Effectiveness Of Manual Handling Training Health Essay

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Nearly a third of all injuries that are reported each year are a result of incorrect manual handling. The cost of these injuries is estimated at approximately £100million each year. This can be a result of poor supervision, lack of training or information, poor instructions or a combination of these things, (Addison and Burgess, 2002).

A manual handling operation may be defined as transporting or supporting of a load which includes lifting, putting down, pushing, pulling, carrying or moving by hand or bodily force, or it can be explained as the use of hands involving application of a degree of physical force to push or pull, lift or put down, throw, move or carry a load, (HSE Books, 2004).

Discs, Ligaments, and muscles are commonly injured in a cumulative nature and are very rarely injured in one isolated event. Ligament or tendon damage is also common with hernias developing after muscle wall tissue becomes too strained. If objects are dropped on the body then abrasions, cuts and fractures can occur. Manual handling injuries have a great impact on the economy. Most of the certified absence from work is attributed to back injuries due to manual handling injuries. It is even more devastating to the sufferers themselves, (Health and Safety Executive, 2006).

According to Health and Safety Executive, (2006), there are a number of ways to reduce the risks associated with manual handling, as required under the Manual Handling Operations Regulations 1992. A risk assessment should be carried out and, if possible, mechanical aids should be used to assist people with the lifting. Workers should be encouraged to undertake team lifts and be aware of their individual limitations. Employers should provide staff with the correct levels of information, instruction and training.

Risk assessments are required under health and safety regulations (regulation 3.1a &b of the Management of Health and Safety at Work Regulations 1999). Employers must take into account the task, load, working environment and the individual capability. Accidents caused by manual handling of loads were the largest single cause of over three day accidents reported to the Health and Safety Executive (HSE) a few years back. When the Manual Handling Operations Regulations recognised this fact they helped in reducing the number of these accidents. As the figures are still rising machanical handling methods should be applied where possible, (Hughes and Ferrett, 2009).

It is the responsibility of the employer to identify every manual handling operation within their business. The operations that pose a risk of injury must be assessed and measures to eliminate or minimise that risk must be put in place. Initially the MHOR did not emphasise on the need for provision of the appropriate information and instructions including training. The Health and Safety at Work Regulations (HSE, 1992b) and the revision (HSE, 1999) imposed to the employer the duty to provide employees with comprehensive and relevant information on the risks to their health and safety they might encounter in their employment. The information includes the measures put in place to eliminate or minimise the risk, (Addison and Burgess, 2002).


The aim of this review is to evaluate and measure the effectiveness of manual handling training in the workplace and its contribution in reducing the risk of injury at work. This is also to establish better methods and frequency of training and its impact on manual handling, (Health and Safety Executive, 2007).

This review was instigated after the author experienced induction training which included manual handling training within NHS hospital setting and outside the healthcare sector in a non-governmental organisation. The similarities and the differences in how the inductions were conducted raised an interest within the author hence this review.

The manual handling training within the NHS trust emphasised on patient transfer using provided equipment which included sliding sheets, hoist, wheel chair and so forth. In the other industrial sector the emphasis included general lifting, pushing and pulling of a load and an assessment was being carried out before each task.


To establish if manual handling training (technique) in the work place reduce the risk of injury

Is adequate training being offered to employees or it is a legislation obligation fulfilment by the employer in order to tick the box.

Should the training be focussed on attitude, behaviour and promoting risk awareness as opposed to manual handling techniques e.g. carrying out risk assessment for specific tasks?

Is there an evaluation process to make sure staffs understand the techniques, and that they are applying them in practice e.g. audits?

What happens when new equipment is being used? Is there a specific departmental training with practical use of their equipment?


Manual handling is known to be a major contributor to ill health and injury in the workplace. The Manual Handling Operations Regulations (MHOR) was published in 1992 by the now- named Health & Safety Executive (HSE 1992a). The MHORs came into force in the UK in January 1993 (Addison and Burgess, 2002). Manual handling injuries are a major burden to the economy, and a burden to the sufferers themselves.

