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BACKGROUND: Neck discomfort and pronounced neck flexion have been associated with smartphone use. OBJECTIVE: Eye glasses with a 90 deg prism in each lens were investigated as a potential intervention to reduce awkward head and neck postures during activities involving viewing the device. METHODS: Sixteen smartphone users with neck pain and 9 asymptomatic users performed a texting task on a smartphone with and without the prism glasses, in sitting and standing postures in a laboratory setting. RESULTS: Cervical erector spinae and upper trapezius muscle activity, head posture and motion, performance, discomfort and other subjective perceptions were assessed. Prism glasses reduced neck extensor muscle activity, neck flexion, and head tilt compared to the direct view. In the symptomatic group, the intervention produced less neck and shoulder discomfort compared to the direct view. CONCLUSIONS: This intervention could offer an alternative way of interacting with a smartphone while texting in stationary postures, by reducing exposure to pronounced flexed neck and head posture commonly seen in users, and thereby could reduce neck discomfort associated with smartphone use.

BACKGROUND: Veterinarians appear to be at risk for work-related musculoskeletal discomfort (MSD), based on surveys conducted outside the US. OBJECTIVE: This study provides new information about MSD prevalence in veterinarians and veterinary technicians in the US. METHODS: Cross-sectional survey and observation. RESULTS: A survey of 56 veterinarians and 38 veterinary technicians in Ohio found 12-month prevalence of MSD exceeded 60% in the neck, low back, and legs/feet. More than 85% of participants reported that work activities exacerbated discomfort in at least one region. Less than one-third of participants reported symptom-related lost work time. Personal and work-related burnout scores were higher for veterinary technicians, compared with veterinarians. Nine percent of observed work activities performed by veterinarians and 43% performed by veterinary technicians were rated high or very high risk. CONCLUSIONS: High prevalence of MSD and low lost work time suggest many individuals are working in pain. Increased adoption of existing ergonomics solutions (equipment and process changes), in addition to further investigation of unmet needs, could improve working conditions and reduce musculoskeletal stress in veterinary health professions.

Introduction The development of pressure ulcers during aeromedical transport of combat casualties is an issue that continues to exist, especially during long transport flights. This study investigated the potential for a new intervention, an air-inflated insulating mattress pad (IMP) that has a pump system designed to alternate the pressurization of air cells under the patient, thus temporally shifting the pressure concentration locations. Materials and Methods In a repeated measures design study, 12 participants experienced the following four simulated transport conditions, each for 90 minutes: (1) The North Atlantic Treaty Organization (NATO) litter by itself (control condition), (2) the NATO litter covered with the standard mattress pad (Warrior Evacuation Pad), (3) the NATO litter covered with the air-inflated mattress (IMP), and (4) the NATO litter, covered with the standard mattress pad that was covered by the insulating mattress pad. Peak pressure readings were obtained every 15 seconds under the head, torso, pelvis, legs, and heels. Results While both mattress pads significantly reduced the peak pressures relative to the litter-only condition, the new IMP with the alternating cell pressurizations, by itself or in combination with the standard mattress pad, further reduced the peak pressures under the regions with the localized highest pressures, namely the head, pelvis, and heels. Moreover, the IMP with alternating pressure introduced the most variability in the peak pressure readings, which reduces the peak pressure exposure periods for specific tissue locations. Conclusions The IMP with alternating cell pressurizations could further reduce the likelihood of pressure injuries during aeromedical transport of combat casualties.

Previous biomechanics studies suggest that higher cognitive mental workload when performing office computer tasks may increase the risk of MSDs among office workers. Cognitive workload can be interpreted in terms of task factors (e.g. task complexity and time pressure) and mental workload factors which include mental demand and mental effort. A laboratory study was conducted to further explore how the task and mental workload factors affected computer users' biomechanical responses, specifically the muscle activation levels and sitting postures. Data were collected as 20 participants worked on computer tasks which varied in their levels of task complexity and time pressure. Visual analog scales were used for assessing mental workload factors. Results indicated that the level of mental effort reported, as opposed to the level of task complexity, was associated with changes in participants' biomechanical responses, but primarily occurred when the chair's backrest was not used.

