reducing static loads. Therefore, thefirst goal of this pilot study was to eval-uate the ErgoStat program. This pro-gram is specifically directed at bringing static loadswithin health-based limits. The research alsoassessed the effect of static loads on caregivers whileshowering a patient on a special type of height-adjustable shower/toilet chair. The height and angleof this device can be adjusted electrically, whichmeans that a patient can be brought from a normalsitting position (with both feet on the ground) to afull lying position at a height selected by theemployee. The chair was included in this study aspart of the intervention.

Study MethodBefore and after tests were designed to measure

the effect of the ErgoStat program. The same meas-uring instruments were used in both cases. The peri-od between measurements was four months. In theintervening period, the ErgoStat program was car-ried out on a unit in a geriatric care facility. No con-trol group was established. Physical (static) loadswere measured using the Ovako Working PostureAnalyzing System (OWAS), a widely accepted andreliable observational method for posture analysis.One advantage of the method is that it enables com-parisons with previous research in similar settings

OWAS Action CategoriesAction Category Description

AC1 Normal position, no action required.AC2 Load in this position is slightly harmful.

Action to change the position should betaken in the near future.

AC3 Load in this position is distinctly harmful.Action to change the position should betaken as soon as possible.

AC4 Load in this position is extremely harmful.Action to change the position should betaken immediately.

Table 1Table 1

Static loads arenot confined towashing, bathingand showeringpatients. They canalso occur whenbending over a tableto update a nursingfile, talking to apatient in a wheel-chair, or retrievingmedicine and othersupplies.

Brinkhoff Knibbe Feature.qxd 4/15/03 1:19 PM 3


The InterventionBased on the information gathered by the

observers during the first measurements, the inter-vention program was set up in collaboration withthe caregivers, the lifting specialists, a physiothera-pist and the head of the unit. One basic principle ofthe ErgoStat program is to provide caregivers with acue about once a week during the course of the pro-gram. These cues can vary widely in nature. Theymay include tangible cues that when used properlycan reduce static loads immediately. For example, asmall stool placed on the bed and on which thepatient’s leg rests allows the caregiver to dress legwounds without static loads.

Psychological cues that contributed to caregiverknowledge and awareness of working more safelywere also used. These included various measures.

•A survey of caregivers was conducted andresults presented to the ward.

•Questions were asked to encourage caregiversto think about problem tasks and solutions regard-ing static loads.

•The ward’s lifting specialist led two discussions inthe progress meetings based on two propositions. Oneproposition was: “Caregivers have a very dynamicprofession, they are always busy. They therefore haveno problems with static loads and it is unnecessary topay attention to this issue on the ward.” The otherproposition was: “Physical load is part of the job, andI have choosen this job, so I have to take it [accept therisk] for granted [as part of the job].”

•Caregivers received an informative book that con-tained basic information about what a caregivershould know about back pain and its prevention.

•All caregivers completed a 30-minute CD-ROMprogram entitled, “Transfer with Care.” It allows theuser to teach him/herself in an interactive, self-pacedmanner. A scientific evaluation among 267 caregiversrevealed that the real-life identification with nursingpractice (in pictures and video clips) was an importantfactor for success. The level of knowledge alsoimproved significantly [Knibbe and Knibbe(d)].

•Use of ergonomic aids such as the multipurposeshower chair. The manufacturer of this device con-ducted two two-hour training sessions on its use.

•A greater number of height-adjustable stoolswere available for use in patients’ rooms.

•All caregivers worked for a day with their backs“strapped” in order to draw their attention to theirposture every time they twisted or bent their backs.

•Several caregivers were trained “on-the-job,”which means they received advice about workingsafely from a specialist in a one-on-one situation.After the training, each caregiver received a penbearing the text: je lijf is je lief (“love your body”).

•Posters were displayed to illustrate key points.For example, one featured a tall caregiver next to ashort caregiver, along with the text: “Set the work upat your own height.”

