I am interested to hear peoples’ opinions on the use of mechanical lift devices in physical therapy. This is a contreversial area, because many PT’s feel the use of equipment for transfers takes away from the personal care that PT’s provide. However, considering that as much as 45-48% of PT’s develop serious low back symptoms during their career, these alternatives for lifting heavy patients seem warranted (1,2). Any thoughts on the subject???
Cromie, JE, Robertson VJ, Best MO. (2000). Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks and responses. Physical Therapy. 80(4), 336-351.
Holder et al. (1999). Cause, prevalence and response to occupational musculoskeletal injuries reported by physical therapists and physical therapist assistants. Physical Therapy. 79(7), 642-652.
Jody Shanks PT, MPT
We have looked at this issue very closely at WorkSafeBC (Workers’ Compensation Board of British Columbia). Mostly as lifting devices apply to patient care by nurses but the principles can just as easily be applied to physiotherapists. Health Care has one of the highest rates of musculoskeletal injuries (MSI) of any industry, nurses making up the bulk of these injuries purely based on numbers. In BC we have ergonomic regulations requiring employers to eliminate or minimize the risk of MSI to workers. The controversy around lifting equipment taking away the ‘personal’ element of care is one that we are familiar with. I wonder how much personal care can a PT give if they are off work with a back injury? The other interesting argument that we’ve heard is that manual transfers and manual lifting is somehow ‘therapeutic’ for the client.
We have assembled a huge resource base dealing with most aspects of mechanical lift devices and I’m copying the link for you to look at. Please feel free to contact me directly if you need anymore information on this topic.
Peter Goyert CCPE
I am a strong proponent of using lift devices and transfer aids by ALL healthcare workers, including PTs and OTs. There is NOTHING therapeutic for the patient when a therapist performs a manual dependent or max assist transfer. It’s also important to be realistic about the pt’s discharge plans and what the family needs in order to do safe transfers when they bring the patient home.
The question to ask is WHEN to use equipment not IF to use it. The policy at St. Luke’s Rehab it that it is the responsibility of all healthcare workers involved in the patient’s care, including therapists, to choose the right tranfer for the right patient at the right time. This includes the appropriate use of equipment and aids. It’s not important if the therapist is able to manually transfer a dependent/max assist patient. A patient centered approach bases the transfer decision on an accurate assessment of what the patient can do, not what the therapist can do. Lift equipment can also be used to enhance therapy, such as putting a pt in a sit-stand device without the foot plate when first ambulating a post-surgical pt.
Check out the White Paper published 12/1/04 entitled “Strategies to Improve Patient and Health Care Provider Safety in Patient Handling and Movement Tasks: A Collaborative Effort of the American PT Association, Association of Rehab Nurses and Veterans Health Administration”. It outlines ways to improve safe pt handling in the rehab setting. I’m attaching the document. I’m not sure where you can find it on the web now.
It’s time for a change in nursing as well as therapy with regard to using equipement and devices to transfer patients. Maybe it will take several years for this paradign shift to happen, but we can be committed to the process today.
I agree with the above posters. With over 2 decades of clinical experience I’ve found little therapeutic benefit in much of the patient handling done by rehab professionals. Moreover, the use of assistive devices in the therapy department makes for a smoother transition to home for the patient and care givers. It’s a change in philosophy for many but I feel a necessary one. Maybe more of us should approach PT programs with lectures on the appropriate use of assistive devices as the nursing program where my wife teaches does.
Thanks for the post.
I’m not a PT, but I thought I would just share a thought (since you asked). I have been doing training and assessments as an ergonomics consultant with home healthcare providers (ie. CNAs, RNs, LVNs). ONE of the many excuses I hear is that using equipment for a patient transfer takes away from the personal care that they provide. What I am asking them is, what about the safety of the patient? If you are not going to use the equipment for your own personal protection against a low back injury then use it to prevent injury (ie. dropping, falling, etc.) to the patient you are taking care of. It seems that this principle could also apply to the PT.
Kristy Schultz, MS, CIE
Here is a great upcoming conference you may be interested in. In addition to the
ARN/APTA/VA white paper in 2004, I understand work is underway to develop with
web-based tools to help present a business case for safe patient handling,
and how to select equipment. Also look for a future collaborative
work on “therapeutic use of safe patient handling equipment”.