Home healthcare workers (HHWs) are routinely exposed to occupational safety hazards when servicing patients in their homes that put them at risk for injury. These hazards can be broadly classified as "electric, fire and burn," "environmental," or "slip, trip, and lift" hazards. To better train HHWs regarding their potential exposure to these hazards, a home healthcare virtual simulation training system (HH-VSTS) was developed. The HH-VSTS contains three training modules, corresponding to the aforementioned hazard categories, and an assessment module. In each training module, the trainee must navigate the virtual space, via a mouse click, and identify items or conditions that represent hazards. Once an item has been clicked on, the HH-VSTS asks the user if the item or condition is a hazard. For items or conditions that are hazards, additional text boxes present material to the user as to why the item constitutes a hazard and potential remediation approaches. Thus, it is important that hazards be identified and clicked on for the trainee to receive the educational component of the training system. This article evaluated the ability of 49 HHWs to find hazards in each of the three categories. In all modules, participants found the most salient hazards (e.g., clutter on stairs, unattended candles, biohazard stains) but struggled to find some of the less salient hazards. Several less salient hazards included the pet food bowls in the path of travel, the frayed electrical cord, oxygen tube leaking into a mattress, hot water that was too hot, and elevated room temperatures. Overall, this analysis found that most of the hazards within the training modules could be found by naïve HH-VSTS users. These data suggest the need for including hints that guide users toward hazards with which they are less familiar.

The use of stair descent devices is an important part of a comprehensive emergency evacuation plan. To date, there is little research on consumer opinion of these devices. A pilot study was performed at a local center for independent living, enabling 14 consumers with mobility impairments to state their initial impressions of 14 devices, representing three general designs: carry-type, track-type, and sled-type. Consumers were able to view the devices, ask questions, and view short videos of the devices in use. Afterwards, consumers were given the opportunity to try out one or more of the devices, and provide their opinion after each trial run. Consumers provided feedback on specific design features, how they anticipated they would feel about using each, and whether they considered each device acceptable for use. Trial use enabled more in-depth opinions, and in some cases, a change in opinion on acceptability.

Conductive or convective heat loss is a serious concern in combat casualties that are an enhanced risk of hypothermia due to shock and environmental exposures. Eleven subjects participated in repeated measures study designed to assess whether alternative hypothermia prevention systems can retain body temperatures better in a cold environment than the currently fielded solution. Results showed that when the subjects were using the new Xtract Heatsaver System there was significantly less change in the body’s core temperature and less thermal discomfort as compared with the currently field Hypothermia Prevention and Mitigation Kit.

Lower extremity musculoskeletal discomfort (MSD) is prevalent, but understudied, in nurses. A comprehensive, theoretical, aetiological model of lower extremity work-related MSD in hospital in-patient staff nurses was developed through a review of the literature to provide a framework for aetiological and intervention research. The framework informed the design of a survey of 502 hospital staff nurses. Symptom prevalence ranged from 32% in hip/thigh to 59% in ankle/foot regions. Logistic regression modelling using survey data showed that different work and personal factors were associated with discomfort in different regions of the lower extremity. Individual factors (e.g. older age, higher BMI or having any foot condition), physical factors (e.g. higher frequency of patient handling), psychosocial factors (e.g. lower job satisfaction) were associated with discomfort in one or more parts of the lower extremity. Future research should target these factors for intervention, to attempt to reduce occurrence of lower extremity discomfort in nurses. Practitioner Summary: Practitioners may find useful the illustrated, theoretical aetiological model of factors that could influence the prevalence of lower extremity discomfort in nurses. The model could guide conversations with nurses and observational analyses of nursing work. The model and survey results may provide ideas for intervention exploration. Abbreviations: MSD: musculoskeletal discomfort; BMI: body mass index; MSK: musculoskeletal; ICU: intensive care unit; NLERF: nurses' lower extremity MSD risk factor; NASA-TLX: NASA-task load index.

For more than two decades, surveys of imaging technologists have consistently reported high prevalence of work-related musculoskeletal discomfort (WRMSD). Yet, workplace intervention research involving sonographers is limited. In this study, a transdisciplinary team of researchers used a participatory approach to work with diagnostic medical sonographers (DMS) and vascular technologists (VT) to identify needs and opportunities for developing new approaches to work that will reduce sonographers’ exposures to WRMSD risk factors. In this paper, we describe the approach and the resulting identified needs. We also describe the prototyping and testing of two work approaches that target specific needs of DMS and VT, respectively. We would like designers, manufacturers, engineers, and ergonomists, in collaboration with sonographers and their managers, to recognize this area of opportunity and come together to apply their knowledge of biomechanics and design in developing useful and usable workplace interventions (solutions) to reduce sonographers’ WRMSD risk factor exposure.

