Does the use of small aids during patient handling activities lead to a decreased occurrence of musculoskeletal complaints and diseases? A systematic review

  • A. FreibergEmail author
  • U. Euler
  • M. Girbig
  • A. Nienhaus
  • S. Freitag
  • A. Seidler



Patient handling increases the risk of musculoskeletal complaints and diseases among healthcare workers. Thus, the use of small aids for patient handling is recommended. Small aids are non-electrical and handy assistive devices that support caregivers during patient handling. To date, there is no evidence about the clinical efficacy of small aids. Hence, the objective of this systematic review was to systematically analyze whether the use of small aids during patient handling leads to a decreased occurrence of musculoskeletal disorders.


A systematic literature search was carried out. The review process was done independently by two reviewers. Methodology was assessed with the “Downs and Black checklist” and the “Risk of Bias tool.” Quality of evidence was determined with the GRADE method.


One randomized and two non-randomized trials were included. Three comparisons of intervention assessing the lumbar spine and shoulder joint were investigated. A statistically significant improvement of the 7-day prevalence of low back pain and shoulder pain was achieved within the intervention group over time of questionable clinical importance in a study with comparisons made between small aids and usual practice or mechanical aids. No comparison between the intervention group and control group at follow-up was made. Each trial showed an insufficient methodology and a high risk of bias. Quality of evidence was low for disability scores and very low for pain outcomes.


To date, there is no convincing evidence (from low-quality studies) for the preventability of musculoskeletal complaints and diseases by the use of small aids. The literature also lacks evidence for the opposite. Generalizability of the study results is further debatable due to the different populations and settings that were investigated. Robust, high-quality intervention studies are necessary to clarify the clinical efficacy of small aids in healthcare work.

PROSPERO registry number



Ergonomics Small aids Healthcare worker Musculoskeletal Systematic review 


Author contribution

All authors were involved in acquisition of data; analysis and interpretation of data; drafting the article or revising the paper for important intellectual content; and approved the final version to be published. AF, UE, MG, and AS were involved in study concept and design.


