Training for Manual Materials Handling Tasks:Strategies for First Responders and Healthcare Workers

CREMSD WebinarOctober 8, 2020

Tyson Beach, Assistant Professor, University of TorontoTilak Dutta, Scientist, KITE Research Institute

Poll question 1

Do you think this type of training would be effective at reducing risk of injury?

a) Yesb) No

Poll question 2

Do you think the training offered by your organization is effective at reducing the risk of injury?

a) Yesb) Maybec) No

Poll question 3

Which type of work are you involved with?

a) Firefightingb) Paramedicc) Healthcared) Other

Denis et al., IRSST: Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Québec

Agenda• Our interpretation of the IRSST’s findings

on training• Our recommendations for implementing

training programs

Injury prevention in the workplace

Fitting the work to the worker

vs

Fitting the worker to the work

More important

Our position• First, fit the work to the worker, then fit the worker

to the work• Worker training is important for injury prevention

particularly for occupations that require manual handling of heavy loads

October 19Steve FisherDan Armstrong

October 30Tyson BeachDave Frost

November 9Catherine BrookmanEmily KingMike Holmes

Our position• First, fit the work to the worker, then fit the worker

to the work• Worker training is important for injury prevention

particularly for occupations that require manual handling of heavy loads

Haslam et al., 2007Martimo et al., 2007Clemes et al., 2009Verbeek et al., 2011Hogan et al., 2014

5 reviews concluded that training doesn’t work

Haslam et al., 2007Martimo et al., 2007Clemes et al., 2009Verbeek et al., 2011Hogan et al., 2014

77 papers

Denis et al. found• The 5 reviews did not consider the quality of

the training programs• Instead, they only considered the quality of

the evaluation

Training Program 1 Training Program 2

High quality training programs had poor quality evaluations

Poor quality training programs had high quality evaluations

Denis et al.’s findings• Conclusions were based on ~10% “high quality”

evaluations• Denis et al. concluded that evidence for training

was stronger than the conclusions of the 5 reviews• Bad training doesn’t work

Individual

Work Environment

To be effective, training should• Help workers apply ergonomic principles in a

changing work environment (rather than focus on specific techniques)

• Include practice that is representative of the real working conditions

• Teach workers how to reduce/eliminate hazardous work when possible

• Handling frequency/duration• Getting help from a co-worker• Rearranging physical obstacles• Etc.

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Contemporarytheoriesandbestavailableresearchevidenceinkinesiologyandimplementationsciencesuggestsapplyingatransdisciplinary,participatoryanditerativeapproachtomanualhandlingtraining.Althoughtherearemanywaystodothis(inprinciple),weproposeusingaprocessmodelconsistingoffourinterdependentphases:(1)assessment;(2)design;(3)implementation;and(4)evaluation.

Anaccompanyingpositionpaperonthetopicisforthcoming,andwillbeavailableontheCRE-MSDwebsite.

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Assessment focusesongatheringessentialinformationandsupport.Keystakeholdersandcontentexperts(wherepossible/warranted)collaboratetodevelopasharedunderstandingofpriorities,responsibilities,resourcesavailableandexpectedoutcomes/impactsviaanalysesofindividual- andcontextual-levelfactorsrelevanttothedesign,implementationandevaluationofatailoredtraininginitiative.Itiscriticaltomanageexpectations,ascommitmenttoongoingandprogressivetrainingislikelyrequiredtoaffectthebiological,psychological,socialandculturalprocessesthatleadtodesiredoutcomes.

keytasksneeds,prioritiesandresourcesassessmentdetailedanalysesofworktasksandsystems

tipsbeginwithend-in-mind(considerevaluation)leverageexistingprogramsandsystems

commonmistakesunrealistictimelines,expectedresults,etc.insufficientstakeholderinput

commonchallengesachievingandsustainingstakeholderbuy-inmanagingexpectations

3

Design involvescraftingatrainingplan– comprisedofgeneralandspecificcomponents– basedontheassessment.Generaltrainingisdesignedtopromoteandsupporthealth-enhancingbehaviours(e.g.adequatephysicalactivity,nutrition,sleep,stressmanagement,etc.),withprimaryemphasisonusingprogressiveexercisetobuildandmaintainphysicalliteracyandcapacity.Thegeneraltrainingyieldsthefundamental“buildingblocks”neededtoreapbenefitsofspecifictraining.Specifictrainingisdesignedtotrainworkerstofirstidentifyandassesstheirwork-relatedhealthhazardsandrisksbeforetrainingthemto(re)organizetheirworkand/orbodilymovementstoeffectivelyregulateunderpinningbiopsychosocialstressors.Todothiswell,itiscriticaltoco-createandcontinuallyco-evolvetrainingwithinputfromstakeholderswhohavetacitknowledge(especiallyexperiencedworkers).

keytasksadaptresearchtolocalcontextaccommodatebarriers/enablers

tipsconsultresearchandexperiencedpractitioners

commonmistakesone-size-fits-all(“cookie-cutter”)programsincompleteergonomicscontentandpractice

commonchallengescausesandconsequencesofMSDarecomplexincorporatingtrainingintomultimodalMSDpreventionprogram