Objective: To identify family members’ and visitors’ needs with relation to the design of a hospital room. Background: There is a trend toward incorporating family zones in hospital patient rooms in order to improve patient satisfaction and encourage family caregivers to stay longer and overnight. Method: A mixed-method study was employed. Interviews of patients and family caregivers were conducted to understand opportunities to improve hospital room designs based on recent experiences. Features intended to support short-term and overnight visitors were embedded in five full-scale simulated room design concepts. Small groups of family caregivers and patients toured two room design concepts and reacted real time to room features. A grounded theory approach was employed to identify emerging themes. Results: A theoretical design framework is developed for the needs of family members and visitors for a range of time periods. This framework is founded upon desires to help make the patient feel more comfortable. There are various levels of helping the patient feel more comfortable, including visiting, keeping company, providing support, providing assistance, and being a caregiver. Beyond this core need, family members and visitors must take care of their own needs in order to feel comfortable in the hospital room. Activities associated with these needs include sitting, relaxing, eating, working, tending to daily needs, and resting overnight. Conclusions: Potential implications for architects, healthcare planners, and interior space designers are described. Design and renovation guidance for the hospital room environment in order to support the needs and expectations of families and visitors is provided.

Firefighters and EMS providers continue to be challenged when lifting heavy patients in their homes. This study investigated the biomechanical efficacy of four devices that could be used by two-person teams when lifting patients from the floor, from a reclining chair, or from a Simulated Inflatable Seat at chair height. Fourteen firefighter-paramedics, working in two-person teams, were instrumented with motion capture and electromyographic sensors. The Binder LiftTM and the Simple Strap were used to lift patient actors, and were compared to current lifting methods. Postural data and the peak dynamic spine shear forces at the L5/S1 level were reduced when using the Simple Strap, the Binder Lift, and the Simulated Inflatable Seat. In summary, each of these devices has been shown to have biomechanical support for their use by EMS providers.

Prior research has found that office workers may not be fully utilizing their chair's back support. This may be due in part to cognitive demands or other psychological stressors. Not using the back support may increase the muscle tension and contribute to muscle fatigue and discomfort. Historically, footrests have been advocated to address anthropometric disparities in office settings. In this laboratory study, it was hypothesized that a footrest may facilitate the use of the backrest and mediate the biomechanical demands on the back and neck muscles, especially when cognitive workload is elevated. Twenty participants performed computer tasks, which varied in their complexity levels, both with and without an angled footrest. Using a footrest increased workers' use of a chair's backrest, increased pelvic rotation towards the backrest, and had a corresponding change in spine flexion. However, no changes were found in the sampled electromyographic activities due to the footrest.

Many warehouse slotting algorithms have overlooked worker ergonomics. This research aimed to develop ergonomics slotting guidelines based upon the back and shoulder postures and electromyographic (EMG) responses of the deltoid and erector spinae muscles when individual items are picked from, or full cases replenished to, different shelf heights In the first study of two studies, participants lifted small items representative of piece-pick tasks from seven shelf heights. In the second study, participants performed a simulated full case replenishment task in which they lifted boxes weighing between 2.7 and 10.9 kg from a cart into a flow rack. Shelf height significantly affected all postural and EMG variables and there was a trade-off between back and shoulder muscle activity across the varying shelf heights. Together, these studies were used to develop some general ergonomic slotting guidelines that could be implemented to reduce biomechanical load exposures experienced by distribution center workers.

Our aim is to enhance the safety and efficiency of all healthcare staff by designing patient rooms that meet the physical and cognitive needs of those providing direct and indirect patient care in hospital settings. A mixed-methods study was employed, where findings were compiled from twenty-six environmental services personnel across study activities. The insights were grouped into six categories of challenges with the design of hospital rooms in acute care settings: room cleaning, bathroom, room size, furniture, communication, and a miscellaneous ‘other’ category. There are design implications for storage, room design features, locations of room items, and fabrics and finishes.

Home healthcare workers are exposed to numerous safety hazards within client homes. A virtual simulation training system has been developed to train home healthcare workers to recognize and remediate these hazards where possible. This paper investigates how well study participants could identify lift, slip, and trip hazards within the client’s home in the virtual simulation training system.