Manual handling is defined as an application of a degree of physical force, to lift, move, carry, put down, throw, push or pull a load by using one or both hands. An employer must list every manual handling operation carried within the business or undertaking to comply with the MHORs regulations, (Manual handling, 2003).

The employer must then determine which of these operations presents a risk of injury and take action to eliminate or minimize that risk. The Health and Safety at Work Regulations impose a duty on every employer to provide employees with comprehensive and relevant information on any risks to their health and safety within their area of work. The employer must provide the measures which have been employed to eliminate or minimize those risks, (Addison and Burgess, 2002).

The manual handling regulations of 2002 also require the employer to provide training for their employees in safe manual handling techniques and assessment of safe manual handling practices (Garcarz and Wilcock, 2005). The employer has a duty to provide safe equipment, information and training on health and safety issues which include manual handling.

Solomon (2002) wrote that the main approaches to preventing agricultural accidents are through engineering improvements, and education and training of the workforce; this was in relation to the agricultural sector. Manual handling injuries are known to be a major setback to the society. Training programmes have been designed to reduce risk of injury through manual handling.

Literature Search Strategy

Summary of Search Strategy

The majority of research for this review will be retrieved from journal articles through databases available through studynet, as they are easy to access and contain peer reviewed studies, providing credible information. The primary databases that will be used are PubMed and Medline; however as the research process develops; other medical databases may be used. The search process will be conducted using key words and concepts to pin-point relevant evidence and to exclude journals that were not on target or going to be of use. To narrow the search further and to make it more useful inclusion and exclusion criteria will be used.

Inclusion Criteria:

Finding articles only published in English.

Finding articles published within the last ten years

Finding articles that had links to full texts, so not just the abstract is available.

Relevant websites including the Health and Safety Executive (HSE) published articles

Online books on manual handling.

Exclusion Criteria

Abstracts from conferences.

Articles that cost more than £20 to obtain.

Detailed Search Strategy

A literature review requires numerous amounts of research to be analysed in order for the basis of the review to be created and arguments to be supported (Hart, 2001). The majority of research for this review will be retrieved from journal articles through databases specifically linked to manual handling and Health and Safety Executive (HSE). This was decided subsequent to searching through Google scholar. This website supplied an abundance of literature with regards to manual handling. In addition to Google Scholar the other primary databases used were PubMed and Medline because they contain a wide range of journals, including up to date articles and peer reviewed studies, which in turn provides a credible source of information (Hewitt, 2007). Additionally these databases are specifically linked to manual handling, thus proving to be very beneficial in pin pointing relevant evidence and filtering out articles and journals that were not going to be of use.

Key words used to search electronic databases

The databases were searched for the following key text words in the title or the abstract: 'manual handling' with the Boolean 'AND' to the terms 'training' or 'manual handling training' or 'effectiveness' or 'reduction in injuries' or 'literature review'

The databases were searched for articles published between 2000 and to date. The search engine used was Google scholar. The search strategy also involved examining the reference lists of the relevant articles found, to check for further studies. Although the review was confirmed to articles from 2000 to 2011, the checking of reference sections revealed some relevant articles from the 1980's and the 1990's. These were not included in this review except for the authors' background reading and understanding of the subject area if they added knowledge to the literature review, (Haslam, Clemes, McDermott, Shaw, Williams, and Haslam, 2007).

Selection Criteria

The literature reviewed encompassed published articles, available in English in the databases mentioned above. The review was confined to articles in peer reviewed journals, reports from health and safety agencies and published conference proceedings.

Articles were included if they described empirical research in the laboratory or workplace interventions providing that the focus of the study was the evaluation of manual handling training. Studies employing a broader approach to improving manual handling in the laboratory and workplace were also incorporated, in particular studies which evaluated the impact of exercise in improving manual handling performance. Questionnaire based surveys and audits of the exercise in improving manual handling were also included. In addition review paper on the effectiveness of manual handling training is also discussed.

