- Email: [email protected]
Physiotherapists and the Manual Handling Operations Regulations
446
FOCUS
Physiotherapists and the Manual Handling Operations Regulations Sue Hignett How many physiotherapy departments have fully complied with the Manual Handling Operations (MHO) Regulations (HSE, 1992a, b)?
I would like to offer my interpretation of how the MHO regulations apply to physiotherapists, together with a proposition for a model to describe handling in a treatment situation.
Physiotherapy Workplaces
The handling interaction between the physiotherapist and the patient is represented by a ‘see-saw’. When it is balanced around its fulcrum (fig 21, there is an equal amount of weight taken on each end of see-saw. In this situation the amount of support needed by the patient is not producing any excess strain on the physiotherapist. Patient
Safe
Safe
Dangerous
Dangerous
Physiotherapist
Fig 2: Equilibrium situation
Physiotherapists work in a wide variety of different workplaces, which can be grouped under the three headings: department/physiotherapy rooms, wards and community. Of these, the physiotherapy manager is responsible for having completed the risk assessment of the department/physiotherapy rooms. On the ward and in the community, it is the responsibility of the ward manager or community team manager to ensure a safe work place for all staff working there. This usually results in the physiotherapist having to move furniture to secure a safe environment, with the treatment area often being a compromise situation.
The patient would be even safer if more of the weight was taken by the physiotherapist (fig 31, but this swings the physiotherapist into the danger zone, placing excess strain on the body.
When completing the risk assessment for a physiotherapy department, the use of standard checklists may be helpful. Examples of these are given in most of the guidance publications (HSE, 1992a, b; McAtamney and Corlett, 1992). Fenety and Kumar (1992) describe a n ergonomic survey of a physical therapy department looking a t the tasks, work station environment, equipment and personnel, and offer solutions, with costs, to rectify the problems.
Fig 3: Physiotherapist in danger zone
These checklists work well when applied to inanimate objects, but are less useful for ‘people handling’. A physiotherapist works to assist in the physical recovery of the patientdclients, and, unlike other members of the health industry, most of our handling is for physical rehabilitation rather than for transferring from A to B or for providing another form of treatment. In most situations in a hospital, ‘peoplehandling’ should be performed in the safest way possible, both for the person and handler, using whatever equipment is required. I suggest that the nature of our job restricts us from using the safest methods for handling.
Treatment Handling In order to treat effectively we have to work in the ‘balance zone’ (fig 1). Patient
Physiotherapist
u Fig 1: Balance zone
Physiotherapy, July 1994, vol80, no 7
Patient
Physiotherapist
If the patient is being encouraged to take more of his or her own weight during a treatment session, then the situation is reversed (fig 4). Physiotherapist
Patient Fig 4: Patient in danger zone
The factor which makes treatment handling so different from most other handling done in a hospital is the need to work within the ‘balance zone’ in order to achieve progress in the treatment. This produces a potential risk for physiotherapists because if a patient suddenly needs more support the ‘see-saw’ swings rapidly, and sometimes uncontrollably, back to the position in figure 3, with the physiotherapist in the danger zone. So a physiotherapist, although expert a t handling for treatment, is potentially at greater risk than other staff members, who should always be handling in the controlled safe zone. When this is combined with the repetitive nature of our work, treating many patients with similar problems each day, it is not surprising that we have a high level of back pain incidents in spite of our knowledge and skills.
447
We should be looking for w a y s t o m i n i m i s e the r i s k to ourselves. T h i s m a y m e a n greater allocation of appropriately t r a i n e d staff for p a r t i c u l a r t r e a t m e n t sessions and, in turn, r e s u l t in fewer p a t i e n t t r e a t m e n t s . B u t if t h e cost of t r e a t m e n t h a n d l i n g i s the loss of
References Health and Safety Executive (1992a). Manual Handling: Guidance
physiotherapists, e i t h e r completely from t h e profession or on sick leave, then we m u s t seriously weigh u p the
McAtamney, L and Corlett, E N (1992). ‘Ergonomic workplace assessment in a health care context’, Ergonomics, 35, 9, 965 - 978.
balance. Author and Address for Correspondence Sue Hignett MCSP is a research physiotherapist in t h e Occupational Health Department, Addenbrooke’s Hospital, Hills
on regulations, HMSO.
Health and Safety Executive (1992b). HSAC Guidance on Manual Handling of Loads in the Health Services, HMSO.
Fenety, A and Kumar, S (1992). ‘An ergonomic survey of a hospital physical therapy department’, international Journal of industrial Ergonomics, 9, 161 - 170.
Road, Cambridge CB2 2QQ.
book reviews Principles and Practice of Restorative Neurology edited by Robert R Young and Paul J Delwaide. Butteworth Heinemann, 1992 (ISBN 0 7506 1172 3). 221 pages. f40.
