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Physical therapists slow to adopt lifts
PTs under-report, work through pain
For many years, "body mechanics" was the mantra of physical therapy. Position yourself correctly as you lift and you can avoid injury, the physical therapists said.
Physical therapists suffered injuries under that philosophy, many of them hidden by underreporting. As patients became heavier and more chronically ill, the risk grew. Today, that burden has been acknowledged and physical therapists are becoming proponents of safe patient handling as a way to protect health care workers while rehabilitating patients.
"They were embarrassed," says Kenneth J. Harwood, PT, PhD, CIE, vice president of practice and education at the American Physical Therapy Association in Alexandria, VA, explaining why physical therapists often failed to report their patient handling injuries. "You were considered the 'go-to' person to prevent injuries, so you were less likely to report an injury. They were doing self-treatments and working injured."
Prevalence studies reveal the risk of injury. "Over half the therapists are experiencing work-related pain each year," says researcher Marc Campo, PT, PhD, OCS, associate professor in the physical therapy program at Mercy College in Dobbs Ferry, NY.
In one study, Campo and colleagues found that therapists who transferred patients six to 10 times a day were 2.4 times more likely to develop low-back injuries than those therapists who did not perform transfers. 1
Many of those physical therapists continued to work through pain. In focus groups, physical therapists who suffer from work-related pain said they altered treatment plans or avoided some activities because of their pain. They worried that they would not be able to continue in their careers.2
But Campo says he is detecting a shift in attitude, especially among younger therapists. APTA also is actively promoting safe patient handling. "In some of the studies we're doing now, we're finding that therapists believe in safe patient handling," says Campo. "There's a belief among some that it may actually improve the [patient] outcomes."
APTA is developing an online course that will teach physical therapists how to integrate safe patient handling programs into their practice.
Pain leads to safer patient handling
Leslie Pickett, PT, now an ergonomics and injury prevention specialist at Swedish Medical Center in Seattle, suffered an injury just nine months after she became a physical therapist. She was working with a stroke patient and was transferring her to a chair when suddenly the patient became rigid and threw herself backward.
The sudden movement jolted Pickett forward, and she felt a surge of pain in her back. The incident caused Pickett to have a herniated disc with radicular pain and numbness in her leg.
"It was very hard on me because I was so new and I felt really embarrassed. I'm supposed to be the expert in moving people. How could this happen to me?" she recalls. "There's a lot of shame, pressure to feel that you have to come back to work right away."
Despite the pain, she returned to work within 10 days. She continued working, even though she wasn't fully healed. She relied on an old Hoyer lift for patient transfers. "I would use that whenever I could," she says.
The experience made Pickett an early proponent of safe patient handling. When the Washington state legislature passed a law in 2006 requiring hospitals to adopt a safe patient handling program, Pickett headed the committee at Swedish Medical Center and helped draft the hospital's policy.
At first, the physical therapists were skeptical about the use of lift devices. After all, their focus was on rehabilitation and sometimes the devices added unaccustomed steps to the process. Pickett pointed out that the equipment could be used to help move a patient from a bed to a chair, where the therapist could then work on the rehabilitation. Or a sling could provide security or support to prevent a fall while a patient ambulated and the therapist assisted or evaluated, she says.
Pickett worked to overcome skeptics, explaining how the equipment could be used as part of the therapeutic process. "They're just very caring folks. They're sacrificing their bodies when they shouldn't be," she says. "I'm trying to get them to think more about their goals. If you integrate it as part of your therapy, then it makes a difference."
Use a team approach to create program
Integrating safe patient handling into physical therapy requires a comprehensive approach, says Harwood. Nurses, therapists, and physicians can work together with the support of employee health to conduct patient assessments, select appropriate equipment, and implement a program, he says.
"The best success is where there was a collaborative team approach in implementing these programs," he says.
If equipment is being used as part of the therapeutic program, it needs to enable patients to move in a more normal (but safe) fashion, Harwood says. Further research and collaboration between physical therapy and manufacturers could lead to better devices, he says.
Ceiling lifts with adjustable slings already provide new possibilities for therapy, he says. "It allows the therapist to observe the movement in a non constrained way," he says. "You're getting better eye and manual contact. Your facilitation techniques may be better."
Meanwhile, Campo and other researchers are continuing to explore the attitudes of physical therapists and their readiness to change. "In some studies we're doing now, we're finding that the therapists who believe in safe patient handling and use the equipment believe their outcomes are actually improved," he says.
The key is to increase the number of physical therapists who adopt safe patient handling. "I'm not going to tell you it's easy," says Pickett. "It takes a lot of culture change with therapists. But I think there are quite a few who are starting to buy-in.
"The trick is to have that happen before they injure themselves," she says. "Everyone's an advocate after they injure themselves."
1. Campo M, Weiser S, Koenig KL, Nordin M. Work-related musculoskeletal disorders in physical therapists: a prospective cohort study with 1-year follow-up. Physical Therapy 2008; 88:608–619.
2. Campo M and Darragh AR. Impact of work-related pain on physical therapists and occupational therapists. Physical Therapy 2010. Available online at http://ptjournal.apta.org/cgi/content/abstract/ptj.20090092v1.