SAFE LIFTING TRAINING FOR PARENTS

The purpose of this study was to determine to what extent techniques taught during a two-day educational training on body mechanics for lifting and transferring are learned and can be demonstrated by Mexican parents with their children who have a disability. Three parents of children with a disability who attended a culturally relevant educational training on body mechanics lead by graduate occupational therapy students participated in research on their transfer safety. Their body mechanics were observed and scored while they performed up to four transfers prior to and after attending the educational training. Participants performed significantly better on floor transfers after the educational training with a large effect size (d = 2.83). There was no statistically significant difference between preand post-tests for bath transfers, and the remaining transfers did not have enough participants to calculate statistical significance. This pilot study had promising results, that using a culturally relevant program, Mexican parents can learn safe transfer techniques. It is important that occupational therapists continue to educate caregivers in how to safely perform a transfer and use multiple methods including verbal instruction, demonstration and practice of real transfers, as well as take into account different cultures and adapt training to be more culturally relevant. Future research is important and could look at a larger sample of participants to see if the training is effective for the other transfer types. SAFE LIFTING TRAINING FOR PARENTS 4 Safe Lifting Training for Mexican Parents of Children with a Disability Health care workers have a high risk for sustaining on the job injuries. The tasks associated with transferring patients and lifting heavy weight repeatedly throughout the day, for a career spanning decades, creates cumulative exposure and thus compounds effects on the spine and body. The Centers for Disease Control and Prevention (CDC) reported that female workers, nursing aides, and orderlies are at higher risk of sustaining an on the job back injury than any other workers (Bell, Collins, Galinsky, & Waters, 2012). Caregivers of children with physical disabilities encounter similar high risk situations daily, but rarely if ever have time off from these activities. As the children grow, the care continues for families who cannot afford additional help or to send their child to a group home or facility outside of the home. The increased weight of the children and the continued dependency only increase the daily risk of injury caregivers face when performing activities of daily living (ADL) and transfers. Lack of training not only puts the caregiver at risk, but also the individual being transferred is at risk for falling or sustaining other injuries. If a caregiver is injured this affects the individual with a disability who relies on that person to help him/her throughout the day, thus impacting both individuals’ quality of life. Past research on ergonomics and transfer training has focused on health care workers, specifically nurses and the types of situations they face as well as efforts made to lessen the risk and time lost to work injuries. These interventions include transfer and lifting training courses, facility policies for safe handling and no-lift procedures, as well as the increased development and use of mechanical lifts including Hoyer’s or lift teams (Nelson & Baptiste, 2004). Many studies have shown that these training sessions and policies decrease the incidence of work related injuries. Unfortunately, few private caregivers have the option of using SAFE LIFTING TRAINING FOR PARENTS 5 mechanical lifts or receiving thorough training. If this training were offered to caregivers, they would be better equipped to protect themselves and their family member(s) with a disability. Background and Significance Work injuries. An interview survey conducted by the CDC (2006) revealed that more than 25% of adults in the U.S. general population experienced low back pain (LBP) in the preceding three months. LBP itself can lead to individuals missing work and not being able to participate in other activities that are important to them, including leisure, which has been linked to quality of life (Specht, King, Brown, & Foris, 2002). Due to the high prevalence of on the job injuries and LBP, considerable research has been conducted on back pain and injury prevention in the workforce. Specifically, nurses and medical personnel have been examined. Due to the increase of on the job injuries in hospitals, new lifting methods have been introduced including mechanical lifts, sliding boards, gait belts, and other transfer aids to assist with moving patients (Laflin & Aja, 1995). However, after the introduction of these new methods, injuries are still occurring (Laflin & Aja, 1995). This has led many hospitals and facilities to adopt a “no lift policy,” and “safe patient handling practices,” including mechanical lifts and multiple people lift teams. These policies require access to mechanical lifts and multiple personnel that would be used when the person being transferred needs more help than what the institution deems safe for a single person transfer. This has been effective in decreasing the number of dangerous transfers and subsequent occurrence of LBP and injuries (Nelson & Baptiste, 2004). While this is a feasible and effective implementation plan for hospitals and facilities with a budget, this is rarely a realistic option for individuals who work in the community or in their homes as caregivers. Interventions. Interventions that have been provided by work sites and other resources include return to work programs, annual hands-on at work training, provision of lift equipment, SAFE LIFTING TRAINING FOR PARENTS 6 video educational trainings, and pain management (Laflin & Aja, 1995; Lieber, Rudy, & Boston, 2000). Some of this research has included people outside the medical profession such as mothers, teenagers and other workers. McCauley (1990) taught a small number of teenagers safe lifting techniques related to on-the-job tasks. The teenagers successfully learned the techniques, and demonstrated them later on the job, when they did not know they were being observed. Another study by an occupational therapy student involved teaching body mechanics and safe lifting techniques to pregnant mothers to use with their babies, using an interactive video tutorial format to present the information and observed the mothers performing the specifics tasks using dolls (LaVilla, 1995). The women varied on the number of existing children they had and thus their experience in childrearing tasks and lifting habits. LaVilla recorded their demonstrating the learned techniques via a video, which limited proper analysis from all angles. All participants improved on lifting tasks with the doll. Thus the video tutorial appeared to be a successful method in teaching these women techniques that could be used later when they were raising their child with or without a disability. Holmes, Lam, Elkind and Pitts (2008) used a video in Spanish, demonstrations, and job related practice to teach fruit warehouse workers and students body mechanics. The students and workers both improved in post test scores and demonstrations. Groups receiving job specific practice and feedback scored significantly higher on the body mechanics evaluation, which is consistent with previous research (Holmes et al., 2008; McCauley, 1990). The results of Carlton’s (1987) research on food service workers somewhat conflicted with the previous studies in that the group that received body mechanics instruction performed significantly better on a specific task compared to the group that received no instruction; however, when performing various on-the-job tasks, there was no significant difference between SAFE LIFTING TRAINING FOR PARENTS 7 the groups. Overall, the research suggests that going through some type of education or training is better than receiving none, therefore, it would be beneficial for caregivers to receive training with the possibility that it might make their work safer. Caregivers. The permanent role of being a caregiver for a family member with an irreversible disability can cause psychological and physical distress (Glozman, 2004). In the U.S. there are over 50 million caregivers for people with disabilities and chronic illness, 16.8 million of whom provide care to children under the age of 18 with special needs (National Alliance for Caregiving & American Association of Retired Persons, 2009a; National Alliance for Caregiving & American Association of Retired Persons, 2009b). The research by the National Alliance for Caregiving and AARP was conducted using surveys, and although their results were consistent with other research, the results were all based on caregiver opinions and did not identify causes of injuries and LBP. Tong et al. (2003) reported that caregivers of children with physical disabilities have a higher prevalence of LBP and lower physical functioning than caregivers of children with a medical disability who are not physically affected, especially when performing transfers. Seventy-two percent of caregivers of children are reported to be female and are less likely to be caring for just one person (National Alliance for Caregiving & American Association of Retired Persons, 2009b). In the U.S. and Mexico, women are the primary caregivers in the home, which makes it important to consider what they can do physically when assessing burden of care and limitations when performing caregiving tasks. Women on average can tolerate only 67% of the spinal compression tolerated by men, and as they get older this strength decreases (Laflin & Aja, 1995). The average safe lifting weight reported for women is 36.4 pounds which is difficult to not exceed as a child ages and the caregiver is still required to lift most of their weight (Snook