Restorative neurology, so the editors inform, integrates the disparate fields of neurology to provide a cohesive backround to patient care. Thus, this volume of 20 chapters (well referenced and easily readable extended essays by leading authors) encompasses a diverse array of material including epidemiology, biochemistry, plasticity, pharmacotherapy, biomechanics a n d rehabilitative engineering, surgery, and genetics. However, the aim of this volume is not to provide extensive reviews but to utilise exemplary areas to illustrate how the convergence of distinct neurological techniques occurs. This aim is generally achieved. The book is aimed primarily a t neurologists but much within it should be of value to therapists working in neurology. By attempting to clarify the rationale behind the available and potential therapeutic techniques and by investigating the efficacy and measurement of such strategies - the principles and practice of the title - the information presented can be incorporated into the understanding of potential physiotherapeutic intervention and the role of other non-physiotherapy research and techniques. Perhaps physiotherapists will be dismayed by the lack of reference to our profession and (more debatably) the strict adherence to purely qualitative measures of outcomes (the ‘cornerstone’ of restorative neurology). Because of the diverse nature of the chapters the book is useful on many levels. The student may find use in the chapters more concerned with pathology, overviews of treatment and models of care, while the practitioner will be interested in the chapters relating to plasticity a n d neurophysiological responses to trauma and intervention. Finally, those who wish to explore the developing fields of neurology (eg genetics and gene therapy) can be introduced here. However, this diversity, combined with the target readership of neurologists, does lead to a discrepancy in presentation. Certain areas (eg available aids) will
I am sure that most manual therapists would agree with the expressed opinion that the most successful results would be obtained by combining manual approaches with exercise, and patient education programmes: ‘In a climate of mutual openness spinal manipulative treatment is moving in the direction of occupying a more appropriate place as one of the many approaches that can be useful in the treatment of low back pain’. The dilemma of physiotherapists practAdvances in Idiopathic Low Back ising in the United States is highlighted. Pain If they use spinal manipulative treatment edited by E Ernst, M I V Jayson. M H Pope they can be charged with employing and R W Porter. Blackwell-MZV, 1993 (ISBN 3 chiropractic without a licence, and this 901 158 08 1). lllus. 408 pages. could lead to imprisonment. This informative book is based on the It must be accepted that inevitably this proceedings of a conference held in book will be superseded by subsequent Vienna a t the end of 1992. It comprises research, but it is still a serviceable a collection of papers by leading guide in the present time. It should authorities in the field. As the approach be particularly useful for medical is international, the opinions presented practitioners involved in treating spinal are not dominated by views held by one problems providing, a s it does, a broad nation alone. view of the many complex factors The book is aimed a t health-care associated with chronic low back pain. professionals who come into contact with It is essential for physiotherapists to those suffering from low back pain. It familiarise themselves with the current acknowledges that in the vast majority literature, if they are ever to become a of cases back pain has no specific, more research-orientated profession, identifiable cause, a n d should be critically evaluating relevant research. In considered idiopathic: ‘Up to 85% of this publication, recent studies a r e patients cannot be given a definite gathered together in a practical manner diagnosis because of the weak association and I feel that the book would be a n among symptoms, pathological changes appropriate addition to any out-patient and imaging results.’ department library that is used by staff Divided into t e n chapters, each specialising in the management of consisting of a selection of relevant patients with spinal problems. research papers, the manual includes Dionne McGovern sections on anatomy and biomechanics, MCSP MMACP PostGradManTher epidemiology and etiology. A comprehensive index is supplied a t the end of the The Hip Tip Book book. The chapter on diagnosis is particularly interesting since it covers by Patricia Steeples, occupational therapist, Princess Elizabeth Orthopaedic Hospital, many of the investigative imaging Wonford Road, Exeter (telO392 403521). 7997, techniques currently utilised in the reprinted 1992. diagnosis of spinal problems. A large part of the text is given over to scrutiny of The aim of this easy-to-follow guide is current methods of treatment, although to help patients who are undergoing emphasis is on medical management hip replacement to prepare for their (eg drugs and surgery) rather than operation. The booklet gives advice on what to bring in to hospital, a list of dos physiotherapy. A manipulative approach to the treat- and don’ts and post-operative information on positions for sitting, sleeping, washing, ment is also discussed, with reference using the lavatory and dressing. There being made to the premise that spinal are also notes about working in the manipulation h a s a very limited kitchen, gardening and getting into a car, application for chronic low back pain a s and a reminder section. it offers only short-term relief.
appear simplistic to the therapist while others (eg neuropharmacology) require a relatively high level of background knowledge. This book will sit happily on a medical library shelf and, perhaps, be a useful bonus for the more f l u e n t physiotherapy department’s library (if any exist!). Richard Stephenson MSc MCSP DipTP
Physiotherapy, July 1994, vol80, no 7
FOCUS
Physiotherapists and the Manual Handling Operations Regulations Sue Hignett How many physiotherapy departments have fully complied with the Manual Handling Operations (MHO) Regulations (HSE, 1992a, b)?
