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Objective The aim of this review was to determine how exoskeletons could assist Australian Defence Force personnel with manual handling tasks. Background Musculoskeletal injuries due to manual handling are physically damaging to personnel and financially costly to the Australian Defence Force. Exoskeletons may minimize injury risk by supporting, augmenting, and/or amplifying the user’s physical abilities. Exoskeletons are therefore of interest in determining how they could support the unique needs of military manual handling personnel. Method Industrial and military exoskeleton studies from 1990 to 2019 were identified in the literature. This included 67 unique exoskeletons, for which Information about their current state of development was tabulated. Results Exoskeleton support of manual handling tasks is largely through squat/deadlift (lower limb) systems (64%), with the proposed use case for these being load carrying (42%) and 78% of exoskeletons being active. Human–exoskeleton analysis was the most prevalent form of evaluation (68%) with reported reductions in back muscle activation of 15%–54%. Conclusion The high frequency of citations of exoskeletons targeting load carrying reflects the need for devices that can support manual handling workers. Exoskeleton evaluation procedures varied across studies making comparisons difficult. The unique considerations for military applications, such as heavy external loads and load asymmetry, suggest that a significant adaptation to current technology or customized military-specific devices would be required for the introduction of exoskeletons into a military setting. Application Exoskeletons in the literature and their potential to be adapted for application to military manual handling tasks are presented.

Objective To validate the effectiveness of MAPO method (Movement and Assistance of Hospital Patient) after the introduction of some changes to improve assessment objectivity. Background The number of operators exposed to patient manual handling is increasing considerably. MAPO, proposed in 1999 as a useful tool to estimate the risk of patient manual handling, is a method characterized by analytical quickness. It has recently been improved to better match the 2012 ISO (International Organization for Standardization) technical report. Methods A multicenter study was conducted between 2014 and 2016 involving 26 Italian hospitals in the Apulia Region. MAPO method was used to assess the risk of patient manual handling in 116 wards. A total of 1,998 exposed subjects were evaluated for the presence or absence of acute low back pain in the previous 12 months. Results Only 12% of the investigated wards fell in the green exposure level (MAPO index = 0.1–1.5), 37% resulted in the average exposure level (MAPO index = 1.51–5) and the remaining 51% in the higher exposure level (MAPO index >5). The results confirmed a positive association between increasing levels of MAPO index and the number of episodes of acute low back pain (adjusted p trend = .001). Conclusion The improvements made over the past years led to a more objective assessment procedure. Despite the changes, the study confirmed the effectiveness of MAPO method to predict low back pain. Application MAPO method is an accurate risk assessment tool that identifies and evaluates workplace risks. The proper application of the method significantly improves working conditions.

Routine husbandry procedures during animal toxicity studies can result in incidental pathological changes. We report on trauma-induced hepatopathy in newborn Göttingen minipigs. Sixty-four neonatal minipigs were allocated to 13- and 26-week treatment arms. There was a 4-week recovery period for both arms. The animals were divided into 2 treatment groups and a vehicle group and were dosed 3 times daily by direct oral administration using a syringe. During the feeding procedure in the first weeks, the animals had to be handled firmly. After 13 weeks, randomly distributed foci of degeneration/necrosis and focal congestion and/or hemorrhage were found in the livers of several animals from all groups. Reduced incidence and severity were evident in the recovery phase, and the lesions were absent after 26 weeks. These changes were considered as related to the manual handling of the animals. Knowledge of these findings is crucial for interpretation of studies utilizing newborn minipigs.

© 2016, © The Author(s) 2016. How home care workers adapt what they learn in manual handling classroom training sessions to their workplaces (i.e., their clients’ homes) is central to their own safety, as their musculoskeletal injuries continue to occur at unacceptably high rates. For this inquiry, new workers were directly observed in their workplaces following classroom training. Findings from these observations propose three environmental considerations for supporting new workers to learn safe manual handling techniques: (1) The physical setting for manual handling is important, (2) clients and their significant others may offer a valuable form of learning support, and (c) when initially learning the requirements for their roles, new workers should be encouraged to focus only on the manual handling tasks at hand.

