Physical Task Demands of Caregivers Working in a Long-Term Care Facility

Providing care to residents and patients significantly contributes to work-related injuries among healthcare personnel, particularly those responsible for transferring and handling residents, who face a higher risk of injury due to the physical demands of their work and other environmental factors.

The purpose of this project is to better understand the daily work requirements, identify their physical demands, and assess injury risk of caregivers. Data will be collected using a new pen-and-paper-based ergonomic surveying tool, a series of questionnaires, and measurements of physiological demands such as heart rate and galvanic skin response.

Collecting this data will enable the investigators and others to create new interventions better tailored to this working population, with a focus on injury prevention. These interventions may include warm-up routines, stretching exercises, training programs, and/or technological advancements.

Purposes/Objectives:

The overall aim of this study is to establish a database on the physical requirements of caregivers working in long-term care homes.

This study will highlight the support needed for caregivers in long term care facilities, aiming to improve their working conditions through interventions and strategies that ensure their physical and mental well-being.

Research Questions:

The research question for this study is as follows:

1. What are the physical/musculoskeletal demands and motor movement patterns performed by caregivers in residential settings, and what does a typical workday entail for this population?
2. Is there a significant increase in perceived discomfort levels among caregivers throughout their workday?
3. What are the lifestyle habits of caregivers, and what is the prevalence and history of musculoskeletal injuries among caregivers?
4. Is there an increase in the fluctuations of their stress levels and heart rate throughout their workday?

Hypotheses:

The hypotheses for this study are as follows:

1. Caregivers spend a significant portion of their workday transferring residents or engaging in various repetitive motor tasks.
2. Caregivers experience significant increases in perceived discomfort in most areas of the body, which will be exacerbated throughout their shift.
3. There will be a correlation between lifestyle habits and injury history among caregivers.
4. Physiological stress levels will increase over the course of a caregiver's workday.

Introduction:

One of the key objectives of this study is to identify the physical demands and requirements of caregivers working in long-term care facilities. The first step involved creating an ergonomic tool tailored to the assessment of caregivers (See appendix A). This tool enables the recording of various motor tasks, behaviors and habits performed repetitively during a typical workday. Additionally, it facilitates the quantification of data to gain a better understanding of the physical demands of their work. This tool will allow investigators to determine the total time spent on specific motor tasks during a workday for this population.

In conjunction with the ergonomic tool, the investigators will administer questionnaires to gather information on lifestyle habits, work-related injury history, perceptions of job-related physical demands (using the Health and Lifestyle Questionnaire), and levels of discomfort during a workday (using the Rate of Perceived Discomfort Questionnaire (RPD-Q)). Additionally, physiological changes, such as galvanic skin response and heart rate fluctuations, will be recorded during data collection to monitor caregivers' physiological responses throughout the workday. This research approach will provide a comprehensive overview of the physical demands and injury risks amongst caregivers working in a long-term care facility. Collecting this data, will enable researchers and others in creating new interventions better tailored to this working population, such as warm-up routines, stretching exercises, training programs and/or technological advancements.

Methods:

This study employs mixed methods research, gathering both quantitative and qualitative data to comprehensively understand the issues surrounding Work Related Musculoskeletal Injuries (WRMSI) among caregivers in long-term care facilities in New Brunswick.

30 full-time caregivers from the York Care Center Nursing Home in Fredericton, Kenneth E Spencer Memorial Nursing Home in Moncton and Westford Nursing Home in Port Elgin will be recruited for this research project.

The participants will be caregivers working with residents with a level three classification. This means that the residents require constant supervision, may or may not be living with a stable chronic condition, and require assistance with personal care, sanitation, and mobility. All participants will be assessed for an 8 to 12-hour workday in a single experimental session.

