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Journal of Occupational & Environmental Medicine:
doi: 10.1097/JOM.0b013e3182a3bb5c
Letters to the Editor

Response: Safe Lifting

Gucer, Patricia W. PhD; Restrepo, Tanya MBA; Shuford, Harry PhD; McDiarmid, Melissa MD, MPH, DABT

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Occupational Health Program, University of Maryland School of Medicine Baltimore, Md

National Council on Compensation Insurance, Inc Boca Raton, Fla

National Council on Compensation Insurance, Inc Boca Raton, Fla

Occupational Health Program, University of Maryland School of Medicine Baltimore, Md

The authors declare no conflicts of interest.

To the Editor:

Lift-related musculoskeletal disorders among caregivers in long-term care facilities were the subject of our reports. Therefore, we focused our literature search on studies that spoke directly to this population. These studies examined the impact of safe lifting programs and powered mechanical lift use on caregiver injuries. Cohort studies of caregiver injury and cost outcomes found that a comprehensive safe lifting program in the context of adequate numbers of lifts reduced injuries and costs (see, eg, Refs.1–3). A cross-sectional study found that the provision of powered mechanical lifts reduced caregiver injuries and costs but training had equivocal impact.4

Given the specificities of our interest, our literature review did not include the excellent Cochrane review on back pain,5 authored by Verbeek and colleagues, because it included a broad range of industries and examined diverse training programs with a wide range of assistive devices available to workers. It also excluded studies that bore directly on our area of interest (see Refs. 1 to 4) if they did not meet the Cochrane review's criteria for inclusion (randomized controlled trials or cohort studies with contemporary controls).

Verbeek et al5 found specific training actions alone or with assistive devices to be ineffective in reducing back pain. We found that a comprehensive safe lifting program did reduce lift-related injuries. Although our results stand in contrast to the Cochrane review findings, these are consistent with the findings of other safe lift intervention studies referenced earlier.

Our differences may be due to the potentially material difference in the outcome variables—back pain versus something that results in a workers' compensation claim. It has been reported that over time lower back pain affects almost a third of the US population, that the cause of most pain due to lower back issues cannot be clearly identified, and that most “correct” on their own in a matter of a few weeks although they are likely to reoccur.6,7 Also, our outcome variables were limited to lift-related injuries. This increases our chances of finding an effect of efforts specifically targeted to reduce lift-related injuries.

Finally, our differences in findings may be because our predictor was a comprehensive measure of safe lifting, while the Cochran review included studies that measured different training actions. A multifactorial approach rather than a focus solely on training may be necessary to effect change. In our Safe Lift Index, we include not only measures of caregiver training but also assessment of the degree to which the facility considers safe lifting (ie, use of powered mechanical lifts) to be important and reinforces its use. Our Safe Lift Index was designed to assess the comprehensiveness of the safe lift policy. We think that the more comprehensive and the less piecemeal is the policy, the better its chance to succeed, at least in the specific setting of long-term care that we studied.

Patricia W. Gucer, PhD

Occupational Health Program, University

of Maryland School of Medicine

Baltimore, Md

Tanya Restrepo, MBA

National Council on Compensation

Insurance, Inc

Boca Raton, Fla

Harry Shuford, PhD

National Council on Compensation

Insurance, Inc

Boca Raton, Fla

Melissa McDiarmid, MD, MPH, DABT

Occupational Health Program, University

of Maryland School of Medicine

Baltimore, Md

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REFERENCES

1. Collins J, Wolf L, Bell J, Evanoff B. An evaluation of a “best practices” musculoskeletal injury prevention program in nursing homes. Inj Prev. 2004;10:206–211.

2. Evanoff B, Wolf L, Aton E, Canos J, Collins J. Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace. Am J Ind Med. 2003;44:451–457.

3. Brophy MO, Achimore L, Moore-Dawson J. Reducing incidence of low-back injuries reduces cost. AIHAJ. 2001;62:508–511.

4. Park RM, Bushnell PT, Bailer AJ, Collins JW, Stayner LT. Impact of publicly sponsored interventions on musculoskeletal injury claims in nursing homes. Am J Ind Med. 2009;52:683–697.

5. Verbeek JH, Martimo KP, Karppinen J, Kuijer PPFM, Viikari-Juntura E, Takela Takela P. Manual material handling advice and assistive devices for preventing and treating back pain in workers (review). Prepared and maintained by The Cochrane Collaboration and Published in The Cochrane Library. Available at: http://www.thecochraneo8brary.com. Accessed June 6, 2011.

6. Carey et al, NEJM 1995 and Wahlgren et al. Pain 1997 as summarized by Nina McIltree. Paper presented at Fifth Annual WC Customer Forum on “The Spine,” Zurich Service Corp, March 25.

7. “Prescription Drugs: Abuse and Addiction,” National Institute of Drug Abuse (NIDA) Research Report, October 2011.

Copyright © 2013 by the American College of Occupational and Environmental Medicine

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