Introduction: No research-based guidelines for adaptation planning for shower chairs and other vehicles with four casters exist, despite the manual handling nature of the manoeuvring task and the occupational therapy responsibility to plan for such vehicles. Method: It was determined from theory that changes in direction for these vehicles, such as from a passageway through a door, could be represented by 13 manoeuvres. Participants (n = 17) carried out 11 (maximum) manoeuvres based on this theory, each with the maximum comfortable occupant weight of their choice (weights represented the occupant). Findings: The maximum occupant weight selected as comfortable varied substantially between some of the 11 manoeuvres: there was a 100% difference between the lowest and highest weight selections. This indicated that four-caster vehicles (such as shower chairs) should not be treated as omni-directional for high occupant weights, or for floor materials with high motion resistance, because the manoeuvre direction substantially affects maximum comfortable weight selection. Conclusion: The manoeuvre with the highest weight selection is proposed as a guideline when manual handling concerns exist for these vehicles. The guideline can be modified for individual vehicles sizes, occupant and carer anatomy.

The manual handling of people and objects is integral to the provision of nursing care to patients globally. Despite over 30 years of research intended to guide improvements for nurses’ safety, substantial rates of manual handling injuries persist internationally within the nursing profession. This paper reviews the contemporary international literature regarding manual handling interventions noting the unique context for injury prevention strategies within healthcare. The review includes the recognition of underlying assumptions inherent in the conceptualisation of manual handling and its management, and the preponderance of the post-positivist paradigm in this field. The complexity of manual handling in healthcare has resulted in a theoretical shift from single factor interventions based on technique training towards an emerging multidimensional approach. However the key elements for sustainable solutions to reduce nurses’ manual handling injuries have not yet been identified and consensus is lacking regarding the implementation and appropriate evaluation of injury prevention programmes. Furthermore, whilst the literature is replete with data derived from surveys or insurance industry records of compensation claims, there is a dearth of literature exploring nurses’ manual handling experiences. The in-depth investigation of nurses’ perspectives on manual handling may uncover new knowledge critical to improvement of the manual handling issues.

The introduction of the Manual Handling Operation Regulations 1992 has forced organizations to review all manual handling carried out in the work-place. Safe manual handling is now a legislative requirement to enable the workforce to carry out their jobs in a safe and structured environment. This project looked in detail at the manual handling that was being carried out when caring for a child after they have died. It was undertaken at CHASE Children’s Hospice in the period up until December 2002, with a telephone survey investigating practice at six other children’s hospices. It aimed to identify incorrect procedures and, by applying the theory of ergonomics, identify changes that needed to occur in practice, making recommendations for environmental changes. The study led to the production of a policy for handling the children, devising child-specific handling guidelines, reducing the number of times the children are moved after they have died and providing appropriate equipment.

Objective: To determine whether transferring equipment designed to assist a carer when moving someone who is able to take some weight through their legs is likely to affect the risk of back problems in the carer. Design: Twelve pieces of equipment were tested by nurses transferring patients from commode to wheelchair and vice versa, and from wheelchair to bed and vice versa. Video recordings were taken of each transfer and freeze-frame pictures at the moment of greatest load were analysed. Compressive disc force was deduced, using a biomechanical model, from the weights of the patient and nurse and measurements of anatomical distances and angles. Setting: The Sir Walter Puckey Gait Laboratory, in the Rehabilitation Research Unit, University of Southampton. Subjects: Six female trained nurses with no recent history of hernia, back pain or pregnancy during the previous six months were recruited to use the equipment. Two female patients were chosen from those volunteering and screened for stroke, confusion and unusual footwear. The patients were able to partially weight-bear and were used to being transferred. Results: The results indicate that the critical value of 3.4 kN at the L5/S1 disc (specified by the US National Institute for Occupational Safety and Health) was not exceeded when using transferring equipment. Conclusion: In this study, loading on the spine during transferring tasks with or without equipment was not considered harmful when good technique was employed.