•All caregivers completed a one-day trainingprogram on reducing static loads. Actual photos ofcaregivers in statically overloaded positions were

sible. In this way, the tasks that caregivers performedmost often, which activity caused the greatest staticload and where the greatest benefit could beachieved were mapped.

Study PopulationOne unit of geriatric care facility was selected for

the study. The 150-bed facility adopted a nonliftingpolicy in 1996 based on a research assessment ofdynamic loads within the organization. Lifting aidswere used extensively, an active lifting committee wasin place and a lifting specialist worked on each unit.

The lifting committee focuses on preventingphysical overloading of caregivers. Preventing phys-ical overloading is a complex matter involved in allfacets of the organization. This group of experts anddecision makers ensures a broad support base for allcaregivers and organized attention to the subject.The lifting specialist is an employee who monitorscompliance with the nonlifting policy. This personindicates whether work is performed in a safe man-ner and whether aids are used properly; clears workbottlenecks that lead to physical overloading; andencourages colleagues to work safely.

As noted, five caregivers were selected for obser-vation with the OWAS method. These caregiverswere permanent employees; it was expected thatthey would work during the before and after meas-urements and could participate in the intervention.All 29 caregivers on the unit participated in theintervention program. The underlying considerationwas that the eventual way people work is deter-mined not only by caregiver awareness and attitude,but also by the social norms within the group(Fishbein and Ajzen). For example, it has beenshown in practice that using a bed’s raising and low-ering mechanism is largely socially determined. Ifthe norm on the ward is to start working at a bed bysetting it to the correct height, those who work onthe ward are encouraged to always do so.

To a large degree, the patient’s mobility deter-mines the physical care needed and thereby alsoimpacts the physical loads placed on the caregivers.This is why efforts were made to observe the samepatients during both sets of measurements.

Percentage of ObservedPositions in AC1 (NormalPosition) Per Observed Period

Before ErgoStat After ErgoStatPeriod % AC1 % AC1

1) 7:00 to 9:00 am 57.6 69.6*2) 9:00 to 11:30 am 67.2 77.6*3) 12:00 to 3:15 pm 71.0 76.0

*alpha < 0.05

Table 2Table 2



used. In addition, all caregivers received a rag dollthat could be set in various positions; it bore the text:“Bending is polite, but not healthy.”

Employee TrainingDuring the training, the caregivers developed a list

of tasks that they believed caused physical overload-ing. They then sought solutions to these tasks amongthemselves. This intervention was based on the prin-ciples of participatory ergonomics (Kogi 1682; Peters53). Participants learned to regard overloading as aproblem within their control. By having them seeksolutions, it becomes clear that they also own the solu-tions. As a result, caregivers become intrinsically moti-vated to work safely [Knibbe and Knibbe(a) 111].

Several of the caregiver-devised solutions wereimplemented immediately. For example, the day aftertraining ended, caregivers showered several patientsin the evening instead of during the busy morningperiod. They also devised a different work pattern fordisbursing medicines. Previously, one person distrib-uted all medication; this process took two hours andrequired standing for extended periods. After train-ing, the task was divided between two people.

Other solutions proposed could only be imple-mented over a longer term due to time and financialconstraints. These included clothing design changes(e.g., using gowns withhook-and-loop fasteners toease patient dressing/un-dressing, which would im-pose fewer physical loads);purchasing a work aid thatmakes the physical loadexperienced when puttingon pressure stockings safefor the caregiver; and enlarg-ing the toilet space by knock-ing down a wall so that ahoist could be used properly.