The equipment used in this study includes:

1. A newly developed Pen-and-Paper based Ergonomic monitoring tool, designed by the researchers to identify the physical demands of caregivers' work, will be utilized in this study (see appendix A). The main objective of this research is to identify the different motor tasks, transfer procedures, positions and behaviors that pose risks of developing WRMSI in caregivers. The researchers will monitor and manually input each task performed by the caregivers.
2. The Rate of Perceived Discomfort Questionnaire (RPD-Q) (see appendix B) will be administered to track the progression of caregivers' discomfort during their workday. The RPD-Q is a self-reported questionnaire with a 100-point visual analogue scale that indicates the level of discomfort relative to specific body parts. A scale of point 0 corresponds to no discomfort and point 100 represents the worst discomfort imaginable; each point is the equivalent of one millimeter. Twenty-four different body parts will be measured in the RPD questionnaire on both the right and left sides of the body. The RPD questionnaire will be administered 3 times throughout the shift: Prior to the start of the shift, at the midpoint, and at the end of the caregiver's workday. Recording the RPD questionnaire at these specific timepoints will provide a snapshot on how discomfort levels develop throughout a typical working shift.
3. A questionnaire on lifestyle habits and work-related injury history (see appendix C) will be administered during data collection to gain insights into current lifestyle and previous workplace injury history of participants. The questionnaire is composed of short-answer, multiple-choice and open-ended questions that can be used as a journal during data collection. The H\&L questionnaire will be filled out once during the workday of data collection. The objective of this questionnaire is to further understand the relationship between current lifestyle of the workers and the development of workplace injuries. The questionnaire is divided into three different subsections:

   * The amount of time spent in sedentary behavior, the amount of physical activity performed, and the amount of alcohol and tobacco consumed by participants in a typical week.
   * The number of years of experience in the sector, and participants' subjective perception of the physical demands imposed by their work.
   * The occurrence or non-occurrence of persistent work-related musculoskeletal injuries or discomfort, and the limitations these injuries impose on individuals' ability to work and their overall well-being.
4. Physiological Measures: An Empatica EmbracePlus watch, a galvanic skin response system, will be used to assess and quantify the participants' stress levels throughout their workday. Additionally, the Polar H10 heart rate monitor will enable the observation of caregivers' heart rate fluctuations during their workday. Data collection will follow a baseline measurement of participants heart rate and stress level, which will be taken after 5 minutes in a seated position, in a quiet area and with eyes closed prior to the start of their shift. Field notes will also be taken to facilitate the identification of the periods of the day when physiological stress levels are highest during data collection.

Statistical Analysis/Data Processing:

Descriptive Statistics:

Descriptive statistics using the software IMB SPSS, Version 29 (mean, median, standard deviation, etc.) will be used to evaluate quantitative values derived from the newly developed ergonomic tool.

Cross Correlations:

A series of cross correlations will be run on the Health and Lifestyle Questionnaire to identify correlations between different Work-Related Musculoskeletal Injury (WRMSI) risk factors. The correlation coefficient will enable the investigators to identify whether the relationships are inversely proportional or directly proportional. For example, it will be possible to examine the correlation between physical activity levels and WRMSI history, as well as whether there is a relationship between increases in smoking and alcohol consumption and WRMSI.

Repeated Measures ANOVA:

A Repeated Measure ANOVA will be used to interpret the results obtained from the RPD-Q. The data will be compared at three different time points: the beginning, middle and end of the caregiver's shift. During analysis, it will be possible to observe whether there has been a significant increase in perceived discomfort during the workday and which areas of the body experienced the most significant increase. Prior to running the repeated measures ANOVA, each data point will be plotted to observe if it is normally distributed. Mauchly's test will be used to assess the sphericity assumption. If the sphericity assumption is violated, the Greenhouse-Geisser correction will be used. The alpha level will be set at p \< .05, and if any significant interactions are found, Tukey and Bonferroni post hoc analyses will be used.

The same approach will be used for the physiological outcome measures: heart rate monitor and the galvanic skin response system. Repeated Measures ANOVA will be utilized to compare the data collected at the beginning, middle and end of the caregiver's shift. The outcome measure will be to quantify whether stress levels and fluctuations of heart rate increased throughout the workday. If any significance is found, a Tukey and Bonferroni correction will be applied.

Qualitative Results:

A qualitative approach will be used to synthesize information gathered from the workers through the use of field notes. This will include documenting the circumstances surrounding their previous injuries and other relevant details.

Eligibility Criteria:
Inclusion Criteria:

* Full-time caregivers
* Caregivers responsible for the care and handling of residents
* Aged 19 or over

Exclusion Criteria:

* Part-time caregivers
* Caregivers not responsible for residents care and handling
* Caregivers under 19 years of age