Work technique in lifting and patient transfer tasks

The overall aim of this thesis was to explore and develop methods for describing, analysing and assessing work technique in lifting and patient transfer tasks, and to study how the work technique is related to personal factors and aspects of patient quality and safety. The focus was on work technique features with implications for musculoskeletal load and for the development of musculoskeletal disorders. Work technique was viewed in two basic elements: method and individual performance. The thesis is based on biomechanical model studies in the laboratory and observational studies in the field. Results from lifting experiments implied that separate variables should be used for descriptions of work methods and task performances. The work technique varied between the subjects to a greater extent than the individual variability over repetitions of a lift task. Differences between men and women in lifting kinematics were found, e.g. in trunk motion, knee angle ranges and hip-knee interjoint coordination. An observation instrument for description and a quantitative assessment of work technique in videotaped patient transfer tasks was developed, and an overall score with regard to musculoskeletal hazard and safety was calculated. The validity and reliability of the instrument were mostly satisfactory, both when evaluating the agreements between the observations of each item and when evaluating the agreements between the overall scores. Observations of nurses at orthopaedic wards revealed that a variety of strategies were used to perform two patient transfer tasks. Being older, suffering from low back symptoms and being male were associated with a poor work technique. Patients perceptions of safety and comfort when being transferred were related to the work technique of nurses, both regarding the work technique score, and the nurses own subjective assessments of their work technique. In conclusion, inter-individual variations regarding work technique in lifting and patient transfers tasks suggest that evaluations of work technique may need to be carried out on an individual level. Evaluations should also consider possible differences in work technique between women and men, younger and older persons, and persons with and without low back symptoms. Finally, the transfer skill of nurses could also be regarded as a matter of quality of care.Arbetsteknik vid lyft och patientförflyttningar Det övergripande syftet med denna avhandling var att utveckla och pröva metoder för att beskriva, analysera och bedöma arbetsteknik vid lyft och patientförflyttningar, och att studera samband mellan arbetsteknik och faktorer hos individen, samt mellan arbetsteknik och patientens säkerhet och komfort. Fokus har varit på aspekter av arbetsteknik som har betydelse den mekaniska belastningen på muskler och leder och för utveckling av besvär i rörelseorganen. Begreppet arbetsteknik delades upp i två beståndsdelar: metod och individuellt utförande. Avhandlingen är baserad på biomekaniska modellstudier i laboratorium och observationsstudier i fält. Resultaten från experiment på lyft visade att olika variabler bör användas för att för beskriva metoden och för att beskriva utförandet av en arbetsuppgift. Variationer i arbetsteknik mellan försökspersonerna var större än variationer inom individerna under upprepningar av lyften. Resultaten visade också skillnader i mäns och kvinnors rörelsemönster vid lyft, t ex i bål- och knäledsrörelser samt i koordinationen mellan höft- och knäledsrörelser. Ett observationsinstrument utvecklades för beskrivning och kvantitativ bedömning av vårdpersonals arbetsteknik vid videofilmade patientförflyttningar, och ett arbetsteknikpoäng , som indikerar risk och säkerhet för rörelseorganen, beräknades. Validiteten och reliabiliteten var i de flesta fall tillfredsställande, både överensstämmelsen mellan observationer av varje enskild bedömningspunkt, och överensstämmelsen mellan de beräknade arbetsteknikpoängen. Observationer av vårdpersonal på ortopedavdelningar vid två olika patientförflyttningar visade att en mängd olika tekniker används för att förflytta patienter. Att vara äldre, ha ländryggsbesvär och att vara man hade samband med att använda en dålig arbetsteknik. Patienternas upplevelser av säkerhet och komfort under förflyttningarna hade samband med vårdpersonalens arbetsteknik, både beträffande arbetsteknikpoängen och sköterskornas egna subjektiva bedömningar av sin arbetsteknik. Sammanfattningsvis kan variationerna i arbetsteknik mellan individer tolkas som att arbetsteknik bör utvärderas på individnivå. Man bör då också beakta möjliga skillnader i arbetsteknik mellan kvinnor och män, yngre och äldre, och personer med och utan ländryggsbesvär. Slutligen, att vårdpersonalen använder en säker arbetsteknik vid förflyttningar, kan också betraktas som en aspekt av vårdkvalitet. Nyckelord: arbetsteknik, biomekanik, lyft, metodutveckling, kön, ländryggsbesvär, observationer, patientförflyttning, patientkomfort, patientsäkerhet, vårdpersonal, ålde