The occupational therapy department at a large acute hospital identified 63 manual handling risks in its practice. To facilitate the management of these risks, a 2-year ergonomic study was carried out to rationalise these risks into generic themes. A qualitative methodological approach was taken to explore the complex professional, social and cultural issues. Data were collected using observations and interviews and then analysed with the assistance of NUD*IST. This article attempts to show the process within the study as well as the findings. An explanatory display was used to communicate the researcher's interpretation to the occupational therapists, resulting in the production of the three generic themes of treatment handling, interagency communication and non-hospital property.

This is a two-part article about legal aspects of safety in two overlapping areas of work relevant to occupational therapists: disability equipment and manual handling. This first part, on safe use of equipment, considers negligence, consumer protection and health and safety at work law, including codes of practice, guidance and notices from bodies such as the Health and Safety Executive and the Medical Devices Agency. A number of common and relatively straightforward themes are picked out through what otherwise might appear to be a forbidding body of law; these are illustrated with practical examples. It is argued that in judging whether a particular action or omission was unlawful and breached safety obligations, the courts do not generally resort to incomprehensible principles. Instead, they often, in effect, simply hold up a mirror to the professional(s) involved and ask whether reasonably competent or practicable steps were taken. To the extent that this is so, it is clear that avoidance of legal liability is very much more within the power of occupational therapists and their employer organisations than is often supposed and that such avoidance is consonant both with patient and client welfare and with good professional practice.

The state of Victoria, Australia proclaimed its first Regulations and Code of Practice to address musculo-skeletal disorders (MSD) in 1988. After 10 years of implementation across industry, it has been replaced by new, revised Regulations and Code of Practice on 1st July 1999. This paper will review evaluation studies conducted as part of the evaluation of the original Australian Regulations on Manual Handling as well as the evaluation of the Draft 1999 Regulations. These studies indicated that industry was able to embrace the performance based approach to legislation relating to manual handling injuries. However, there was a distinct difference in the approach between small and large employers. The second study identified that the useability of the new Regulations and Code of Practice was influenced by the length, complexity of technical language and practical information relating to compliance provided in the Regulation and Code of Practice.

This study presents the results of an ergonomics evaluation of a patient handling aid commonly used for transferring patients. The results of the study showed that use of the patient handling aid (Medesign) increased the rate of perceived exertion at the lower back and the shoulder but did not indicate any significant difference in the muscular activity in the regions. It is suggested that users' anthropometry should be considered in designing a patient handling aid.

Concurrent verbal protocols were used to collect reports of subjects' thoughts during the completion of a manual handling task, and to investigate whether the content of these thoughts was influenced by changes in the weights and positions of the loads which were handled. A taxonomy was constructed to help in the analysis of the potential effects of weight of the load and of load position on the numbers of reports of a range of dependent variables such as posture, load, elements of the task and outcome. An association was found between load position and numbers of references to posture when handling loads of 8kg weight. This suggested that postural awareness might be heightened when more extreme postures were adopted during the handling of loads above a weight threshold. However, the references were often ambiguous, raising concerns about the subjects' depth of awareness of the postures they were adopting.

An investigation was carried out by teams from various centres coordinated by the EPM (Ergonomics of Posture and Movement) Research Unit on 54 different hospitals in various regions of northern and central Italy. The teams examined a total of 3800 health workers whose job involved manual handling of patients. Numerous meetings were held to ensure that the methods of assessing the exposure indexes and spinal impairment were identical in the various teams. The final data were processed centrally at the EPM Research Unit. Physical examination revealed that 8.4% of the workers had had at least one episode of acute low back pain in the previous 12 months: i.e., 4 times the values of the reference groups. The best association between index of exposure to manual patient handling and consequent injury was the association evaluated via the incidence rates of episodes of total low back pain.

The authors describe and propose a model for identifying the main risk factors in this type of occupational exposure: presence of disabled patients, staff engaged on manual handling of patients, working environment, aids for moving patients, training of workers. For each factor a procedure for assessment is proposed that is easily applicable in practice. The authors also propose a formula for the calculation of a exposure index (MAPO Index), which brings together the various factors. From a practical point of view, in the present state of knowledge, it can be stated that for MAPO Index values between 0 and 1.5, risk is deemed negligible, average for values between 1.51 and 5, and high for values exceeding 5.