I would like to offer my interpretation of how the MHO regulations apply to physiotherapists, together with a proposition for a model to describe handling in a treatment situation.
Physiotherapy Workplaces
The handling interaction between the physiotherapist and the patient is represented by a ‘see-saw’. When it is balanced around its fulcrum (fig 21, there is an equal amount of weight taken on each end of see-saw. In this situation the amount of support needed by the patient is not producing any excess strain on the physiotherapist. Patient
Safe
Safe
Dangerous
Dangerous
Physiotherapist
Fig 2: Equilibrium situation
Physiotherapists work in a wide variety of different workplaces, which can be grouped under the three headings: department/physiotherapy rooms, wards and community. Of these, the physiotherapy manager is responsible for having completed the risk assessment of the department/physiotherapy rooms. On the ward and in the community, it is the responsibility of the ward manager or community team manager to ensure a safe work place for all staff working there. This usually results in the physiotherapist having to move furniture to secure a safe environment, with the treatment area often being a compromise situation.
The patient would be even safer if more of the weight was taken by the physiotherapist (fig 31, but this swings the physiotherapist into the danger zone, placing excess strain on the body.
When completing the risk assessment for a physiotherapy department, the use of standard checklists may be helpful. Examples of these are given in most of the guidance publications (HSE, 1992a, b; McAtamney and Corlett, 1992). Fenety and Kumar (1992) describe a n ergonomic survey of a physical therapy department looking a t the tasks, work station environment, equipment and personnel, and offer solutions, with costs, to rectify the problems.
Fig 3: Physiotherapist in danger zone
These checklists work well when applied to inanimate objects, but are less useful for ‘people handling’. A physiotherapist works to assist in the physical recovery of the patientdclients, and, unlike other members of the health industry, most of our handling is for physical rehabilitation rather than for transferring from A to B or for providing another form of treatment. In most situations in a hospital, ‘peoplehandling’ should be performed in the safest way possible, both for the person and handler, using whatever equipment is required. I suggest that the nature of our job restricts us from using the safest methods for handling.
Treatment Handling In order to treat effectively we have to work in the ‘balance zone’ (fig 1). Patient
Physiotherapist
u Fig 1: Balance zone
Physiotherapy, July 1994, vol80, no 7
Patient
Physiotherapist
If the patient is being encouraged to take more of his or her own weight during a treatment session, then the situation is reversed (fig 4). Physiotherapist
Patient Fig 4: Patient in danger zone
The factor which makes treatment handling so different from most other handling done in a hospital is the need to work within the ‘balance zone’ in order to achieve progress in the treatment. This produces a potential risk for physiotherapists because if a patient suddenly needs more support the ‘see-saw’ swings rapidly, and sometimes uncontrollably, back to the position in figure 3, with the physiotherapist in the danger zone. So a physiotherapist, although expert a t handling for treatment, is potentially at greater risk than other staff members, who should always be handling in the controlled safe zone. When this is combined with the repetitive nature of our work, treating many patients with similar problems each day, it is not surprising that we have a high level of back pain incidents in spite of our knowledge and skills.
447
We should be looking for w a y s t o m i n i m i s e the r i s k to ourselves. T h i s m a y m e a n greater allocation of appropriately t r a i n e d staff for p a r t i c u l a r t r e a t m e n t sessions and, in turn, r e s u l t in fewer p a t i e n t t r e a t m e n t s . B u t if t h e cost of t r e a t m e n t h a n d l i n g i s the loss of
References Health and Safety Executive (1992a). Manual Handling: Guidance
physiotherapists, e i t h e r completely from t h e profession or on sick leave, then we m u s t seriously weigh u p the
McAtamney, L and Corlett, E N (1992). ‘Ergonomic workplace assessment in a health care context’, Ergonomics, 35, 9, 965 - 978.
balance. Author and Address for Correspondence Sue Hignett MCSP is a research physiotherapist in t h e Occupational Health Department, Addenbrooke’s Hospital, Hills
on regulations, HMSO.
Health and Safety Executive (1992b). HSAC Guidance on Manual Handling of Loads in the Health Services, HMSO.
Fenety, A and Kumar, S (1992). ‘An ergonomic survey of a hospital physical therapy department’, international Journal of industrial Ergonomics, 9, 161 - 170.
Road, Cambridge CB2 2QQ.
book reviews Principles and Practice of Restorative Neurology edited by Robert R Young and Paul J Delwaide. Butteworth Heinemann, 1992 (ISBN 0 7506 1172 3). 221 pages. f40.