I rörelse - ett trafikprogram för Nacka

In motion –a traffic program for Nacka is the result of a survey of the traffic system and transportation situation in Nacka and suggests possible development opportunities. A new traffic strategy will be developed in the municipality of Nacka the coming years, which is the reason for this study: to map the current situation, identify strengths and weaknesses, needs and opportunities. This program suggests possible development opportunities and gives an historical overview of the transportation system, the current situation and an analysis of different transportation modes. A mapping of other municipalities’ traffic strategies or programs have been done and included into the program as well as a prognosis for the coming years in the municipality. The work has identified goals and contains a suggestion for an action plan. The suggestions can serve as a basis for further development to fulfill the set goals in the comprehensive plan, and also more specific in the transportation plan, to get a better interlinked and efficient transportation system in Nacka

Livet för personer med afasi och deras närstående efter stroke : Personer med afasi och deras närståendes skattningar på COAST respektive Carer COAST i relation till en språklig bedömning med testet A-ning

ABSTRACT Stroke can result in aphasia which is an acquired language disorder. It affects both the person with aphasia and the relatives. Previous studies have shown that people with aphasia consider themselves to have fewer difficulties with communication in comparison to their relatives’ opinions. The relatives rate the difficulties as less severe in comparison to the speech and language pathologists. The scales Communication Outcome after Stroke (COAST) and Carer Communication Outcome after Stroke (Carer COAST) can be used to investigate the experiences of the people with aphasia and their relatives regarding the language and communication ability of people with aphasia and the quality of life for both groups. By using COAST and Carer COAST this study aimed to investigate the experiences of people with aphasia and their relatives and to compare their experiences to the assessment of language. This study also aimed to start a validation of COAST and Carer COAST on a Swedish population. A qualitative and a quantitative analysis were used. Twenty people with aphasia and nineteen relatives were participating. The ratings between people with aphasia, their relatives and the speech and language pathologist did not differ a lot even though the relatives rated the difficulties as most severe. The quality of life was negatively affected for almost all participants. This study provided deeper insight in the different experiences which can be crucial in the clinical practice. The validation of COAST and Carer COAST can contribute to an extended use of the scales clinically and in research. Keywords: aphasia, stroke, relative, experiences, speech and language pathology, Communication Outcome after Stroke, Carer Communication Outcome after Stroke SAMMANFATTNING Afasi är en förvärvad språkstörning som kan uppkomma efter stroke och påverkar både personen som fått afasi och de närstående. Enligt tidigare studier anser personer med afasi att de har mindre kommunikationssvårigheter än vad de närstående upplever. De närstående upplever i sin tur svårigheterna som mindre än vad logopeder bedömer. Skattningsformulären Communication Outcome after Stroke (COAST) och Carer Communication Outcome after Stroke (Carer COAST) kan användas för att undersöka upplevelserna hos personer med afasi och deras närstående avseende den språkliga och kommunikativa förmågan hos personen med afasi samt livskvaliteten hos båda parter. Studien syftade till att med COAST och Carer COAST studera upplevelserna hos personer med afasi och deras närstående samt hur dessa förhöll sig till en språklig bedömning. Ytterligare ett syfte var att påbörja validering av COAST och Carer COAST på en svensk population. En kvalitativ och en kvantitativ analys gjordes. Tjugo personer med afasi och nitton närstående deltog. Det var inga större skillnader mellan skattningarna av deltagarna med afasi och deras närstående. Skattningarna stämde även till stor del överens med den språkliga bedömningen även om de närstående överlag skattade svårigheterna som störst. Livskvaliteten var negativt påverkad för de flesta deltagarna. Studiens resultat ökar insikten om de olika upplevelserna vilket kan vara av betydelse i den kliniska verksamheten. Valideringen av COAST och Carer COAST kan innebära att skattningsskalorna i större utsträckning kan användas kliniskt och inom forskning.   Nyckelord: afasi, stroke, närstående, upplevelser, logopedi, Communication Outcome after Stroke, Carer Communication Outcome after Strok

Reliability and criterion validity of an observation protocol for working technique assessments in cash register work

© 2015 Informa UK Limited, trading as Taylor & Francis Group. We evaluated the intra- and inter-observer reliability and criterion validity of an observation protocol, developed in an iterative process involving practicing ergonomists, for assessment of working technique during cash register work for the purpose of preventing upper extremity symptoms. Two ergonomists independently assessed 17 15-min videos of cash register work on two occasions each, as a basis for examining reliability. Criterion validity was assessed by comparing these assessments with meticulous video-based analyses by researchers. Intra-observer reliability was acceptable (i.e. proportional agreement  > 0.7 and kappa  > 0.4) for 10/10 questions. Inter-observer reliability was acceptable for only 3/10 questions. An acceptable inter-observer reliability combined with an acceptable criterion validity was obtained only for one working technique aspect, ‘Quality of movements’. Thus, major elements of the cashiers’ working technique could not be assessed with an acceptable accuracy from short periods of observations by one observer, such as often desired by practitioners. Practitioner Summary: We examined an observation protocol for assessing working technique in cash register work. It was feasible in use, but inter-observer reliability and criterion validity were generally not acceptable when working technique aspects were assessed from short periods of work. We recommend the protocol to be used for educational purposes only