Study ResultsThe primary objective of

this study was to gain aquantitative and qualitativeimpression of the ErgoStatprogram. Several subjectiveitems were also revealedwhen observing on the ward.For example, caregivers indi-cated that they became moreaware of their own workpractices during the project.Furthermore, once its usehad become customary, themultipurpose shower chairwas used for other non-intended activities, such astreating feet and lower legs ata working height convenientfor the person giving thetreatment. Whether these

Mean Time Spent on Each of 10 Basic Nursing Activities*

Percentage Activity of Observations

0.14.32.62.2

18.9

5.5

8.8

3.432.9

21.4100.0

*(n = 3,447)

Table 3Table 3

1) Making a bed with a patient in it2) Lifting or moving a patient3) Assisting while using the toilet4) Transport with a patient in bed orwheelchair, or walking5) Patient care (e.g., washing, dressing,medical wound care)6) Assisting with eating/drinking ortaking medicine7) Social activities (e.g., talking, play-ing games)8) Washing/showering (not in bed)9) Attendant work and preparationsfor activities 1 through 3 and 5through 8 (e.g., housekeeping, gettingtowels before showering, making bedswithout patients in them)10) Other tasks, mostly administrativeTotal

Figure 1Figure 1

Percent of Observations in Action Categoriesin the First & Second Measurements



Table 4 showsthe percentage ofobservations forwhich a particularpart of the bodywas held in a par-ticular position. Itshows that differ-ences between thebefore and aftermeasurements arep a r t i c u l a r l ynoticeable withrespect to posi-tions of the backand the head;however, a signifi-cant differencecan only be seenwith respect to theposition of thehead. In the be-fore tests, thehead was held ina neutral, healthyposition 54 per-cent of the time;this rose to 71.2percent (alpha<0.01) after theintervention.

Consideringthe differences inmeasurements, itwas noticeable

that the caregivers did not seem to have lifted at all.This does not mean that no transfers were per-formed, because 4.3 percent of the time was spentperforming transfers (Table 2). However, accordingto the observers, the caregivers seldom actually lift aload during patient transfers due to compliance withthe unit’s nonlifting policy. For caregivers to providea reasonably reliable estimate of the actual transferload and to enable choices about the optimumpatient transfer method, the Dynadisc was used[Knibbe and Knibbe(d)]. Based on calculations madeusing the revised NIOSH equation for the manualhandling of loads, it indicates whether a hoistshould be used (Waters and Putz-Anderson).

Static Loads & ActivitiesThe next consideration was whether the improve-

ment in positions occurred with certain activities.Figure 2 shows (for each activity) what percentage ofcaregivers worked in a healthy position (AC1). Whatcan first be deduced from the figure is that, except forthe tenth activity (administration), a percentageincrease was seen in the time caregivers spent work-ing in a healthy position. This is particularly true foractivities 5, 6 and 8, but only for activity 5 (directpatient care) can a significant increase in healthyworking positions be seen (alpha <0.05). When thesefindings are combined with the data from Table 2, it

“subjective data” actually led to a reduction in staticloads on the body is revealed by the OWAS scores.

Activities PerformedAll activities performed during one dayshift were

grouped into 10 categories. Doing so provided a pic-ture of which activities occurred, how often and forhow long during a shift (Table 3).

OWAS ScoresA total of 3,447 OWAS scores were recorded dur-

ing the first measurement, and 3,292 during the sec-ond. At the time of the first measurement, 33.9percent of the scores were categorized in AC2, 3 or 4.During the period in which the ErgoStat programwas conducted, static loads fell significantly (alpha<0.05) from 33.9 percent to 25 percent (Figure 1).These results showed that healthy positions werebeing assumed more often after the interventionthan before it. The remaining questions werewhether improvements were seen with particularparts of the body; with particular activities; with par-ticular periods; with particular caregivers; or withparticular patients; and whether there were any dif-ferences in using the multipurpose shower chair.

Static Loads & Parts of the BodyThe OWAS ACs can be decoded to provide insight

into the static loads on the various parts of the body.