The prevalence of musculoskeletal (MSK) symptoms in radiographers is high, similar to other healthcare occupations that involve high levels of physical exertion (e.g. patient handling; grasping and moving equipment). Reports of interventions to reduce MSK discomfort in radiographers are limited. A participatory approach was used to investigate daily challenges, needs, and opportunities for developing interventions to address exposures to many of the risk factors that contribute to MSK symptoms in radiographers. In this paper, we present the expressed needs of experienced radiographers (including assistance with patient handling, security, supportive design of equipment and work spaces), along with their evaluations of several intervention concepts intended to address some of those needs. We also report results from tests of three prototype interventions stemming from this participatory process that demonstrate the potential for new engineering control concepts to reduce the physical effort associated with some of the most common tasks radiographers perform.

Objectives: This research investigated medical/surgical (Med/Surg) patient room design to accommodate the needs of hospital staff, while at the same time accommodating the needs of patients and their visitors. Background: Designing hospital patient rooms that provide a comfortable healing experience for patients, while at the same time meeting the needs of the hospital staff, is a challenging process. Prior research has shown that many hospital patient room designs adversely affect the ability of hospital staff to perform their tasks effectively, efficiently, and safely. Method: Twenty-seven design sessions were conducted in which 104 participants, representing 24 different occupations, worked in small mixed occupational groups to design an ideal single patient Med/Surg patient room to fit their collective needs using a full-scale mock-up. During analysis, the investigators reduced the resulting 27 room designs to 5 hybrid designs that were sequentially reviewed by patients and visitors and by staff to address design conflicts. Results: This design process identified 51 desirable room design features that were incorporated into 66 evidence-based design guidelines for the different areas within the Med/Surg patient room including the entry way (16 guidelines), the patient clinical area (22 guidelines), the bathroom (17 guidelines), the family area (8 guidelines), and storage areas for patients and their visitors (3 guidelines). Conclusions: The guidelines developed through this study identified many opportunities for improving the design of hospital Med/Surg rooms to allow staff to be more effective, efficient, and safer, while at the same time addressing the design needs of patients and their visitors.

Patient handling related musculoskeletal injuries are prevalent among Emergency Medical Service (EMS) providers. The first step in many patient handling situations is where a supine patient on the floor is brought to a sitting position. This study investigated whether a strap, placed under the patient's torso and long enough that EMS providers can perform the patient raising task in a standing posture, reduced muscular effort. Fifteen participants raised a simulated patient, with the help of an assistant, using the strap method and a traditional method (grasping the shoulders) in an open area, a restricted space, and in a bathtub. Torso postures improved in all location conditions when using the strap. The muscle activation data showed mixed results. While EMG responses from the latissimus dorsi muscles were reduced, EMG activity of the erector spinae muscles increased when the strap was used. Perceived effort assessments supported the use of the strap.

Manual patient handling tasks put formal and informal caregivers at risk of musculoskeletal injury. Intervention research to reduce risks to informal caregivers is limited. This study examined effects of slide sheet use when individual informal caregivers performed patient boosting and turning tasks. Three methods of slide sheet use and a baseline method (no slide sheet) were compared, to reposition a 70 kg individual. Muscle activity, ground reaction force, posture, and rating of perceived exertion were significantly affected by task method. Erector Spinae activity was reduced in boosting and turning away tasks with the slide sheet. Shoulder elevation, torso angle, and normalized vertical ground reaction force were also reduced with the slide sheet during boosting. The turn towards task was generally not improved with the slide sheet. Overall, using a slide sheet provided biomechanical benefits to individual caregivers performing two common patient handling tasks: boosting and turning patient away from caregiver.

Many retail distribution centers (DCs) manually load and unload boxes into or out of trailers and shipping containers. This study investigated whether an articulating belt conveyor with a height adjustable platform, positioned at the end of an extendable conveyor, significantly reduces shoulder and back muscle loading and the spine kinematics associated with these tasks. Electromyographic and kinematic data were collected from eight volunteer employees as trailers at a shoe DC were unloaded and from nine volunteer employees as trailers at an apparel DC were loaded. Participants in this repeated measures study handled boxes with a conventional powered extendable conveyor system and with the articulating belt conveyor positioned at the end of the extendable conveyor. Bilaterally the normalized activation levels of the erector spinae and anterior deltoid muscles were reduced when loading and unloading boxes with the articulating belt conveyor. Spine movement speeds were also reduced with the articulating conveyor.