A fundamental part of the prevention strategies aimed at reducing risk due to manual handling of patients is the use of appropriate aids. This paper defines the basic types of aids for hospital wards and also proposes a procedure for choice of the type of aid. The procedure uses a specific protocol and also analyses work organisation and the environmental features of the ward. The proposed criteria for choice concern at first place the fundamental requirements of the equipment: safety for operator and patient, simplicity of use and comfort for the patient. Secondly the basic determinants for the choice of the type of aid are the kind of disabled patient usually present in the ward, and the analysis of the movements done during patients handling.

Problems with manual handling create a significant impact on: • patients - through affecting patient safety, comfort and quality of care • nurses - through injury and adverse career prospects • Trusts - through risk assessment and litigation. It is essential that manual handling problems be addressed. This article seeks to explore these issues in the perioperative environment.

Manual handling is known to be a major contributory factor in the high level of musculoskeletal injury among health care workers. One increasingly popular way to attempt to decrease total load hand...

This article describes a qualitative study which aimed to explore the implications of the implementation of the Manual Handling Operations Regulations (MHOR) 1992 for the patient. Ten participants, where the use of a hoist was indicated in view of the MHOR 1992, were interviewed individually in their own homes. Through this method, those aspects influencing acceptance or rejection of the use of a hoist were established and the meanings of the experiences for those individuals were clarified. The results of the study have implications for practice. For some participants, the use of a hoist involved physical, social and psychological levels of response. To implement MHOR 1992 successfully, these issues must be acknowledged and addressed.

In 1896 Beatrice Webb reported that those individuals opposed to special labour laws designed to protect women employees had formed a powerful alliance. The alignment of forces making up this alliance was composed of employers, free market economists and the middle-class wing of the movement for women's emancipation. In this paper it is argued that a similar alliance is active presently in Australia. Like its 1890s counterpart, this modern Australian alliance is campaigning for the abolition of certain special laws that exist to defend women employees from excessive demands on the part of employers. The paper discusses the nature of this alliance and examines one of its more recent successes. It is concluded that industrial relations analysts have paid insufficient attention to the protective character of these laws and that this is an omission that must be remedied.

Studies have shown that twisting and lateral bending postures and motions increase the risk of low back disorders in manual handling tasks (Marras et al., 1993; Punnet et al., 1991). These motions are often associated with asymmetric lifting. Thus, it has been hypothesized that one means for controlling these motions is through carefully designing the layout of the workplace. We hypothesized that spatially separating a lift's origin and destination to encourage stepping/turning of the body during a manual transfer task would reduce these motions. At the same time, however, the added distance may increase the tendency to reach, therein increasing the amount of forward bending, increases handling time, and may increase the physiologic cost. Thus, the objective of the current study was to determine if there is a separation distance between a lift's origin and destination during the lateral transfer of boxes that minimizes the lateral bending and twisting motions on the spine while not increasing the amount of forward bending due to reaching. The study was performed by having 29 male volunteers transfer boxes between two conveyors spaced .50, .75, 1.0, 1.25, 1.50, and 1.75 meters apart. Transfers were performed using loads of 9.5 and 16.5 kg. Spine kinematic data were collected with a magnetic motion capture system. The data from the box pick up and the box placement were analyzed separately. The twisting motions associated with the box placement were significantly affected by the transport distance (p=.007). However, the twisting motion when pick up the box, while showing a trend toward less motion with a 1 meter transport distance was not significantly different across the transport distances (p=.15). The lateral bending motions, both during the box pick up and the box placement were significantly affected by the transfer distance (p

Historically, manual handling of materials has consistently accounted for over 25 pct of all industrial accidents. In underground coal mining, the situation is worse. Materials-handling accidents routinely account for 30 to 35 pct of all lost-time injuries. Research sponsored by the Bureau of Mines, U.S. Dept. of the Interior, and conducted by Essex/Canyon Research, Inc., developed and evaluated several mechanical-assist devices to reduce the manual effort and the corresponding risk of injury from handling supplies and equipment in underground coal mines. The prototype devices were supplied to cooperating coal mining companies for evaluation. On-site visits, task analyses, and interviews were used to evaluate the devices. Three of them performed exceptionally well and have shown promise for reducing the amount of manual lifting and handling required underground.