This study was funded by the German Social Accident Insurance Institution for the Health and Welfare Services (BGW).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Alperovitch-Najenson D, Treger I, Kalichman L (2014) Physical therapists versus nurses in a rehabilitation hospital: comparing prevalence of work-related musculoskeletal complaints and working conditions. Arch Environ Occup Health 69:33–39. doi: 10.1080/19338244.2012.719555 CrossRefGoogle Scholar
  2. Altman DG, Bland JM (1995) Absence of evidence is not evidence of absence. BMJ 311:485CrossRefGoogle Scholar
  3. Atkins D et al (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490. doi: 10.1136/bmj.328.7454.1490 CrossRefGoogle Scholar
  4. Atkins D et al (2005) Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system. BMC Health Serv Res 5:25CrossRefGoogle Scholar
  5. BGW (2013) Starker Rücken. Ganzheitlich vorbeugen, gesund im Beruf bleiben. Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), HamburgGoogle Scholar
  6. Bolm-Audorff U et al (2007) Relationship between manual materials handling and lumbar chondrosis—results of the German Spine Study. Zbl Arbeitsmed 57:304–316CrossRefGoogle Scholar
  7. Campo M, Weiser S, Koenig KL, Nordin M (2008) Work-related musculoskeletal disorders in physical therapists: a prospective cohort study with 1-year follow-up. Phys Ther 88:608–619. doi: 10.2522/ptj.20070127 CrossRefGoogle Scholar
  8. Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46. doi: 10.1177/001316446002000104 CrossRefGoogle Scholar
  9. Dawson AP, McLennan SN, Schiller SD, Jull GA, Hodges PW, Stewart S (2007) Interventions to prevent back pain and back injury in nurses: a systematic review. Occup Environ Med 64:642–650. doi: 10.1136/oem.2006.030643 CrossRefGoogle Scholar
  10. Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52:377–384CrossRefGoogle Scholar
  11. Elford W, Straker L, Strauss G (2000) Patient handling with and without slings: an analysis of the risk of injury to the lumbar spine. Appl Ergon 31:185–200CrossRefGoogle Scholar
  12. Engkvist I-L (2008) Back injuries among nurses—a comparison of the accident processes after a 10-year follow-up. Safety Sci 46:291–301. doi: 10.1016/j.ssci.2007.06.001 CrossRefGoogle Scholar
  13. Engkvist I-L, Hjelm EW, Hagberg M (2000) Patient transfers and the preventive effects for over-exertion back injury of training and use of transfer devices among nursing personnel. In: Proceedings of the human factors and ergonomics society annual meeting, California, Santa Monica, 30 July–4 August 2000, vol 30, pp 5-427–5-429. doi: 10.1177/154193120004403007
  14. Euler U, Wegewitz UE, Schmitt J, Adams J, van Dijk Jaap L, Seidler A (2013) Interventions to support return-to-work for patients with coronary heart disease. doi: 10.1002/14651858.CD010748
  15. Freiberg A, Euler U, Girbig M, Nienhaus A, Freitag S, Seidler A (2014) Does the usage of small aids during patient handling activities lead to a decreased occurrence of complaints and diseases in the region of the lumbar spine, the cervical spine and the shoulder joints? A systematic review. PROSPERO: CRD42014009767.
  16. GUV (2007) Sicheres Arbeiten in der häuslichen Pflege—Kleine Hilfsmittel. Bundesverband der Unfallkassen, MünchenGoogle Scholar
  17. Hartvigsen J, Lauritzen S, Lings S, Lauritzen T (2005) Intensive education combined with low tech ergonomic intervention does not prevent low back pain in nurses. Occup Environ Med 62:13–17. doi: 10.1136/oem.2003.010843 CrossRefGoogle Scholar
  18. Higgins JPT, Green S (eds) (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration.
  19. Hignett S (2003) Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review. Occup Environ Med 60:E6CrossRefGoogle Scholar
  20. Hignett S, Crumpton E, Ruszala S, Alexander P, Fray M, Fletcher B (2003) Evidence-based patient handling: tasks, equipment, and interventions. Routledge, New YorkGoogle Scholar
  21. Hofmann F, Stossel U, Michaelis M, Nubling M, Siegel A (2002) Low back pain and lumbago-sciatica in nurses and a reference group of clerks: results of a comparative prevalence study in Germany. Int Arch Occup Environ Health 75:484–490. doi: 10.1007/s00420-002-0332-6 CrossRefGoogle Scholar
  22. Jager M, Jordan C, Theilmeier A, Wortmann N, Kuhn S, Nienhaus A, Luttmann A (2013) Lumbar-load analysis of manual patient-handling activities for biomechanical overload prevention among healthcare workers. Ann Occup Hyg 57:528–544. doi: 10.1093/annhyg/mes088 CrossRefGoogle Scholar
  23. June KJ, Cho SH (2011) Low back pain and work-related factors among nurses in intensive care units. J Clin Nurs 20:479–487. doi: 10.1111/j.1365-2702.2010.03210.x CrossRefGoogle Scholar
  24. Karahan A, Kav S, Abbasoglu A, Dogan N (2009) Low back pain: prevalence and associated risk factors among hospital staff. J Adv Nurs 65:516–524. doi: 10.1111/j.1365-2648.2008.04905.x CrossRefGoogle Scholar
  25. Koppelaar E, Knibbe JJ, Miedema HS, Burdorf A (2013) The influence of individual and organisational factors on nurses’ behaviour to use lifting devices in healthcare. Appl Ergon 44:532–537. doi: 10.1016/j.apergo.2012.11.005 CrossRefGoogle Scholar