Percentage of Observations Indicating TimeSpent in Different Working Positions

First SecondMeasurement Measurement

Working Position n = 3,447 n = 3,292

Back 1) Straight 62.5 73.12) Bent 24.9 21.03) Straight and twisted 4.1 2.94) Bent and twisted 8.4 2.9

Arms 1) Both arms below shoulder level 98.3 98.72) One arm at or above shoulder level 1.3 1.23) Both arms at or above shoulder level 0.4 0.2

Legs 1) Sitting with legs below buttock level 21.7 23.02) Standing with both legs straight 32.0 37.53) Standing with one leg straight 28.9 23.44) Standing or kneeling with both legs bent at the knee 2.6 2.55) Standing or kneeling with one leg bent at the knee 0.4 0.26) Kneeling on one or both knees 1.0 0.77) Walking or moving 13.3 12.7

Head* 1) Free 54.0 71.22) Bent forward 20.3 15.03) Bent to one side 0.6 4.24) Bent backward 4.8 1.25) Twisted 20.2 8.4

Load 0-10 kg 98.5 99.310-20 kg 0.5 0.4> 20 kg 0.9 0.3

*alpha < 0.01

Table 4Table 4



remaining the same. The increase was greatest forNurse H, which was taken as an indication that stat-ic loads and the degree to which people responded tothe intervention were determined individually to acertain extent.

This conclusion agreed with results from previousresearch into static loads in nursing practice [Knibbeand Knibbe(b) 37]. This study revealed that the harm-ful load has a clear relationship with the caregiver(e.g., height, preferred position, working speed). Asfar as the amount of time taken to complete nursingtasks, it was determined that 43 percent of the varia-tion in that time can be explained by the “caregiver”factor. Only 16 percent could be attributed to the typeof equipment used (e.g., shower chair, shower trolley,high-low bath, high-low bed) and even less (0.2 per-cent) was related to the “patient” variable (mobility).Therefore, the results suggest that the cues given toprevent physical loads should mainly be tailored tothe individual caregiver. It can, therefore, be assumedthat the best results can be expected from individualcaregiver training on the job.

Static Loads & the PatientThe researchers also planned to evaluate the

extent to which improvements occurred during carefor particular patients; this was taken into accountwhen designing the research. However, it was notpossible—for practical reasons—to observe the samepatients during both the before and after measure-ments. Consequently, insufficient data were avail-able from observed caregivers performing the sameactivities on the same patients at the same times bothbefore and after the intervention. Although such

becomes clear thatthe largest benefi-cial effect on health-ier working wasachieved for activity5, which consumesa large proportionof work time.

Static Loads &ObservationPeriods

The next ques-tion was whetheri m p r o v e m e n t soccurred duringcertain periods ofthe shift. Table 2shows static loadsdivided over threeperiods in the shiftin terms of the per-centage of workingtime in AC1. Thelowest AC1 percent-ages (i.e., the moststatic overloading)were recorded dur-ing the morningperiod (alpha <0.01). A significant improvement inpositions was seen during the early morning (7:00 to9:00) and during the late morning (9:00 to 11:30)(alpha <0.5). This fits with the earlier results whichshowed that the most benefit was gained in activity 5(patient care). These tasks—which include washing,showering and dressing patients; dressing wounds;assisting with transfers in bed or to the bathroom;and serving breakfast—are performed mainly dur-ing the busy morning period.

Static Loads & CaregiversThe researchers also wondered whether the

improvements occurred among certain caregivers,which required determining to what extent staticload is associated with the individual. Three care-givers were working at the time of both measure-ments, so the researchers first evaluated whether thereduction in static load as measured after the inter-vention could be explained by replacing caregiverswith poor skills by those with proper skills. This didnot seem to be the case. The improvement of thereplaced caregivers was similar to that of those whowere incorporated in both measurements.