7th Annual Safe Patient Handling & Movement Conference
This conference will provide participants with cutting edge research, best practices, and lessons learned in safe patient handling. The conference includes diverse learning opportunities, including plenary sessions, concurrent sessions, workshops, “hands on” practice sessions and a large exhibit hall with new and emerging technologies. Innovations from around the world will be presented addressing such topics as safety legislation, practice tips, technology solutions, effective training techniques, successful organizational strategies, and building a business case for safe patient handling programs. Detailed conference materials will include a textbook on Safe Patient Handling, education materials, and other cognitive aids and tools to facilitate implementation of best practices.
If these dates don’t work or you want to get more people exposed to the info, I just
got word there will also be a special presentation at APTA Annual Conference in Denver on Safe Patient
Handling this summer. Keep an eye out for that info. One of the speakers is Kathy Rockefeller
who did her doctoral work in WA state with Barbara Silverstein on staff transitions/barriers, etc.
She may be a good person to contact, her info should be on the APTA site.
Dee Daley, PT
S. Pines, NC
Thanks everyone for your great postings. I completely agree that there needs to be a shift towards greater use of assistive devices with transfers. I am teaching the transfer section of a class for PT students and wanted them to be exposed to this controversy before we get to this portion of the class. Thanks so much for the insight you all have provided.
Jody Shanks PT
In my opinion, mechanical lifts should only be utilized for those individuals who are unskilled in transfers. I am a PT (a small one at that) and have been practicing for 15 years. I have transferred numerous neurological patients that are max to dependent transfers and still going strong. I feel that just as a computer can’t replace a human, a mechanical lift can’t substitute for the human touch. In addition, if there is a remote chance of patient participation with a transfer, I believe a mechanical lift makes the patient’s participation null and void. After all, we are there to educate and assist patient’s with functional independence and that becomes lost when the human touch is removed. Not only may the patient assist with the transfer, even very minimally is better than no participation, but there are balance and positional gains from pateint participation,( even if its minimal) that you lose with a mechanical lift.
I am a Physical Therapist and I cannot agree more with the other comments posted that support the use of mechanical aids (I do not like to call them all lifts). There is a growing amount of literature on the subject. Our Acute Care Hospital implemented a Safe Patient Handling program 2 years ago, and we have seen 60-80% reduction in costs, lost days and restricted days. From personal experience using the equipment, especially the standing aids, when the machine is taking the "strain" of however much weight the patient is lending to the machine (which would have otherwise have been taken by our backs), our hands are now free to facilitate quads control or hip extension, or to promote upper body extension, or whatever the patient needs. We can work on knee control safely. We can still give the human touch, and the personal touch to our patients, and in my opinion, in a safer and more controlled manner, thus achieving our rehabilitation goals as well as maintaining our safety.
We have been considered the mobility experts for lifting and biomechanics, and promoting safe lifting. We need to be leaders in promoting these safe practices throughout healthcare systems.
Many valid points have been brought out in this discussion on both sides of the debate over the use of mechanical aids for safe lifting of clients. The bottom line is that clinical judgment must be exercised as to the appropriateness of the device for any individual client given the level of ability of the client and the caregiver. I am an OT providing intensive rehab in a skilled nursing facilty. We treat many clients that are so acute and low functioning they do not yet "qualify" for hospital inpatient rehab. The use of the mechanical aid with some of these clients is most appropriate to get them started along the path to skill development and participation in mobility. In other instances the use of the device only prolongs dependence. It is our unique training that allows us the abilty to critically assess the client’s needs and make the appropriate clinical decision for intervention whether that includes use of a mechanical aid or only human support. The more tools we have in our box the better outcomes we can help our clients achieve.
Sheila Krajnik OTR/L
Our hospital is in the beginning stages of instituting a "Safe Patient Handeling" program. One of the tools that has helped convince our Rehab. Medicine staff is the LIKO VIKING XL lift. We have many patients come through our doors who weigh well in the 4-500 lb plus range. We had one of those patients be bed ridden for about 30 days. She was too weak to help herself even sit on the edge of the bed, but her goal was to go home to be with her family and new grandchild. We rented this lift, staff were trained in its use and her acute care rehab began. The cool thing about this lift, with the right harness (pants style), it brings the patient up to a normal standing posture, not leaned posterior like many others. The patient gained confidence with getting to a standing posture and began walking, with weight bearing controlled by the lift. Another componant of this lift is it can be turned around so the patient can see where they are going and gain a little more confidence in they’re ability to walk. Soon, she was using a walker with the lift in this configuration, with increasing weight bearing as tolerated. As I recall, it was another month in the hospital, but she went home, walking independently with a rolling walker. This is all it took to convince PT it was a valuable tool and is a part of their equipment now. Our PT’s use it frequently now. They are getting hurt less and patients who would not have gotten out of bed are getting better, quicker. If you would like to see this lift in use, I believe the website is LIKO.com. They have a new letter. A localTV station did a story on the patient and the lift. LIKO has it in their new letter….in the April issue as I recall. This story may be of benefit to help show Rehab Medicine how a lift can assist Therapies.
