A three-dimensional movement analysis of the lumbar spine during lifting of patients from chair to bed

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A three-dimensional movement analysis of the lumbar spine during lifting of patients from chair to bed

 

Author: Poon, Yee-hung
Title: A three-dimensional movement analysis of the lumbar spine during lifting of patients from chair to bed
Degree: M.Sc.
Year: 1997
Subject: Lumbar vertebrae -- Movements
Spine -- Mechanical properties
Lifting and carrying -- Physiological aspects
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Pages: xi, 115 leaves : ill. ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1410559
URI: http://theses.lib.polyu.edu.hk/handle/200/752
Abstract: Low back disorder was found to be associated with industrial work resulting in high compensation and medical cost. Health care workers were found at a high risk from occupational low back injury. The national accident statistics in Denmark showed that 45% of the injured workers were of 5% - 14% of permanent disability. Lifting and transferring of patients were the most frequent precipitating factors or causes of low back disorders. The problem of lifting and transferring of patient was not simply overcoming a heavy weight. Firstly, extreme care was required in handling the patient. Secondly, some patients were unpredictable, uncooperative or with severe contractures. Therefore, the recommended safety guidelines on industrial lifting might not be applicable in health care settings. Many studies had been conducted to evaluate the postural and biomechanical stress to the lumbar spine during transferring patients. However, the adjustability of bed and chair, the types of patients to be lifted and the confined workspaces would influence the recommendation of these studies. Therefore, the objective of this study was to investigate the effects of bed height and bed/chair configurations on the risk of low back injury. Dynamic trunk motion characteristics had been identified and utilized for quantifying the risk on the lumbar spine. Trunk kinematics included the maximum extreme positions and maximum velocities in three anatomical planes during transferring patient from sitting in chair to long sitting in bed with patient's leg unsupported on the ground. The effects of bed height and angle of approach of chair to the bed on the trunk kinematics were also evaluated. This study was a 2 x 2 factorial design. Combinations of two commonly used bed/chair configuration (0o and 30o) and two bed heights (45 cm and 65 cm) were investigated. An electromagnetic device, Flock of Birds (Ascension Technology Corporation), was used to monitor the trunk motion in the three planes of movement. The results of the study showed that the lumbar spine was in a flexed and right side bent posture during both the lifting and lowering phases of the transferring task. The major movement of the lumbar spine during the lifting and lowering phases was in the sagittal plane. The lumbar spine was in a more flexed posture or in a narrower range of flexion during the lifting phase for the low bed condition with p<0.05 when compared with the high bed condition. The lumbar spine was in a more flexed and right side bent posture during the lowering phase for the low bed condition (p<0.05) when compared with the high bed condition. The ranges of motion in flexion and right side bending were found to be higher during the lowering phase for the low bed condition (p<0.05). The maximum velocity in axial rotation to the right was also higher in the high bed condition and with the bed/chair configuration at 30o during the lowering phase. There was evidence that the risk of low back disorders would be higher when lifting a patient from a chair to low bed owing to the more flexed posture under the low bed condition. Therefore, lifting patient during the transferring task was not recommended in the low bed condition. Lowering patient onto different bed heights with the bed/chair configuration at 30o was also not recommended as the risk of the low back disorders might be higher at the bed/chair configuration at 30o owing to the higher angular velocity in axial rotation to the right at this position. Controversial findings were noted for determining whether the risk of low back disorders was higher in the low bed or high bed conditions during the lowering phase. The risk of low back disorders would be higher when lowering patient from a chair to a low bed with regard to the trunk motion in both the sagittal and coronal planes. The risk of low back injury was found to be higher when lowering a patient from a chair to a high bed when the angular velocity of the lumbar spine in the axial rotation was taken into account. The effect of bed height and angle of approach on the risk of low back disorders should be further investigated. Future researches on the effects of environmental constraints in health care settings, professional background and the level of dependence of patients, on the dynamic trunk motion characteristics and load on the lumbar spine were also recommended.

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