Studies were excluded if they used the words 'manual handling training' in their abstract and title but when reviewed were found not to encompass training.

Systematic Literature review Results

Approximately 1714 papers were located. These were then checked to eliminate duplications arising from the different search strategies and papers which were inappropriate to the research topic, based on their title and details contained within their abstract, were eliminated. Of these, 40 were intervention studies with the primary aim of investigating the effectiveness of manual handling training. A further 20 papers consisted of questionnaires based on surveys or audits assessing the effectiveness of prior manual handling training, and 10 comprised either review papers or reports describing the reviews of expert groups on manual handling training.

Manual handling Interventions

With regard to manual handling, the primary physiological area of concern has always been the discs of the lumber spine which is the lower part of the spine.

Manual handling training programs are designed to make workers aware of the risks associated with manual handling as well as providing training in how to reduce the likelihood of becoming injured. The effectiveness of the training offered may depend on the teaching method, type of training technique and deliverance, or the organisation's settings, (Haslam, et al., 2007).

In relation to health, low back pain and injuries among healthcare professionals is common within the National Health Service (NHS). The study carried out in 2004 reveals the problems associated with the delivery of training in some organisations. The concerns included unsatisfactory attendance, training records and difficulty in making the support chain for cascade systems explicit within the management structure, (Smedley, Poole, Waclawski, Harrison, Stevens, Buckle and Coggon, 2004).

The study also revealed that most of the resources are spend on support and management of manual handling training. This emphasis on training is related to the fulfilment of the legal requirement to train all employees exposed to manual handling activities at work. There is ample evidence that training in manual handling does little to improve musculoskeletal symptoms in healthcare professionals, (Haines, Wilson, Vink and Koningsveld, E., 2002)

Technique or Education based Training Interventions

Technique training or educational based interventions are proving not to have a great impact on working practices or reducing injury rates as evidenced in the journal. The training is very basic and generic including the environment that it is carried out in. Attendance is compulsory for every new starter in employment and refreshers are also compulsory. Records of attendance are kept by the employer as it is a legislation requirement, Hignett, S., (2003). The techniques seem to be applicable during training alone and not in departmental daily task operations.

Observations from healthcare sectors show that workers rarely used correct lifting techniques, despite the fact that during workers initial training, correct handling procedures were taught. The manual handling training team also provided refresher training from time to time and workers' awareness of manual handling procedures appeared to be good in the refresher training, (Swain et al., 2003).

The deductions drawn in the healthcare setting reveal very little evidence on the effectiveness of educational based training in safe patient handling. The same results were observed in the technique and educational based training outside the healthcare sector. As Bewick & Gardner, 2000; de Castro et al., 2006; Swain et al., 2003 reported that in the healthcare there is enough evidence supporting that the principles taught during training, are not always applied into the working environment, (Hartvigsen et al., 2005). This has also been reported in the other sectors outside the healthcare.

In summary this proves that adequate training is being provided in manual handling by the employer as the employees are proving to have the knowledge and awareness of the procedures of manual handling. A departmental assessment should be employed which is task specific. This approach will then be followed by a comprehensive design of a training program which is departmental based. As an idea each department should appoint a nominated person to undergo a comprehensive training related to department tasks and equipment used. The nominated person can then carries out audits, observations and discuss it with the manual handling team. The same principle that is applied in quality assurance of equipment, infection control, first aid, and or fire drills. This is the author's opinion not validated facts. The training proves to be adequate but not producing the required results of reducing manual handling risks. It is cost effective and fulfils legislation requirements.

Single Factor Interventions

Single factor interventions are cost effective like the provision of equipment and re-design of the method used. It is unusual to consider provision of equipment alone without other factors, (Haslam, et al., 2007). A quality research has to be considered to measure the significance of these single factors and their impact on reducing injuries which can be measured or considered by looking at sickness absence records and incidents report. On their own these single factor interventions seem not to pay much dividend although there are signs of having an impact in work practices and risk reduction. These can only be effective when proper risk assessments are carried out and recommendation and reviews are contacted before use of equipment. This also goes with sufficient training on how to use the equipment more on the practical training instead of reading the manual and educational based or theory training, (Hignett, 2003).