To make reliable interindividual comparison,comments about the differences between the beforeand after measurements can only be applied to thethree caregivers. Figure 3 shows the times whenthese caregivers worked in a healthy position (AC1).During the first measurement, Nurse H worked themost time in AC1 on average, followed by Nurse Kand Nurse A (alpha <0.01). During the second meas-urement, an increase in AC1 was found for all three,with the differences (alpha <0.01) and the sequence

Figure 2Figure 2

Percentage AC1 Scores in Relation to Activities*



were measured during wash-ing a patient using differenttypes of aids [Knibbe andKnibbe(b) 37]. In that study,an AC1 percentage of 58.8was measured for a standardheight-adjustable showerchair, while caregivers usingthe multipurpose showerchair included in the currentresearch stand in an AC1position 74.8 percent of thetime. The researchers recog-nize that it is risky tocompare these figures—especially since working withdifferent patients and differ-ent caregivers makes statisti-cal tests impossible. Still, thewide difference between stat-ic loads is food for thought.

DiscussionThe OWAS method was

used to study the effects ofan ergonomic interventiondirected at the static loads oncaregivers during their dailytasks. The research was notdesigned to use a controlgroup. In theory, it is notexpected that a group withoutthe ErgoStat program wouldchange anything with respectto static loads. Nevertheless, a

control group should be included in the design of sub-sequent research. This present research can, therefore,be classified as an intensive pilot study.

Since the OWAS method is labor-intensive, a rel-atively small number of caregivers were observed.Consequently, the results could be more dependenton coincidental factors than would be true had morecaregivers been included. As a result, generalizationto other situations and persons remains open todebate. However, using this method means that alarge amount of data was collected, meaning statisti-cal analyses could be performed reliably.

In the scope of classifying this study as a pilot, datawere collected only during the dayshift. Differentactivities were usually performed during the eveningand nightshifts, with different staff being present andpeak loads occurring at different times in the shifts. Itis recommended that these data be collected during asubsequent study so that the problems which occurduring those shifts can be identified.

The ErgoStat intervention is intensive. It is a mix-ture of different cues and reminders communicatedto caregivers using various media. The fact that apilot study was being performed and that caregiverswere being observed should not be ruled out. It isimpossible to determine what element—or synergybetween several elements—from the interventionhad a particular effect on the final result. Although

analysis would be advantageous, it should be notedthat according to one laboratory study, the harmfulload on the caregiver’s back had no clear relation-ship with the amount of patient cooperation [Knibbeand Knibbe(a)]. Furthermore, nothing indicates thatthe patients being cared for during the first meas-urement differed with respect to care burden frompatients in the second measurement.

To prevent such a practical problem in subse-quent research, patients should be classified accord-ing to their mobility. The Residents AssessmentInstrument developed originally in the U.S. (adopt-ed by Medicare and Medicaid facilities) and theResidents Gallery linked to it (Knibbe, J.J., et al) pro-vide useful tools for patient classification. This isuseful not only in nursing practice in order to makecare plans more comprehensive and patient-specificthrough improved patient assessment, but also inscientific research (Crumpton, et al).

Static Loads & the Multipurpose Shower ChairDespite the fact that the improvements in posi-

tions during activity 8 (washing, showering andbathing outside the bed, using hygiene equipment)were not statistically significant, a substantial per-centage difference was found. The percentage of AC1positions increased from 46.5 percent to 74.8 percent.It is, therefore, beneficial to compare this result withpreviously published research in which static loads

Figure 3Figure 3

Percentage Observed Positions in AC1 (Normal Position) for Three Nurses



strongly participative, tailored to caregiver needsand driven by them.

•Pay particular attention to the position of thehead as well as to direct care activities (e.g., washing,dressing, caring for medical wounds)

•Ensure sufficient individual attention and on-the-job training. �

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Integrated Back Injury Prevention Program in Nursing Homes.London: The Ergonomics Society, 2001.

Engels, J.A. “The Effectiveness of an Intervention Program toReduce Physical Workload in the Nursing Profession.” Thesis.The Netherlands: Catholic University of Nijmegen, 1998.

Engels, J.A., et al. “Physical Workload and Its AssessmentAmong the Nursing Staff in Nursing Homes.” Journal ofOccupational Medicine. 36(1994): 338-345.

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Kahru, O., et al. “Postural Stress Analysis in Industry.”Applied Ergonomics. 25(1994): 77-87.

