Manual handling and back pain among health care professionals in neurological inpatient and outpatient settings: a mixed methods study.

Background: The number of patients with neurological disorders and severe disability is increasing globally. These patients often need help with positioning and the amount of support varies with their level of impairment. High rates of work-related musculoskeletal disorders are observed among healthcare professionals (HCP) with patient contact due to injuries during manual handling. There is insufficient research on manual handling by nurses and other HCP.

Objectives: The primary aim of this study was to explore manual handling strategies by HCP in neurological inpatient and outpatient settings. A secondary aim was to explore pain during and post manual handling activities.

Design: A convergent parallel mixed methods design.

Methods: A quantitative survey was combined with qualitative semi-structured telephone interviews of HCP. The inclusion criteria were licensed allied HCP with at least seven years of experience with neurological patients in inpatient and/or outpatient settings and expertise in manual handling. Exclusion criteria included insufficient proficiency in German and pre-existing illness prior to start of professional education. The survey data were analysed using descriptive statistics and interviews were evaluated through inductive-reflexive thematic analysis.

Results: Ten nurses, 10 occupational, 12 physiotherapists participated. Survey findings showed moderate time pressure, body strain, and low back and neck pain during patient transfers. HCPs spent an average of 7.3 (± 5.5) hours per week on personal endurance and strength training. They considered transfer aids moderately important and accessible, predominantly using the transfer board. Interdisciplinary collaboration in patient transfers was reported as crucial and usually available. We identified three themes from interviews: (1) individualised manual handling; (2) facilitating active patient participation during transfers; (3) maintaining personal physical fitness.

Conclusions: Neurological symptoms, patient fears, and goal setting necessitated personalised transfer strategies. Patient characteristics, lack of space and time complicated transfers, prompting HCPs to use perception-oriented techniques, leverage, gravity, and momentum.