Daynard et al. (2001) analysed the study carried out by Yassi et al. (2001), for compliance with correct lifting technique and biomechanical stress to the lower back during patient handling tasks. Daynard et al. (2001) reported that no single intervention can be recommended, and suggested that all patient-handling tasks should be considered separately to determine which method could reduce cumulative lumbar forces during a manoeuvre.

Agruss et al. (2004) also carried out a study on the effects of a feedback training program on lumbar compression during simulated occupational lifting. The report showed reductions in peak lumbosacral disc compression from pre to post training. Gagnon (2003) reported that training programs should be based on workers knowledge about their jobs. Training programs should be designed based on the observation of workers strategies for manual handling. This was following a laboratory study whereby substantial biomechanical and ergonomics changes were observed post training.

Straker, (2000), has examined the effects of exercise programmes on human capacity for manual handling tasks. The research highlights beneficial effects resulting from exercise training. It was concluded that a general physical fitness training program was effective in improving the manual handling capabilities of women, (Maher, 2000). Following a review of literature on exercise-based training to improve manual handling capabilities, Maher, (2000) and Straker, (2000) concluded that this form of training shows promise in the short term.

Exercise and physical training showed some good signs as a measure to reduce manual handling injuries in the short term and further research is needed to determine whether the intervention could sustain long term to reduce injuries in the industrial sector. According to Cromie et al., (2000), there is no evidence determining the effectiveness of back schools in treating or preventing low back pain.

Single factor interventions can be effective in reducing manual handling risks if adequate assessment is carried out. These can be incorporated with specific task based training in departments. The involvement of the workforce in the design and implementation of the training program is vital. These single factor interventions play a role in reducing manual handling risks. As they are cost effective employers tend to resort to them. If a proper risk assessment is carried out they outweigh the educational based training in manual handling significantly. Physical fitness as a single factor has proven to play a short term role in reducing the risk. This is applicable in that the workforce are emotionally motivated as they physically tend to feel healthier and fit to work. Physical training at the workplace creates team bonding. It can be a deterrent if it is applied to certain tasks and a de-motivator to other workforce who cannot participate in the exercise for other reasons. As the evidence suggest that they contribute to reducing manual handling injuries they should be highly considered and applied intensely in training programs of manual handling.

.The reviews summarised above concludes that training alone is ineffective in reducing the rate of manual handling injuries. (Hignett, (2003); Maher, (2000); Straker, (2000)). Hignett (2003) also reported from the studies that manual handling training alone was ineffective in reducing back injury rates in nursing personnel. This leads to the conclusion that it is more beneficial employing more multifactor approach interventions. These include risk assessments and work environment redesign along with technique training. It was also suggested that training needs to be part of a broad based approach that tailors the training to the task and work environment, (White and Gray, 2004). This was also supported by Graveling et al. (2003) on the report of the findings of a meeting carried out by experts in a variety of interventions of manual handling. The meeting was designed to develop standards on basic physical and behavioural elements of good manual handling principles. In summary, the findings from review papers suggest that the traditional manual handling training approaches are ineffective in preventing low back pain, while exercise-based interventions fit in the multifactor approach.

Multifactor interventions

Interventions which include risk assessment, equipment provision and design, education and training, work environment design, injury monitoring systems, problem solving, team building and change of policies and procedures, patient assessment systems, hazard registers, audit of working practices, physical fitness training and medical examination seem to have a great impact on reducing musculoskeletal symptoms. These interventions proved to have an impact on injury rates and work practices, (Hignett, 2003).

They are time consuming and expensive to operate hence employers tend to deviate away from them. Because of their intensity they require extensive research and a comprehensive training program. They appear to be costly initially but in the long run they pay dividend as they reduce compensation claims as a result of manual handling injuries. They are beneficial to the workers as they reduce long term suffering from back pain and to the economy as they reduce accidents rates and sick leave therefore increasing production.