The main objective of this study was to evaluate the physiological strain imposed on individuals engaged in unloading boxes from a truck. The actual operation was performed in one of the local industries, and was videotaped and timed. This operation served as a basis for a simulation study in the authors' laboratory. Six subjects participated in this study. Since the containers utilized in the actual operation varied greatly, empirical distributions derived from the box sizes and weights handled at that industry were developed based on a sample of 466 boxes. The frequency of handling was 20 times/min. The task duration was 30 min. Heart rate and oxygen consumption were recorded every 5 min for a period of 5 min. The results showed that the task performed can be classified as very heavy work compared to industrial tasks reported in the literature. Physiological responses showed a significant increase over time.

Subjects performed a series of psychophysical lifting tasks simulating USAF aircrew maintenance activities. The tasks involved lifting while in unusual postures: lying prone, supine, sideways, and standing. Maximum acceptable weights on the tasks were then related to performance on a series of isoinertial and isometric strength tests. High correlations were obtained between lifting task and strength test performance. Prediction models developed indicated that an isoinertial 1.8 m lift and isometric one hand pull were the best predictors of task performance. The prediction models can be used in the establishment of design weights for aircrew maintenance tasks.

This study was conducted to assess physiological work load of manual handling works such as lifting and lowering plastic beverage container which have been considered to be causative for shoulder or back ache occurring in industrial fields. Energy metabolism in lifting and lowering works was closely related to the increase of handling load under given conditions. Both lifting and lowering works seemed ineffective in comparing bicycle ergometer task with higher O2-debt ratio while they showed an equivalent level in heart rate in relation to handling amount (mkp/min). The most economical working frequency with the least O2-requirement existed at around 10–15 times/min both in lifting and lowering works.

Fifteen second shift male industrial workers from local industries performed 61 variations of lifting, pushing and pulling tasks to investigate the effects of task frequency, height, distance, and box size. A psychophysical methodology was employed whereby the test subject controlled the amount of weight or force being handled. Measurements of heart rate, oxygen consumption, and body size were also taken. The results indicated that size, distance, height and frequency are significant variables to consider when establishing guidelines for maximum acceptable weights.

Manual materials handling (MMH) tasks or unaided acts of lifting, lowering, carrying, pushing, and pulling are common types of activities in industry. Design and organization of work involving manual handling of materials has been the goal of many researchers. Their attempts have resulted in information that can be objectively used in designing manual materials handling tasks. The main objectives of this paper are (1) to review and evaluate existing energy and cardiac cost prediction models for various MMH tasks, (2) to present these models in a concise fashion that can be easily accessed by designers and practitioners of MMH, and (3) to provide recommendations for future research in modeling physiological responses of individuals engaged in MMH. More emphasis is placed on information that has become available since the publication of the NIOSH guide on work practices for Manual lifting.

The following hypotheses were investigated: (1) continuous-work capacity does not decrease with increasing age, and (2) physique has a greater effect on continuous-work capacity during slower, heavier tasks than during faster, lighter tasks. Twenty-eight, healthy male subjects, 14 between 25 and 35 years of age, and 14 between 45 and 60, performed 54 manual handling tasks for a duration of 40 min. Three lifting, three lowering, four pushing, one pulling, and six carrying tasks were performed at three different rates of work. Three replications of a walking task were also performed. The continuous-work capacity of each subject for each task was measured by a psychophysical technique which required subjects to adjust their work loads to the maximum amount that they could perform without strain or discomfort, and without becoming tired, weakened, overheated, or out of breath. Heart rates were monitored continuously during task performance. The age hypothesis was tested by subjecting both work-load and heart-rate data to analyses of variance. The physique hypothesis was tested by correlating work-load data with each of 41 anthropometric measurements obtained from each subject. The results supported the age hypothesis. The physique hypothesis, however, was supported only by the results of the younger group of subjects.