Increasing interest in acuity-adaptable patient rooms, performing more services in patient rooms, and the increasing size of the population all have implications for the patient room as a workspace, including the number of people working in the room, types of tasks performed, and amount and layout of the space in which tasks are performed. This presentation describes an analysis of the opinions of professionals who typically control the design of hospital patient rooms, concerning five med/surg patient room designs developed through a participatory process involving mixed groups of hospital staff members, all of whom work in patient rooms. Ratings and comments provided by the design professionals identified clear preferences for one of the designs, as well as rooms and design elements for which there were more mixed or negative opinions. It is important for architects and designers to understand how room size, layout, and organization of features can be used to facilitate work for the full spectrum of hospital staff members who work in patient rooms. Such facilitation can reduce physical strain and improve efficiency and patient care.

The biomechanical loading on the lumbar spine was assessed as 12 female nurses applied and removed slings under two patients of differing weights (54 and 100 kg), using two work methods, and while working at three bed heights (56, 71, 93 cm). Three-dimensional spine loads at the L2/L3, L3/L4, L4/L5 and L5/S1 disc levels were measured using a validated EMG-assisted biomechanical model. Anterior/posterior (A/P) shear loading at the L5/S1 level consistently exceeded the tolerance threshold limit for disc failure. The peak compression values exceeded the 3400 N tolerance threshold for several participants when placing the sling under the 100-kg patient. In general, working from both sides of the bed generated slightly higher A/P shear loading than the one-sided method. Raising the bed significantly decreased compression and A/P shear forces. Therefore, raising the bed to at least the nurse's knuckle height is recommended when applying and removing patient slings. Practitioners Summary: We investigated the spine loading associated with placing and removing slings used for the mechanised lifting of patients. Peak compression and anterior shear forces exceeded recognised thresholds when placing slings underneath heavier patients. Raising the bed to at least knuckle level helps mitigate these spinal loads.

Mammographers are an understudied group of health care workers, yet the prevalence of musculoskeletal (MSK) symptoms in mammographers appears to be elevated, similar to many occupations in health care. In this study, we used a participatory approach to identify needs and opportunities for developing interventions to reduce mammographers' exposures to risk factors that lead to the development of MSK symptoms. In this paper, we present a number of those needs and several intervention concepts along with evaluations of those concepts from experienced mammographers. We include findings from a preliminary field test of a novel intervention concept to reduce the need to adopt awkward postures while positioning patients for a screening or diagnostic mammogram. Practitioner Summary: This paper discusses needs, opportunities and methods for working with mammographers in order to develop interventions to reduce their exposure to risk factors for work-related musculoskeletal discomfort. Results from a field test of a novel intervention to reduce mammographers' awkward work postures while positioning patients are presented.

Skilled drummers performed a 4:3:2 polyrhythm with 2 hands and 1 foot. For each pair of limbs patterns of temporal covariation were used to infer relatively independent parallel streams versus integrated timing relationships. Parallel timing was more prevalent between hand and foot than between the 2 hands, and parallel timing generally increased with tapping rate. Different combinations of integrated and parallel timing were found among the 3 limbs. A second experiment used a wider range of tapping rates and explored 3:2 tapping with 2 hands, 2 feet, or hand and foot. The latter 2 limb pairs resulted in greater prevalence of parallel timing. These results can be interpreted in terms of a Gestalt principle of grouping known as Korte's Third Law, which can be extended from the perceptual domain to the perceptual-motor domain. This principle indicates that perceived velocity is a key factor in determining whether a sequence of events is represented as a single integrated pattern or as multiple parallel patterns. The present results put disparate previous findings on bimanual polyrhythmic tapping and rhythmic aspects of the golf swing under a common theoretical perspective. (PsycINFO Database Record

The number of personnel providing in-home health care services is increasing substantially. The unique configuration of environmental hazards in individual client homes has a significant impact on the safety and health of home health care providers (HHPs). This mixed-methods study used data from a standardized questionnaire, focus groups, and individual interviews to explore environmental health and safety hazards encountered by HHPs in client homes. The participant sample ( N = 68) included nurses, aides, therapists, and owners/managers from a variety of geographic locations. The most often-reported hazards were trip/slip/lift hazards, biohazards, and hazards from poor air quality, allergens, pests and rodents, and fire and burns. Frequency of identified key hazards varied by room, that is, kitchen (e.g., throw rugs, water on floor), bathroom (e.g., tight spaces for client handling), bedroom (e.g., bed too low), living room (e.g., animal waste), and hallway (e.g., clutter). Findings indicate the need for broader training to enable HHPs to identify and address hazards they encounter in client homes.