Redesign of Equipment

Another study reveals that redesign or equipment use did not reduce the working incidents significantly. This does not conclude that redesign of the working environment and equipment interventions do not have a significant reduction in risks. This varies depending with the changes made and the equipment interventions used. Based on this study, redesign of the environment actually increased the risk and equipment interventions reduced the risk not significantly though. The interventions can have an impact in reducing the risk if they are applied appropriately, (Marras, Allread, Burr, and Fathallah, 2000).

The design and operation of equipment are important, the tasks employees are expected to perform, the design of their jobs, together with factors motivating behaviour, combine to affect exposure to risk. Individual's knowledge, habits, desires and abilities makeup their actions and this is also influenced by psychological and social drivers. Upon an ergonomic improvement an operator using a redesigned machine or adopting a different way of performing a task, the operator needs to have an understanding of the benefits, must be willing to change and should be supported through the process of change with education, training, encouragement and feedback, (Haslam, 2002).

According to Haslam, et al., (2007) these researches concluded that interventions mainly based on technique training have no impact on injury rates or working practices. It has also demonstrated that certain ergonomic interventions, such as lift aids, can significantly reduce the incidents rates. For ergonomic interventions to be effective, they must be applied correctly. Finally, these studies have shown that ergonomic interventions, when applied according to known biomechanical principles, can be effective in reducing low-back injuries to employees. The question still lies on why the emphasis is on technique training when there is enough evidence to show that it has no impact on risk reduction? This predominantly concludes that technique based training is for the employer to tick the boxes and fulfil the legislation requirement. It is cheap and easy for the employer to employ this strategy hence popular. These interventions combined together are proving to have a significant impact on reducing risk. As an example combining risk assessment, equipment aids and comprehensive technique training will have a great impact on reducing these risks, (Hignett, 2003).

Training based on behaviour

A study showed a significant reduction in physical work demands and musculoskeletal symptoms when mechanical lifting devices were part of the intervention. It also showed improvements in behaviour indicating the importance of facilitating educational strategies. Ultimately, changing workers' behaviour is a necessary condition for reducing physical work demands and musculoskeletal symptoms in the longer run when ergonomic measures are implemented, (Van der Molen, Sluiter, Hulshof, Vink and Frings-Dresen, 2005).

Research has demonstrated the effectiveness of behaviour modification programmes in improving workplace safety. These programmes incorporate combinations of training, education, goal setting, observation, measurement and feedback in view of encouraging safety behaviour in the workplace. There is evidence to support that behavioural approaches are likely to be the key for progression in reducing accidents. The contributing factors are the precision and effectiveness of attention to design, systems and procedures. The behaviour modification programmes incorporate both individual and collective behaviour to have an effect on risk, (Li, Wolf, and Evanoff, 2004).

In a study carried out with the objective of evaluating the efficacy of training for manual handling strategies, it reveals that training actually produced safer strategies. This was by reducing mechanical work and back extensor moments. With the results of this study the conclusion was that training programs should be based on observations of workers in their area of work. Assess the risks involved and develop strategies which reduce these risks. When this is evaluated then training programs should be launched, (Gagnon, 2003).

In another study training in safe handling techniques is recommended to reduce the risk factors in the working environment. However, training programs have proven not to have substantial reductions in musculoskeletal problems like back injuries and maybe has to do with inadequate training methods, (Gray, and White, 2004).

The study revealed that it is better to involve the workers in the designing of safer training methods. This study lacked the relative contributions of soft tissue such as ligaments, muscles or co-contraction process. This is due to the complexity of the evaluation of risk factors, (Gagnon, 2005). The researchers are thriving to establish better ways of eliminating or reducing manual handling risks. This is resulting in different approaches to manual handling training programs which now include ergonomic interventions.

