An exploration of movement and handling by physiotherapists in a rehabilitation setting: a motion analysis study.

Johnson, Katharine Sarah

Abstract

Work-related musculoskeletal disorders (WRMSD) affect between 56-80% of physiotherapists, with patient handling often reported as a risk factor. Physiotherapists use therapeutic handling to aid patient rehabilitation. Therapeutic handling involves the physiotherapist "guiding, facilitating, manipulating or providing resistance" to the patient. Therapeutic handling can subject physiotherapists to high loading forces during patient handling. The aims of this doctoral thesis were to quantify physiotherapists' movement during therapeutic patient handling tasks, assess risk of injury against a frequently used ergonomic tool, and investigate whether there may be a relationship between patient handling and WRMSD. This research employed a descriptive cross-sectional study design and a positivistic approach to explore and quantitatively measure physiotherapist movement. A portable three-dimensional motion analysis system, Xsens MTw Awinda, was used to measure physiotherapist movement during patient treatments in a neurological setting. The physiotherapists' movement and posture were quantified, described and assessed using the Rapid Upper Limb Assessment (RULA) tool. The incidence and personal impact of WRMSD were investigated with the extended Nordic Musculoskeletal Questionnaire (NMQ-E) and potential patient tasks of risk were discussed. The physiotherapists used four main positions during patient handling tasks: 1) kneeling; 2) half-kneeling; 3) standing; and 4) sitting. Eight patient handling tasks were identified: 1) lie-to-sit; 2) sit-to-lie; 3) sit-to-stand; 4) upper limb; 5) lower limb; 6) trunk; 7) standing; and 8) walking facilitation. Kneeling or sitting positions were used by the physiotherapists most often during lie-to-sit, sit-to-lie, sit-to-stand, upper limb, trunk and standing facilitation tasks. Standing was the most common physiotherapist position during lower limb and walking tasks. Kneeling, half-kneeling and sitting positions demonstrated greater neck extension, which scored highly with the RULA and indicated potential risk of injury. Standing demonstrated more cervicothoracic flexion than kneeling and sitting, which demonstrated greater lumbosacral flexion than standing. The physiotherapists' hips and knees often maintained end-range flexion when kneeling or half-kneeling, which is discouraged in ergonomics literature. The low back was the most frequent anatomical area of WRMSD, with 60% of the physiotherapists having experienced discomfort there within their career. Physiotherapists were found to temporarily have changed jobs, sought professional help or taken medication for their shoulder, elbow or low back discomfort. However, none of the physiotherapists had taken sick leave in the last twelve months. This research found that tasks were more often performed in kneeling or sitting positions than in standing. Moving and handling guidance considers the handler in a standing position; guidance should therefore start to consider the handler in the variety of positions found in clinical practice. Ergonomic assessments, such as the RULA, consider the trunk as one joint. This research investigated three trunk joints, with different postures found at the cervicothoracic and lumbosacral junctions. Future research should appreciate how the position of the handler can impact trunk posture. More research needs to be conducted to qualitatively investigate physiotherapists' perceptions and experiences of patient handling. This research has provided a detailed exploration into therapeutic handling the neurological setting which can be used to guide future research.

Citation

JOHNSON, K.S. 2023. An exploration of movement and handling by physiotherapists in a rehabilitation setting: a motion analysis study. Robert Gordon University, DPT thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-2071667

• Thesis Type: Thesis
• Deposit Date: Sep 5, 2023
• Publicly Available Date: Sep 5, 2023
• DOI: https://doi.org/10.48526/rgu-wt-2071667
• Keywords: Work-related musculoskeletal disorders; Physiotherapists; Manual handling; Ergonomics; Occupational therapy
• Public URL: https://rgu-repository.worktribe.com/output/2071667
• Award Date: May 31, 2023