Introduction

Currently, the most common occupational diseases include damage to the musculoskeletal system (MSs). They are characterized by frequent repetition of the same work movements with demands on movement coordination and sensory control. This involves long-term work performed at a forced work pace with excessive static load, unilateral overloading of limbs in forced work positions (Tureková, 2015). Healthcare is a sector with a high risk of musculoskeletal system damage. The causes of damage may be related to ignorance, lack of skill, or their combination in the prevention of ergonomic risks. This fact was pointed out by Lukáč (2019), who describes that healthcare workers have deficits in knowledge and skills in the area of ergonomics and kinetics. Nurses lack skills in using support devices that eliminate excessive physical load and possible damage to MSs. The author agreed with the views of several experts and states that healthcare workers have problems using the principle of leverage, friction, and inertia when caring for patients. Deficits in this segment of work are highlighted by Lajdová, Botíková, Tomíková (2020). They state that 60 % of nurses rate their profession as physically demanding. Paradoxically, the results of their survey showed that nurses do not use knowledge of ergonomics when handling patients. According to Gómez-Galán, Péres-Alonso, Carreo-Felle et al. (2017), MSs are considered the most common health problems among workers in the European Union. The Finnish Institute of Occupational Health (FIOH) considers MSs the most common work-related disease, emphasizing that the back is exposed to the greatest risk of damage. Prevention of MSs includes work analysis and identification of risk factors. Modern methods of assessing postural stability dysfunction determine the need for early preventive interventions. One of the methods for rapid assessment of overall body posture during work is the Rapid Entire Body Assessment (REBA) method. It takes into account the load on the entire body when handling a load. The methodology consists of a comprehensive assessment of body posture (work positions), which is divided into two groups A and B (Hlávková, Valečková, 2007). Body posture scoring is illustrated in Table 1 and Table 2.

Table 1 Score of work positions – group A (Source: Lukáč, 2019)

Table 2 Score of work positions – group B (Source: Lukáč, 2019)

The REBA method is considered a tool of ergonomic analysis for biomechanical and postural load of individual body parts. The total REBA score indicates the ergonomic risk of MSs and the urgency of corrective interventions.

Aim

To conduct a rapid assessment of postural stability dysfunction in selected interventions of healthcare workers using the REBA method. To identify the risk of damage and the need for interventions to eliminate the risk of MSs.

Sample and methodology

The object of the assessment was 4 persons. Two nurses providing standard nursing care in a geriatric department and two paramedics from an emergency medical service crew. We used the method of direct observation during patient handling. We assessed postural stability and potential damage to MSs using the REBA method in nurses during three interventions.

  • transferring a patient from a transport bed to a bed in the room
  • transferring a patient from a bed to a transport stretcher
  • turning a patient in bed when changing bed linen.

In paramedics, we assessed postural stability during comparable interventions:

  • transferring a patient from the ground to a bed
  • transferring a patient from a bed to a transport stretcher
  • transferring a patient from a bed to a transport chair.

The methodology of scoring body posture – work positions is illustrated in Table 1 and Table 2.

Results and discussion

Table 3 REBA score in nurses

Analysis of postural activity showed a high ergonomic risk score in two interventions: transferring a patient from a transport bed to a bed in the room (8-10) and turning a patient in bed when changing bed linen. The REBA results demonstrate the need to take preventive measures in terms of postural stability education as soon as possible. The REBA score was very high when transferring a patient from a bed to a transport stretcher, signaling a high risk of MSs damage. The risk score (10-15) requires immediate interventions to eliminate the risk of MSs damage.

Table 4 REBA score in paramedics

The results of the assessment of postural activity of paramedics in three selected interventions (Table 4) achieved a very high score (10-15). This finding evokes the need to adopt operational measures in work ergonomics. We note a worse result and higher risk of MSs damage in paramedics compared to nurses. The results of the assessment of the three most common interventions demonstrated the existence of ergonomic risk and the need to adopt measures to reduce the risk of health damage. It is possible to agree with Matoušek (2011), who states that lifting, pushing, pulling, carrying or moving loads carries with it a risk of health damage. Attention to ergonomic risks during patient handling was drawn by Jong, Bos (2014). They consider the most frequently occurring risks to be lifting, pushing, unnatural postures, repeated postures, prolonged standing and sitting. They see the causes in insufficient professional training and poor ergonomic design. According to the published outputs of the European Agency for Safety and Health at Work (OSHA, 2007), manual handling of loads, absence of postural stability as an ergonomic risk, can cause cumulative MSs disorders manifesting as pain especially in the lumbar region. In healthcare, we assign high priority to the knowledge and application of ergonomic principles. The goal should be to minimize the impact of cumulative factors that can have a negative impact on physical health. We find consistency between our results and the opinion of Popaďáková, Rimárová, Kaňuková (2023). They describe that objective assessment of postural stability dysfunctions by available methods is a valid evaluation of the presence of ergonomic risk factors. The assessment results warn that the worker is at risk of developing imbalance of the musculoskeletal system and therefore musculoskeletal damage becomes an immediate reality. Within prevention, we accept the opinion of Valkovič (2012). He states that quality prevention of damage consists in the use of cognitive movement strategies. Their essence is conscious thinking about every movement, which allows avoiding the performance of several activities at once. Such a movement strategy can be fixed in motor memory.

Conclusion

Addressing the issue of musculoskeletal system damage using available methods requires a multidisciplinary approach. We propose the introduction of a comprehensive risk prevention system, the application of suitable methods, and the establishment of good practice in occupational health and safety. We consider the implementation of ergonomic principles and postural control as a procedure for identifying ergonomic risks. Their analysis, implementation of solutions, and subsequent evaluation of the effectiveness of adopted measures can significantly reduce the number of MSs.

Author: prof. PhDr. Mária Kilíková, PhD., MPH

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