Ergonomics interventions

The manual handling has changed drastically from the initial approach whereby the worker was made to adapt to fit the workplace compared to recent approaches whereby the workplace is adjusted to fit the worker in order to reduce injuries linked to manual handling. It was established by Venning (1988), that education on its own will not resolve this occupational problem. An ergonomics approach was considered as they prove to be effective in reducing manual handling injuries.

A high quality study was carried out by Carrivick et al. (2001) initially in 2001 testing the effects of an ergonomics intervention among cleaning services staff in a large hospital. The aim was to assess the risks of manual handling within the cleaning services in the workplace. This was conducted in a three stage process of identification, assessment, and control of risks from manual handling. The study was followed for a period of 36 months. The report showed a significant reduction in the number and rates of injuries, but not the severity of injuries. A follow-up study was carried in 2005 using the same participants. Carrivick et al. (2005) carried a further analysis to determine whether there was a change in the rate and severity of injury from manual handling and reported a reduction in the rate of injury by two-thirds, and reductions in compensation claims costs by 62% and hours lost by 35%, for manual handling injuries were found to be associated with the intervention period.

Poosanthanasarn et al. (2005) tested the effectiveness of an applied ergonomics intervention program (AEIP) aimed at reducing work-related low back muscular discomfort in another study. This study included observing working postures and correcting improper postures. Warm-up exercises were also performed before starting work each day. The report revealed the significant changes in the low back muscular loads seen after the intervention. No changes in muscular load were noted in the control group. There was no variation noted between the two groups in terms of muscular activity. After the intervention there were significant differences between the two groups, which were attributed to the intervention.

Straker et al. (2004) wrote that the basic concept of a participative ergonomics approach involves workers in improving their workplaces to reduce injury and increase productivity. The workers are anticipated to have the expert knowledge of their own tasks, and this can be utilised to assist in risk assessment. This came as a result after the test on the effectiveness of a participative ergonomics intervention aimed at reducing injuries associated with manual tasks carried out by Straker et al. (2004). The study aimed to improve each workplace's management systems to support participation in a risk assessment and to provide supervisors and work teams with sufficient knowledge and skills to enable them to perform manual tasks, risk assessment and control. According to Straker et al. (2004)'s report the results from the second audit revealed that the total assessed risk exposure decreased for the experimental group compared to the control group. This leads to the conclusion that a participative ergonomics intervention can be effective in reducing the risk of musculoskeletal disorders in the workplace.

In review of the literature above and the studies carried out by the authors above, the ergonomics interventions applied in the studies they all had a positive outcome on manual handling injury rates and techniques, (Carrivick et al., 2001; 2005; Poosanthanasarn et al., 2005; Straker et al., 2004). None of them proved that technical training had an effect in reducing the risk of injury due to manual handling or otherwise. According to Straker et al. (2004), knowing the anatomy is not essential for effective manual risk management process and advised that it will be of benefit to spend time on risk assessment and control skills. They also proved in one of their studies that training in lifting technique is not effective in reducing musculoskeletal risks. In conclusion the effort should emphasise on developing effective risk assessment and control skills. This should also extend to effective management systems within the workplace, (Haslam, et al., 2007).

This also concludes that there is very little evidence of the effectiveness of educational or technique based training for safe patient handling, Hartvigsen et al., (2005). Ergonomics interventions that include risk assessments, involving workers in the redesign of equipment and environment, and patient handling tasks have been shown to successfully reduce the risk of manual handling injuries (Ore, 2003; Owen et al., 2002).

An investigation on manual handling training and its significance in reducing injuries was carried out in this study. One group which was the control group did not receive any training. The other group received training provided by an ergonomist. The training involved on-site assessment of manual handling tasks, training on specific techniques, the selection and purchase of equipment, design of manual handling tasks, and it all took place at the workers workplace. The findings were that training was effective with the group that had the training by having a lower risk of injury than the control group, (Ore 2003).

