Journal of Occupational & Environmental Medicine:
Letters to the Editor
Safe Lifting and Apparently Conflicting Evidence: Increase Understanding for Making Progress in Prevention of Musculoskeletal Disorders
Kuijer, P. Paul F. M. PhD; Verbeek, Jos H. MD, PhD
Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Finnish Institute of Occupational Health, Kuopio, Finland
The authors declare no conflicts of interest.
To the Editor:
We would like to compliment Restrepo1 and Gucer2 and their colleagues on taking up the challenge of evaluating the use of safe lifting practices, including the use of mechanical lifts both from the perspective of the caregivers and the residents. This is of major importance because we seem to make slow progress in preventing musculoskeletal disorders in health care staff and that is not for a want of trying.3 One important reason for this slow progress might be that we rely too much on the implementation of seemingly effective interventions. Both authors state firmly in their articles that evidence is available that the use of powered mechanical lifts prevent the onset of work-related musculoskeletal disorders or in their own words, “Several intervention studies have since shown that using mechanical lifts to assist frail patients clearly decreased worker injury from MSDs [musculoskeletal disorders]”1 and “Evidence linking the use of powered mechanical lifting in LTC [long-term care] facilities to reduced caregiver injuries has been accumulating,”2 referring to primary scientific articles and general reports. In contrast to this statement about effectiveness, a Cochrane Review article that was recently updated concluded that manual material handling advice and training with or without assistive devices does not prevent back pain or back pain–related disability when compared with no intervention or alternative interventions.4,5 There is neither evidence available from randomized controlled trials nor controlled prospective studies for the effectiveness of manual material handling advice and training or manual material handling assistive devices for treating back pain. Remarkably, this review is not discussed nor referenced in the two articles.1,2 Given this apparently conflicting evidence, we would like to invite both authors to address why, in their opinion, the present intervention of safe lifting practices, including the use of mechanical lifts, differs from the interventions discussed in the Cochrane Review. In this way, we can learn and increase our understanding of why some interventions work and others do not.
P. Paul F.M. Kuijer, PhD
Coronel Institute of Occupational Health,
Netherlands Center for Occupational
Diseases, Academic Medical Center,
University of Amsterdam, Amsterdam, the
Jos H. Verbeek, MD, PhD
Finnish Institute of Occupational Health,
1. Restrepo TE, Schmid FA, Gucer PW, Shuford HL, Shyong CJ, McDiarmid MA. Safe lifting programs at long-term care facilities and their impact on workers' compensation costs. J Occup Environ Med. 2013;55:27–35.
2. Gucer PW, Gaitens J, Oliver M, McDiarmid MA. Sit–stand powered mechanical lifts in long-term care and resident quality indicators. J Occup Environ Med. 2013;55:36–44.
3. Wells R. Sounding board: why have we not solved the MSD problem? Work. 2009;34:117–121.
4. Verbeek JH, Martimo KP, Karppinen J, Kuijer PP, Viikari-Juntura E, Takala EP. Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database Syst Rev. 2011;15:CD005958.
5. Martimo KP, Verbeek J, Karppinen J, et al. Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database Syst Rev. 2007;18:CD005958.
Copyright © 2013 by the American College of Occupational and Environmental Medicine