Objective: The aim of this study was to learn from a wide range of hospital staff members about how the design of the patient room in which they work adversely affects their ergonomics or hinders their job performance. Background: In addition to providing a healing space for patients, hospital patient rooms need to serve as functional workplaces for the people who provide clinical care, to clean, or to maintain room functions. Therefore, from a design perspective, it is important to understand the needs of all the users of hospital patient rooms with regard to room design. Method: One hundred forty-seven people, representing 23 different occupational stakeholder groups, participated in either focus groups or interviews in which they were asked to identify room design issues that affect the performance of their work tasks. Results: Key issues shared across multiple stakeholder groups included an inability to have eye contact with the patient when entering the room, inadequate space around the bed for the equipment used by stakeholders, the physical demands experienced as stakeholders move furnishings to accomplish their activities or access equipment, and a lack of available horizontal surfaces. Unique issues were also identified for a number of stakeholder groups. Conclusions: There are a number of issues that should be addressed in the next generation of hospital patient rooms, or when refurbishing existing facilities, so that all occupational stakeholder groups can work effectively, efficiently, and without undue physical stress.

Many individuals work in jobs that require them to spend much of their day walking. There is evidence to suggest that shoe insoles may reduce the lower extremity discomfort for these workers. This study compared the effects of static and dynamic shoe insoles on lower extremity forces when walking at different speeds. Tibial acceleration (a.k.a. tibial shock) was assessed bilaterally in 30 participants who walked in both athletic shoes and work boots without any additional insole, with additional static insoles, and with additional dynamic insoles. The participants walked a prescribed course at a "slow", "normal", and "fast" pace. With both shoe types, there were significant reductions in tibial shock values when insoles were used. With the work boots, the dynamic insole further reduced tibial shock relative to the static insole. The significant interactions show that the differences between insole conditions become greater with faster walking speeds.

Objectives: To identify patient needs and expectations that can be utilized to inform the design or renovation of medical–surgical patient rooms in a hospital. Background: There is an increased interest in supportive room design to increase patient satisfaction and improve the healing process. Methods: Patients’ and family caregivers’ reactions were elicited to intentional room elements embedded in a set of five full-scale simulated room prototypes. Small groups of patients and caregivers toured two of the five rooms and provided verbal and written evaluations of room features. A grounded theory approach was employed to generate a codebook, identify the frequency of codes, and to group codes and memos into emerging themes. Insights from emergent themes were compared with findings from written surveys on the importance of various room design elements completed at the beginning of each session. Results: A theoretical design framework was generated, showing patients expect a hospital room that provides them with the core components of comfort to support healing, facilitates a strong sense of connection to people and the outside world, enables quick and independent access to the patient’s things, and offers suitable levels of control to the patient throughout their hospital stay. Conclusions: The implications for assisting architects, healthcare planners, and interior space designers are described using this framework, as well as its potential for design guidance. In addition, the connection between patient-centered room elements and relevant survey questions in publicly reported patient satisfaction scores for hospitals is discussed.

Firefighters and EMS providers continue to be challenged when lifting heavy patients in their homes. This study investigated the biomechanical efficacy of four devices that could be used by two-person teams when lifting patients from the floor, from a reclining chair, or from a Simulated Inflatable Seat at chair height. Fourteen firefighter-paramedics, working in two-person teams, were instrumented with motion capture and electromyographic sensors. The Binder Lift™, the Simple Strap, and the Slip Preventer were used to lift patient actors, and were compared to current lifting methods. Postural data and the peak dynamic spine shear forces at the L5/S1 level were reduced when using the Simple Strap, the Binder Lift, and the Simulated Inflatable Seat. The Slip Preventer reduced spine flexion when the Binder Lift was not used. In summary, the tested devices can potentially reduce the biomechanical loads experienced by EMS providers as they lift and move patients.