Promoting occupational health interventions in early return to work by implementing financial subsidies : a Swedish case study

Background In 2010, the Swedish government introduced a system of subsidies for occupational health (OH) service interventions, as a part in a general policy promoting early return to work. The aim of this study was to analyse the implementation of these subsidies, regarding how they were used and perceived. Methods The study was carried out using a mixed-methods approach, and comprises material from six sub-studies: a register study of the use of the subsidies, one survey to OH service providers, one survey to employers, one document analysis of the documentation from interventions, interviews with stakeholders, and case interviews with actors involved in coordinated interventions. Results The subsidized services were generally perceived as positive but were modestly used. The most extensive subsidy – for coordinated interventions – was rarely used. Employers and OH service providers reported few or no effects on services and contracts. OH service providers explained the modest use in terms of already having less bureaucratic routines in place, where applying for subsidies would involve additional costs. Information about the subsidies was primarily communicated to OH service providers, while employers were not informed. Conclusions The study highlights the complexity of promoting interventions through financial incentives, since their implementation requires that they are perceived by the stakeholders involved as purposeful, manageable and cost-effective. There are inherent political challenges in influencing stakeholders who act on a free market, in that the impact of policies may be limited, unless they are enforced by law.Funding Agencies|Swedish Social Insurance Agency||Ministry of Health and Social Affairs||</p

The influence of social capital on employers use of occupational health services: a qualitative study

Background: Occupational health services may have a strategic role in the prevention of sickness absence, as well as in rehabilitation and return to work after sick leave, because of their medical expertise in combination with a close connection to workplaces. The purpose of this study was to explore how employers and occupational health service providers describe their business relations and the use of occupational health services in rehabilitation in relation to the organization of such services. The study uses a theoretical framework based on social capital to analyse the findings. Methods: Interviews and focus groups with managers with Swedish public employers (n = 60), and interviews with occupational health services professionals (n = 25). Results: Employers emphasized trustful relationships, local workplace knowledge, long-term contracts and dialogue about services for good relationships with occupational health providers. Occupational health providers strove to be strategic partners to employers, promoting preventive work, which was more easily achieved in situations where the services were organized in-house. Employers with outsourced occupational health services expressed less trust in their providers than employers with internal occupational health provision. Conclusions: Social capital emerges as central to understanding the conditions for cooperation and collective action in the use of occupational health services, with reference to structural (e.g. contracts), relational (e.g. trust) as well as cognitive (e.g. shared vision) dimensions. The study suggests that attention to the quality of relationships is imperative for developing purposeful occupational health service delivery in rehabilitation and return to work.Funding Agencies|AFA Forsakring [090315]</p

Occupational lifting and rhegmatogenous retinal detachment: A follow-up study of Swedish conscripts

Objectives To investigate the association between occupational lifting and the risk of rhegmatogenous retinal detachment (RRD) using data from a large population of men. Methods We used data from a national cohort of 49 321 Swedish men conscripted for compulsory military service in 1969-1970. We collected information on surgically treated RRD from the National Patient Register and we followed up the cohort between 1991 and 2009 at ages 40-60 years. Exposure to occupational lifting was assessed by applying a job exposure matrix to occupational data from the 1990 census. Incidence rate ratios (IRRs) and 95% CIs were estimated through Poisson regression models adjusted by degree of myopia, income and education level. Results We observed 217 cases of RRD in 7 80 166 person-years. In univariate analyses we did not observe an association between occupational lifting and RRD. However, after adjustment for myopia and socioeconomic factors, we found an increased risk of RRD (IRR 2.38, 95% CI 1.15 to 4.93) for subjects in the highest category of exposure compared with those in the lowest one. The incidence rate of RRD among subjects lifting heavy loads at least twice per week, aged between 50 years and 59 years, and affected by severe myopia was as high as 7.9 cases per 1000 person-years, compared with an overall rate of 0.28. Conclusions Our study supports the hypothesis that heavy occupational lifting is a risk factor for RRD. Information on myopia degree and socioeconomic status is necessary when studying the association between occupational lifting and RRD