Restorative neurology, so the editors inform, integrates the disparate fields of neurology to provide a cohesive backround to patient care. Thus, this volume of 20 chapters (well referenced and easily readable extended essays by leading authors) encompasses a diverse array of material including epidemiology, biochemistry, plasticity, pharmacotherapy, biomechanics a n d rehabilitative engineering, surgery, and genetics. However, the aim of this volume is not to provide extensive reviews but to utilise exemplary areas to illustrate how the convergence of distinct neurological techniques occurs. This aim is generally achieved. The book is aimed primarily a t neurologists but much within it should be of value to therapists working in neurology. By attempting to clarify the rationale behind the available and potential therapeutic techniques and by investigating the efficacy and measurement of such strategies - the principles and practice of the title - the information presented can be incorporated into the understanding of potential physiotherapeutic intervention and the role of other non-physiotherapy research and techniques. Perhaps physiotherapists will be dismayed by the lack of reference to our profession and (more debatably) the strict adherence to purely qualitative measures of outcomes (the ‘cornerstone’ of restorative neurology). Because of the diverse nature of the chapters the book is useful on many levels. The student may find use in the chapters more concerned with pathology, overviews of treatment and models of care, while the practitioner will be interested in the chapters relating to plasticity a n d neurophysiological responses to trauma and intervention. Finally, those who wish to explore the developing fields of neurology (eg genetics and gene therapy) can be introduced here. However, this diversity, combined with the target readership of neurologists, does lead to a discrepancy in presentation. Certain areas (eg available aids) will
I am sure that most manual therapists would agree with the expressed opinion that the most successful results would be obtained by combining manual approaches with exercise, and patient education programmes: ‘In a climate of mutual openness spinal manipulative treatment is moving in the direction of occupying a more appropriate place as one of the many approaches that can be useful in the treatment of low back pain’. The dilemma of physiotherapists practAdvances in Idiopathic Low Back ising in the United States is highlighted. Pain If they use spinal manipulative treatment edited by E Ernst, M I V Jayson. M H Pope they can be charged with employing and R W Porter. Blackwell-MZV, 1993 (ISBN 3 chiropractic without a licence, and this 901 158 08 1). lllus. 408 pages. could lead to imprisonment. This informative book is based on the It must be accepted that inevitably this proceedings of a conference held in book will be superseded by subsequent Vienna a t the end of 1992. It comprises research, but it is still a serviceable a collection of papers by leading guide in the present time. It should authorities in the field. As the approach be particularly useful for medical is international, the opinions presented practitioners involved in treating spinal are not dominated by views held by one problems providing, a s it does, a broad nation alone. view of the many complex factors The book is aimed a t health-care associated with chronic low back pain. professionals who come into contact with It is essential for physiotherapists to those suffering from low back pain. It familiarise themselves with the current acknowledges that in the vast majority literature, if they are ever to become a of cases back pain has no specific, more research-orientated profession, identifiable cause, a n d should be critically evaluating relevant research. In considered idiopathic: ‘Up to 85% of this publication, recent studies a r e patients cannot be given a definite gathered together in a practical manner diagnosis because of the weak association and I feel that the book would be a n among symptoms, pathological changes appropriate addition to any out-patient and imaging results.’ department library that is used by staff Divided into t e n chapters, each specialising in the management of consisting of a selection of relevant patients with spinal problems. research papers, the manual includes Dionne McGovern sections on anatomy and biomechanics, MCSP MMACP PostGradManTher epidemiology and etiology. A comprehensive index is supplied a t the end of the The Hip Tip Book book. The chapter on diagnosis is particularly interesting since it covers by Patricia Steeples, occupational therapist, Princess Elizabeth Orthopaedic Hospital, many of the investigative imaging Wonford Road, Exeter (telO392 403521). 7997, techniques currently utilised in the reprinted 1992. diagnosis of spinal problems. A large part of the text is given over to scrutiny of The aim of this easy-to-follow guide is current methods of treatment, although to help patients who are undergoing emphasis is on medical management hip replacement to prepare for their (eg drugs and surgery) rather than operation. The booklet gives advice on what to bring in to hospital, a list of dos physiotherapy. A manipulative approach to the treat- and don’ts and post-operative information on positions for sitting, sleeping, washing, ment is also discussed, with reference using the lavatory and dressing. There being made to the premise that spinal are also notes about working in the manipulation h a s a very limited kitchen, gardening and getting into a car, application for chronic low back pain a s and a reminder section. it offers only short-term relief.
appear simplistic to the therapist while others (eg neuropharmacology) require a relatively high level of background knowledge. This book will sit happily on a medical library shelf and, perhaps, be a useful bonus for the more f l u e n t physiotherapy department’s library (if any exist!). Richard Stephenson MSc MCSP DipTP
Physiotherapy, July 1994, vol80, no 7