Ceiling lifts have been implemented in skilled nursing facilities to reduce the physical demands associated with patient-handling activities. However, despite the apparent ergonomic advantages of using such interventions, multiple studies have reported the reluctance of health care professionals to use the provided ceiling lifts. This study investigated factors that affect the adoption of ceiling lift interventions and considered a process that involves individuals progressing through multiple stages of change that ultimately lead to an intervention’s use. Eighteen participants from three nursing homes, who have had opportunity to use ceiling lifts, completed a survey and were interviewed afterwards. Four physically demanding tasks where ceiling lifts would benefit the healthcare provider were examined with regard to their adoption stages and the factors that affect their use. The findings show that for obviously physically demanding tasks, most participants fully adopt the use of a ceiling lift. However, when using a ceiling lift leads to a decrease in work efficiency or could result in adverse effects, a participant’s tolerance of physical demands increases beyond recommended levels and results in the use of compromised lift methods.

Infection control is of central importance when designing hospital rooms, particularly to reduce hospital-acquired infections. Existing room design standards include private rooms, toilets, and showers, ample space between a patient’s bed and a family member’s bed, and separate spaces for clean and dirty nursing activities. We investigated various hospital room factors that make it challenging for staff to reduce hospital-acquired infections. Focus groups and interviews were conducted with multiple stakeholder groups as part of a larger research effort to generate guidelines for hospital room design. Transcripts were generated for eight of these stakeholder groups, including housekeeping staff, and qualitatively analyzed for emerging themes. The insights suggest additional areas for consideration during the design of hospital rooms, in particular the need for standardized, dedicated locations for supplies brought into the patient room and inclusion of the perspective of housekeeping staff in the design process.

The physical demands on firefighting personnel were investigated when using different types of hand-carried stair descent devices designed for the emergency evacuation of high rise buildings as a function of staircase width and evacuation urgency. Twelve firefighters used three hand-carried stair descent devices during simulated urgent and non-urgent evacuations. The devices were evaluated under three staircase width conditions (0.91, 1.12, and 1.32 m). For comparison, an urgent manual carry was also performed on the 1.12 m wide stairs. Dependent measures included electromyographic (EMG) data, heart rates, Borg Scale ratings, task durations and descent velocities. Results indicated that the stair chair with extended front handles, which allows the front person to descend the stairs facing forward, reduced the time integrated back muscle EMG by half and showed a descent velocity that was 1.8 times faster than the other stair descent devices in the study. There were no differences across staircase widths.

This study investigated the effects of a prolonged repetitive asymmetric lifting task on behavioural adaptations during repetitive lifting activity, measures of tissue oxygenation and spine kinematics. Seventeen volunteers repeatedly lifted a box, normalised to 15% of the participant's maximum lifting strength, at the rate of 10 lifts/min for a period of 60 min. The lifts originated in front of the participants at ankle level and terminated on their left side at waist level. Overall, perceived workload increased during the repetitive lifting task. Erector spinae oxygenation levels, assessed using near-infrared spectroscopy, decreased significantly over time. Behavioural changes observed during the repetitive lifting task included increases in the amount of forward bending, the extension velocity and the lateral bending velocity, and a reduced lateral bending moment on the spine. These changes, with the exception of the reduced lateral bending moment, are associated with increased risk of low back disorder.

Patient-handling tasks are integral to Emergency Medical Service (EMS) work as are the musculoskeletal injuries associated with these tasks. The aim of this study was to develop and test a structural equation model that describes the interactions between previously identified factors that contribute to the adoption of a specific ergonomics intervention designed for EMS work. EMS responders (n = 187), from six different organisations, participated in a 2-month longitudinal study following the introduction of a foldable patient transfer-board (slide-board) designed to assist with lateral patient transfers. Surveys administered at baseline, after 1 month and after 2 months sampled factors potentially influencing EMS responders' adoption decisions. Perceived ergonomics advantage, which was influenced by access and storage concerns and prior tool experience, contributed most strongly to intention to use at the end of the first month and to the emergence of champions, which contributed to the intention to use at the end of the second month.