Knibbe, J.J. and R.D. Friele. “The Use of Logs to AssessExposure to Manual Handling of Patients, Illustrated in anIntervention Study in Home Care Nursing. International Journal ofIndustrial Ergonomics. 24(1999): 445-454.

Knibbe, J.J., et al. Kleine hulpmiddelen: hulp voor bewoners enzorgverleners? The Netherlands: NIVEL, Utrecht, 1998.

Knibbe, N.E. and J.J. Knibbe(a). “De ergonoom doet eenstapje zijwaarts. Probleem Gestuurd Oplossen van ergonomischeproblemen. Nederlands Tijdschrift voor Ergonomie. 24(1999): 111- 115.

Knibbe, N.E. and J.J. Knibbe(b). “Postural Load andEfficiency of Bathing and Showering: Results of a LaboratoryStudy.” Professional Safety. Nov. 1996: 37-39.

Knibbe, N.E. and J.J. Knibbe(c). “PreGo! How Back Pain inthe Nursing Profession in The Netherlands is Tackled.”Proceedings of International Section of the ISSA on the Prevention ofOccupational Risks in Health Services. Paris, 2002.

Knibbe, J.J. and N.E. Knibbe(d). “The New Dynadisc.” UserInstruction Brochure. Roselle, IL: ARJO Inc., 2001.

Knibbe, N.E., et al. “Evaluation of Interactive CD-ROM ‘Trans-fer with Care.’” LOCOmotion, Bennekom: The Netherlands, 2001.

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indications suggest that individual on-the-job train-ing in particular can be expected to have an effect,statements can only be made about the effect of theintervention as a whole. On theoretical grounds, itcan be said that repeated communication of thesame message in different modes (e.g., in a booklet,through individual training, via CD-ROM) doeshave a synergistic effect on the final result.

The duration of the program is also relatively short.Although the results are positive in the short term, noinsight can be offered regarding developments in thelong term. Because the program is interactive, tailoredto caregiver needs and driven by them, it is hoped thatthe results will continue. Furthermore, because theprogram is driven by participants, they came to ownthe problems and the solutions, and were empoweredto take action. This allowed caregivers to protect theirown health, interwoven as far as possible with caringfor patients (Engels). It is important to remember thatpatient welfare is a powerful motivator as well(Hersey, et al). In any case, long-term evaluation ofErgoStat is required.

This particular intervention does not lend itself tobeing copied in detail and being executed in otherhealthcare facilities. The concept can, however, serveas a successful example for intervention programsdirected at static loads in healthcare. The stimuliselected must match the employees’ level of knowl-edge, the environment and the organization’s cul-ture. Considering that different problems can occurin other facilities and that other caregivers will bedriving the program, the content will always be dif-ferent, which is a condition for success.

ConclusionThe intervention detailed was specifically direct-

ed at bringing static loads within health-based lim-its. The static load on the caregivers’ musculoskeletalsystem was measured before and after the programusing OWAS. Despite the methodological limita-tions, it was determined that the program was bene-ficial. After the intervention, a significant increasewas observed in the percentage of time that care-givers spent working in a healthy position. The mostnoticeable improvement was seen in performingdirect care tasks—demonstrated in particular by animprovement in head position. This benefitappeared to be associated with the individual. Notall caregivers were affected by the program to thesame extent.

RecommendationsBased on this study, the following recommenda-

tions are offered for an intervention program designedto prevent static overloading in geriatric care:

•Combine software (e.g., training, guidance)with hardware (e.g., height-adjustable equipment).

•Avoid peak loads during the busy morningperiod by spreading relatively heavy tasks (e.g.,showering and bathing) throughout the day.

•Use a broad, creative mixture of interlinked cuesthat convey the message in an appealing way.

•Make the ergonomic intervention program

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Because theprogram wasdriven byparticipants,they cameto own theproblems andthe solutions,and wereempoweredto take action.


study #2 the ergo stat program - arjohuntleigh · the ergo stat program: pilot study of an ... the...

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