Theta Grimaud, OTR/L
Thank you for the information regarding the LIKO lift, Theta. After reading the comments and the article regarding California’s governer vetoing the safe handling bill, it appears that we therapists OT’s and PT’s alike are in prime positions to lead the acceptibility and promotion of such lifts in medical facilities. I know in our facility, lifts are used infrequently, so there’s almost a need to re-train staff each time it is utilized. I also know that the lifts that we have cannot accomodate some of the heavier patients that warrant such lifts. There is also the cost issue. However, with data regarding time lost due to employee injuries, costs associated with patient injuries and data revealing increases in the incidence of obesity, there should be enough justification to convince administrators. I’ll be checking out the LIKO website!
Linda Wikselaar, PT,CWS
I have been following this topic for a little while now and I must say that I am responding to your previous remark because not only did it explain my thoughts exactly,but it could not have been said any better.
Just as no 2 patients with total knee replacements are alike, qualify for identical treatment nor should they compare themselves, no 2 patients are alike in terms of their functional levels, needs and prescribed/recommended treatments.
Having said that, I think each dependent/max assist patient/therapist interaction should be assessed and transfer type carried out on an individual basis. There will be some patients/therapists that will find mechanical lifts to be best for patient A and some patients/therapists that will find hands on transfers to be best for patient A.
This topic should not be viewed in such a way as to whether 1 therapist perceives their way as superior, but as a topic to gain knowledge and insight as to pros/cons and others first hand experience.
As an additional note, if I treat a patient that is at a dep-max level and the mechanical lift set up requires time that will take away from my treatment session than I may prefer other trained professionals on the unit transfer the patient with the mechanical lift so as not to use the therapy session time for that.
In the end, we are treating human beings, with individualized personal needs and this is not a one size fits all situation. If we use our individual professional knowledge and expertise on each individual as a unique case, as a profession we will make sound judgement that is best for the patient and the therapist.
I appreciate your concern for the human touch aspect and for promoting the patient doing all they can to help themselves. I am a practicing OT for 16 yrs, in Acute Care for 14.5. I have lifted some very heavy dependent people in these years. My max assist lift of a 350 lb patient who chose to not put her feet on the floor was not therapeutic. She was scared. If we would have had the LIKO Viking 13 years ago, we could have used the sling pants or gait vest to help her gain confidence in her ability to stand and walk. The versitility of this lift would have been taylored to meet her individual needs. Yes, I gave her a great deal of "human touch" for that transfer, but it did nothing for her "Rehab". Lifts like the LIKO can govern weightbearing, help build LE strengthening, build confidence, endurance and independence. It also helps prevent staff and patient injuries. In my position as Ergonomic Safety Specialist, I promote taking a few extra minutes to do the task safely, with the right equipment. I know our PT’s who are using this lift are giving excellent care, promoting independence and providing that vital human touch. I know, as an OT, if my patient feels confident they will not fall, they are able to engage in their ADL’s. I would ask you to check out the news clip on the LIKO site and talk to other PT / OT’s who use a lift as a piece of the rehab puzzle.
Theta Grimaud, OTR/L
I am presently participating in a group called the APTA/OSHA V Alliance which is addressing this issue directly. A formal agreement between APTA and OSHA Region V was signed this year and the group working on serveral items to make some positive changes in this area. Not just with injuries to PTs but to health care individual in general. When initially approached about the subject I had the same impression and reaction as many now have that do not work with an ergonomic perspective. I am excellent in safely transferring patients, mechanical assists are patient unfriendly, mechanical lifts/assists are expessive, they are difficult to store, you can never find one when they are needed, my time is more valuable to waste it on trying to find the complete lift device, etc, fill in your own excuse. There is no excuse, however for the rate of injury in healthcare and what the evidence indicates clearly reveals an incredible cost benefit and ROI. It doesn’t take a rocket scientist to do the math. Back injuries are expensive in more than dollars. I think this Alliance is a huge step in the right direction through education and training to change the culture in healthcare.
So far we are providing education to Physical Therapists in all of the 5 Midwest States at there State conferences over the next year. There are 7 subcommittees working to address these issues.
I will try to keep everyone updated with new information as it becomes available. Thanks.
Ron Knickrehm PT, CEAS
The forum ‘General Ergonomics Topics’ is closed to new topics and replies.