Flooring surfaces can be made from concrete, bar grate, composite materials, or may be covered with matting material. Anecdotal data suggested that surfaces made from wood composite materials may be a more comfortable surface on which to work. The objective of this study was to quantify differences in tibial shock as 16 people walked on concrete, bar grate, a wood composite material, and a concrete surface covered with matting. An accelerometer was attached to the right shin of volunteers who were asked to walk on each surface. Significant differences across the four surfaces were observed when each participant walked at their normal walking speed (p=.041) and when they walked at a faster than normal pace (p=.023). These findings suggest that individuals working in distribution centers, where extensive walking is part of the job, would possibly experience less lower extremity discomfort on selected floor surfaces.

Mezzanine surfaces can be made from concrete, bar grate, or composite materials. Anecdotal data indicate that mezzanines in distribution centers made from composite materials, due to their increased compliance, may be a more comfortable working surface. Prior research suggested that a measure of tibial shock, peak tibial acceleration, could potentially discriminate the biomechanical differences between these surfaces. The objective of this study was to quantify differences in tibial accelerations as 27 people walked on mezzanines constructed from concrete and a wood composite material. Accelerometers were attached bilaterally to the shins of volunteers, and data were collected as they walked 30.5 m on each surface at their normal walking speed, a faster-than-normal walking speed, and a slower-than-normal walking speed. Peak acceleration values obtained from the leg with the highest values were compared. On average, the peak acceleration values were 5% higher on the concrete mezzanine as compared with the wood composite mezzanine (p = .036). These findings suggest that individuals working on mezzanines in distribution centers constructed from composite surfaces would potentially experience less discomfort associated with long exposure periods on these surfaces.

An experiment was conducted in order to examine the effect of differences in the design of two powered ambulance cots on operators. Experienced EMS workers performed two common tasks, loading and unloading the cots from a simulated ambulance bed. Dependent measures included muscle activity (trunk, shoulder, and arm muscles) and subjective perceptions. Independent variables were cot (Cot R and Cot Y), and weight on the cot (100, 150, and 200 lbs., to simulate patients of different weights). Muscle activity was found to be significantly lower when using Cot R, for both tasks, in comparison to Cot Y. Subjective preferences were mixed, with many subjects preferring the handle design of Cot Y, while preferring Cot R overall. This study showed that it is possible to substantially reduce the physical stress imposed on operators when loading and unloading a cot to and from an ambulance through improvements in cot design.

The study investigated the participation experiences of elderly women with hand limitations in a maketools-inspired activity for improving bottle openability and verified the usefulness of the results from this approach. Participatory design was used to stimulate participants' hands-on fabrication of new bottle lid concepts. Air-dry modeling clay, Crayola Model Magic® (Crayola LLC, 1100 Church Lane Easton, PA 18044-0431), clay modeling tools sets and empty bottles were the tools used to explore feasible and user-envisioned ideal lids that could potentially reduce hand pain and improve function when opening bottles. Twenty-five elderly women fully participated in the study. They generated 36 bottle lid design concepts. Qualitative analysis identified inclusion of four primary design features as follows: 1) surface texture; 2) increased leverage through lid shape or diameters; 3) increased contact surface with palm/fingers through lid shape or height; and 4) facilitation of alternative grip types. The major limitations of the study were inclusion of only women participants and healthier persons living in a retirement community. Future research is needed to investigate the bottle lid preferences of men and persons with more severe hand function living in places other than independent living communities.

Effects of ambulance cot design features (handle design and leg folding mechanism) were evaluated. Experienced ambulance workers performed tasks simulating loading and unloading a cot to and from an ambulance, and a cot raising task. Muscle activity, ratings of perceived exertion, and performance style were significantly affected by cot condition (p 0.05). Erector Spinae activity was significantly less when using Cot-2's stretcher-style handles. Shoulder muscle activity was significantly less when using Cot-2's loop handle. During loading and unloading, operators allowed the cot to support its own weight most often with Cot-2's stretcher-style handles. Preference for Cot-2 (either handles) over Cot-1 (with loop handle) was consistent across tasks. Handle effects were influenced by operator stature; taller participants received more benefit from Cot-2's stretcher-style handles; shoulder muscles' demands were greater for shorter participants due to handle location. Providing handle options and automatic leg folding/unfolding operation can reduce cot operator's effort and physical strain. Practitioner Summary: Paramedics frequently incur musculoskeletal injuries associated with patient-handling tasks. A controlled experiment was conducted to assess effects of ambulance cot design features on physical stress of operators, as seen through muscle activity and operator's perceptions. Differences between cots were found, signalling that intentional design can reduce operator's physical stress.