  26. Kuijer PP et al (2014) An evidence-based multidisciplinary practice guideline to reduce the workload due to lifting for preventing work-related low back pain. Ann Occup Environ Med 26:16CrossRefGoogle Scholar
  27. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(264–269):W264CrossRefGoogle Scholar
  28. Muto S, Muto T, Seo A, Yoshida T, Taoda K, Watanabe M (2008) Effect of nursing assistance tools on preventing musculoskeletal pain among staff in schools for disabled children. J Occup Health 50:245–250CrossRefGoogle Scholar
  29. Rice MS, Dusseau JM, Miller BK (2011) A questionnaire of musculoskeletal injuries associated with manual patient lifting in occupational therapy practitioners in the state of ohio. Occup Ther Health Care 25:95–107. doi: 10.3109/07380577.2011.566308 CrossRefGoogle Scholar
  30. Schneider S, Lipinski S, Schiltenwolf M (2006) Occupations associated with a high risk of self-reported back pain: representative outcomes of a back pain prevalence study in the Federal Republic of Germany. Eur Spine J 15:821–833. doi: 10.1007/s00586-005-1015-2 CrossRefGoogle Scholar
  31. Seidler A et al (2001) The role of cumulative physical work load in lumbar spine disease: risk factors for lumbar osteochondrosis and spondylosis associated with chronic complaints. Occup Environ Med 58:735–746CrossRefGoogle Scholar
  32. Seidler A et al (2003) Occupational risk factors for symptomatic lumbar disc herniation; a case-control study. Occup Environ Med 60:821–830CrossRefGoogle Scholar
  33. Seidler A et al (2007) Relationship between the cumulative spinal load due to materials handling and lumbar disc herniation—results of the German Spine Study. Zbl Arbeitsmed 57:290–303. doi: 10.1007/bf03349131 CrossRefGoogle Scholar
  34. Seidler A et al (2009) Cumulative occupational lumbar load and lumbar disc disease—results of a German multi-center case-control study (EPILIFT). BMC Musculoskelet Disord 10:48CrossRefGoogle Scholar
  35. Seidler A et al (2011) Physical workload and accelerated occurrence of lumbar spine diseases: risk and rate advancement periods in a German multicenter case-control study. Scand J Work Environ Health 37:30–36CrossRefGoogle Scholar
  36. Simon M, Tackenberg P, Nienhaus A, Estryn-Behar M, Conway PM, Hasselhorn HM (2008) Back or neck-pain-related disability of nursing staff in hospitals, nursing homes and home care in seven countries—results from the European NEXT-Study. Int J Nurs Stud 45:24–34. doi: 10.1016/j.ijnurstu.2006.11.003 CrossRefGoogle Scholar
  37. Smedley J, Egger P, Cooper C, Coggon D (1995) Manual handling activities and risk of low back pain in nurses. Occup Environ Med 52:160–163CrossRefGoogle Scholar
  38. Smedley J, Inskip H, Trevelyan F, Buckle P, Cooper C, Coggon D (2003) Risk factors for incident neck and shoulder pain in hospital nurses. Occup Environ Med 60:864–869. doi: 10.1136/oem.60.11.864 CrossRefGoogle Scholar
  39. Tinubu BM, Mbada CE, Oyeyemi AL, Fabunmi AA (2010) Work-related musculoskeletal disorders among nurses in Ibadan, South-west Nigeria: a cross-sectional survey. BMC Musculoskelet Disord 11:12. doi: 10.1186/1471-2474-11-12 CrossRefGoogle Scholar
  40. Todd KH, Funk KG, Funk JP, Bonacci R (1996) Clinical significance of reported changes in pain severity. Ann Emerg Med 27:485–489CrossRefGoogle Scholar
  41. Trinkoff AM, Lipscomb JA, Geiger-Brown J, Brady B (2002) Musculoskeletal problems of the neck, shoulder, and back and functional consequences in nurses. Am J Ind Med 41:170–178CrossRefGoogle Scholar
  42. Tullar JM et al (2010) Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector. J Occup Rehabil 20:199–219. doi: 10.1007/s10926-010-9231-y CrossRefGoogle Scholar
  43. Verbeek JH, Martimo KP, Karppinen J, Kuijer PP, Viikari-Juntura E, Takala EP (2011) Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD005958.pub3 Google Scholar
  44. Vieira ER, Miller L (2008) Facing the challenge of patient transfers: using ceiling lifts in healthcare facilities. HERD 2:6–16Google Scholar
  45. Yassi A, Lockhart K (2013) Work-relatedness of low back pain in nursing personnel: a systematic review. Int J Occup Environ Health 19:223–244. doi: 10.1179/2049396713y.0000000027 CrossRefGoogle Scholar
  46. Yassi A, Cooper JE, Tate RB, Gerlach S, Muir M, Trottier J, Massey K (2001) A randomized controlled trial to prevent patient lift and transfer injuries of health care workers. Spine (Phila Pa 1976) 26:1739–1746CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Medical Faculty Carl Gustav Carus, Institute and Policlinic of Occupational and Social MedicineTechnische Universität DresdenDresdenGermany
  2. 2.Institute for Health Service Research in Dermatology and NursingUniversity Clinics Hamburg EppendorfHamburgGermany
  3. 3.Department of Occupational Health ResearchGerman Social Accident Insurance Institution for the Health and Welfare ServiceHamburgGermany

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