Ergonomic interventions have shown to successfully reduce the risk of manual handling injuries. The interventions that include risk assessments, redesign of equipment, tailoring the training to suit the specific task requirements and observing workers in their working environments seemed to be more effective in reducing the risk of injury in manual handling in the healthcare settings, (Ore, 2003; Owen et al., 2002). According to Carrivick et al., 2001; 2005 and Poosanthanasarn et al., 2005 there is also strong evidence of beneficial outcomes outside the healthcare sector when ergonomic interventions are applied.

Ergonomist are working tirelessly to overcome this occupation problem. With development in technology and sophistication laws and regulations it is imperative to create a safer working environment. Ergonomic interventions combined with multifactor interventions are showing positive and beneficial outcomes in reducing manual handling risks. The involvement of the workforce in these interventions had a big impact in the outcome of the training programs. As indicated above there is strong evidence that these interventions have positive outcomes in reducing manual handling risks.


The aim of this report is to evaluate and measure the effectiveness of manual handling training in the workplace and its contribution in reducing the risk of injury at work. Some of the aspects reviewed in this report include manual handling training and its effectiveness of training in healthcare and non-healthcare workers, and manual handling interventions. Included were the effectiveness of exercise or physical training interventions, and the effectiveness of ergonomics training and interventions on manual handling, (Haslam, et al., 2007).

Dean, (2001), Edlich, et al., (2004) and Hignett, (2003) concluded the lack of effectiveness of technique based training. A number of reason were put forward which included; people reverting to old habits after the training if there is no enforcement or refresher, in emergency situations, and stressful requirements of the job. According to Dean, 2001, 'designing a safe job is fundamentally better than training people to behave safely'. Edlich, et al., 2004 supported this theory by stating that 'the problem is not training the worker, but the workers' compliance with the training'. It is therefore conclusive that money and effort should be directed to research and implementation of techniques for ergonomic task design than in training programs. The employer tend to revert to training programs as it is the easy and cheap option and lay the blame on the workforce for not following the technical procedures they have been shown and taught in training.

As reported by de Castro et al., (2006) there is a change in the healthcare facilities as the healthcare professionals are starting to embrace the concept of patient care ergonomics implemented through safe patient handling programs. In a study carried out by Hignett and Crumpton, 2007 conclusions were made that in healthcare organisations that were practicing safety cultures which was in compliance to the Royal College of Nursing, the levels of postural risks were lower. This concludes that the development of comprehensive and multidimensional ergonomic interventions could be a break through to reducing manual handling risks, (Straker, 2000). These ergonomic training programs should focus on risk assessments, physical training to improve fitness and equipment design or redesign applicable to all industries requiring manual handling.

Haslam et al., (2007) and Whysall et al., (2006; 2007) commented that for the interventions to be more effective it is also depended on the willingness of managers' and workers' awareness and readiness to change. The managers should have the same level of knowledge with the workers in terms risks. According to Solomon, (2002) there is lack of research based in the agricultural and farming industries even though it is regarded as a high risk area in manual handling risks. With the application of multidimensional ergonomic interventions this could become a secondary problem as the solutions can be applied to all industrial sectors. Tailoring of training to suit the recipient and specific task requirements, along with equipment design or redesign, are effective in reducing manual handling injuries, (Haslam, et al., 2007).

As indicated above there is evidence that exercise training has a beneficial effect in terms of improving capacity of the individual for manual handling tasks in short term. Training that is tailored to workforce' knowledge and awareness of risks is likely to be more effective. This is supported by research funded by HSE which has shown that interventions tailored to workers and managers knowledge and awareness of risks are more effective in reducing MSDs compared to standard approaches (Haslam et al., 2007 and Whysall et al., 2006; 2007). It is also important to train workers and managers in assessing and reporting risks in the workplace as it is effective in reducing manual handling injuries.

The most successful ergonomics interventions are those that have included the observation of workers in their working environment, prior to the development and implementation of an intervention. There is evidence in the literature for a more ergonomic approach to reduce the risks associated with manual handling, in terms of redesigning the workplace environment, as compared to relying on traditional approaches of fitting the worker to the workplace environment, (Graveling, 2000).

There is enough evidence, drawn from many studies to suggest that training in lifting technique is ineffective in reducing injuries involving manual handling. Technique and educational based training were also proved to be ineffective. The studies above show that principles learnt during training are not applied into the working environment and this seem to encompass all industries involving manual handling. There are differing views amongst the ergonomists on what constitute appropriate handling techniques, (Haslam, et al., 2007).

Risk assessment

Risk assessments have proven to be the way forward in manual handling. There is is a noticeable difference in sectors that emphasise on risk assessments as a primary goal in their training programs in proportion to those that do not. Carrying out and acting on a risk assessment has a positive outcome in reducing manual handling injuries, (Health and Safety Executive, 2000).


In view of the highly rated review considered in this literature the deductions are that training in manual handling is paramount and essential to minimise manual handling injuries. A number of studies have been carried out in different approaches and settings to find the best solution to manual handling issues.

Educational and technical based training programs have proven not to have a great impact on manual handling risks. The training program is general and does not target specific tasks as (Hignett, 2003) suggested. Employees have proven to have the knowledge delivered in the training but are not applying it in the working environment, (Swain et al., 2003).

What is ergonomics?

Ergonomics is a science concerned with the 'fit' between people and their work. It puts people first, taking account of their capabilities and limitations. Ergonomics aims to make sure that tasks, equipment, information and the environment suit each worker

talking to employees and seeking their views. Employees have important knowledge of the work they do, any problems they have, and their impact on health, safety, and performance;

â-  assessing the work system by asking questions such as: -Is the person in a comfortable position? -Does the person experience discomfort, including aches, pain, fatigue, or stress? -Is the equipment appropriate, easy to use and well maintained? -Is the person satisfied with their working arrangements? -Are there frequent errors? -Are there signs of poor or inadequate equipment design, such as plasters on workers' fingers or 'home-made' protective pads made of tissue or foam?

â-  examining the circumstances surrounding frequent errors and incidents where mistakes have occurred and people have been injured. Use accident reports to identify details of incidents and their possible causes;

â-  recording and looking at sickness absence and staff turnover levels. High numbers may result from the problems listed earlier and/or dissatisfaction at work.

What can I do if I think I have identified an ergonomic problem?

â-  Look for likely causes and consider possible solutions. A minor alteration may be all that is necessary to make a task easier and safer to perform. For example: -provide height-adjustable chairs so individual operators can work at their

preferred work height; -remove obstacles from under desks to create sufficient leg room; -arrange items stored on shelving so those used most frequently and those

that are the heaviest are between waist and shoulder height; -raise platforms to help operators reach badly located controls; -change shift work patterns; and -introduce job rotation between different tasks to reduce physical and mental


â-  Talk to employees and get them to suggest ideas and discuss possible solutions. Involve employees from the start of the process - this will help all parties to accept any proposed changes.

â-  Always make sure that any alterations are properly evaluated by the people who do the job. Be careful that a change introduced to solve one problem does not create difficulties elsewhere.

â-  You don't always need to consult ergonomics professionals, and the expense of making changes can often be kept low. However, you may need to ask a qualified ergonomist if you are unable to find a straightforward solution or if a problem is complex.

â-  HSE has published a range of guidance material, some of which is free. Aimed at employers and employees, this guidance provides help on how to achieve safe and healthy work environments. It includes practical evaluation checklists and advice.

â-  Good ergonomics sense makes good economic sense. Ergonomics input does not necessarily involve high costs, and can save money in the long term by reducing injuries and absence from work.

An understanding of ergonomics in your workplace can improve your daily work routine. It is possible to eliminate aches, pains, and stresses at work and improve job satisfaction. Ergonomic solutions can be simple and straightforward to make ­even small changes such as altering the height of a chair can make a considerable difference.

HSE, (2007) Understanding ergonomics at work: Reduce accidents and ill health and increase productivity by fitting the task to the worker. Retrieved on December, 1st 2010 from www.hse.gov.uk/pubns/ indg90.pdf