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Causes/consequencesofMSDmultifactorialandcomplex– manualhandlingtrainingbyitselfcanonlydosomuch.Assuch,weproposecombiningbothgeneral(health,fitnessandperformance)andjob-/activity-specificcomponents.

generalcomponentpromoteandsupportoverallhealth• nutrition,sleep,physicalexercise*• stressmanagement,emotionalregulation• smokingcessation,limitalcoholconsumption

*Thereispreliminarysupportforthenotionthatengaginginphysicalexercise canhelppreventandmanageill-effectsthatmanualhandlinghasonworkerhealthandperformance.Basedontheavailableevidence,thespecificexercisedosesrequiredareunknown,asaretheunderlyingmechanisms.However,whenexerciseelicitsimprovementsinphysicalliteracyandstrength,thereisboththeoreticalandempiricalgroundsforitsinclusionasageneralcomplementtoworkplace-specificmanualhandlingtrainingprograms,providedthatoveralllifestressesaremonitoredandmanagedaccordingly.

specificcomponentself-monitorandself-regulateworkstressorsi. hazardidentification&riskassessmentii. interprethazards&risksiii. transformwork(tasks,environments,systems)tocontrolhazards&reducerisks

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Implementation isputtingthetrainingplanintoaction.Generaltrainingneedsstakeholder-specificmessagingtoconjuresupportnecessarytochangeattitudes,beliefsandhealthbehaviours.Acentralmessageisthatwhenexerciseisadministeredbasedonfoundationalprinciplesandpracticesofkinesiology,itisnotonlyapowerfultooltocultivateoverallworkerhealthandwellbeing,butalsodevelopsthecapacitytomeetdemandsofwork,lifeandplay.Supportfromorganizationalleadershipisneededtofosterworkers’capabilities,opportunitiesandmotivationstoexercise;thisusuallyconsistsofproviding:time;space;equipment;andaccesstohealthprofessionalswhocanhelpmanagelifestressors.Specifictrainingusesexperientiallearning(vs.didacticteaching)methodstotrainworkerstosafelyandeffectivelymeetjobdemandsby:using(in)formalhazardidentificationandriskassessmenttoolsto“read”theirworksituations;andmodifyinghazardousorhigh-risksituationsusingacombinationofergonomicandpersonalmovementstrategies.Itiscriticaltoprovidepracticeactivitiesandenvironmentsthataccuratelyrepresentrealisticworkingconditions,andforworkerstoexperimentwithandreflectontheirmovementstrategiestodevelopsituationalandbodyawarenessrequiredtoregulatework-relatedstresses.

keytaskstrain& coach (vs.teach)workerstohandlesafelyandeffectively

tipsprioritizecompetencyandskilldevelopment(vs.technique-training)

commonmistakesoveremphasizeknowledgetransfer(education&teaching):trainer vs.trainee-centredunderemphasizepractice(training&coaching):manualhandlingisamotor activity,afterall

commonchallengesappropriatecommunication/messagingprioritizinglearning overteachinglackoftimeandexpertise

6

Ononehand,exercisesimplyprovidesthe“rawmaterials”or”ingredients”tomakethemostofspecifictraining.But,usingmoresophisticatedmethodsofexercisedesignandimplementation(i.e.basedonfundamentalkinesiologytheory),wehavealsoshownthatifwe“coach”exercisetochangepreferredmovement“habits”,thesehabitstransfertojob-specificactivitieswithouthavingtorehearse/practicethejob-specificactivitiesthemselves.Thisisespeciallypromisingfortheactivitiesperformedbyemergencyrespondersandhealthcareworkers(esp.in-home)becausetheirworkenvironmentsandtasksareoftenhighlyvariableandunpredictable.

Usingthismoresophisticatedexerciseapproach,traineesessentiallylearntopositionandmovetheirbodiesmoreeffectivelywhenexecutingreal-worldtasksbecausetheyhavedevelopedthecapabilitiestobetter“read”and“interpret”theirtask-environment,andtohavebetterawarenessoftheirowncapabilitiesingivencircumstances(i.e.to“act”basedontheirinterpretation).

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Experientiallearningparadigmsusedtotrainworkerstodevelopsituational- andself-awareness.Wecomparedthestandard”teaching/educating”(didacticmethod)to“coaching/training”(experientiallearningmethod),andfoundslightadvantageforthelatterapproachforacquisition,retentionandpositivetransferoflearning/traininginacontrivedlaboratorystudy.Eitherapproachmayworkwellwhenthejobtasksaresimilarandpredictabletothetraining/learningsetting,but…[nextslide]

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…theevidenceisnotconsistentonhowwellcontrivedtraining/learningactivitiestransfertocomplex,real-worldscenariosthatdifferremarkablyfromthepracticesetting.

9

Wehavestartedtakingourresearchtothefieldtobetterdesignrealisticpracticeconditions(tofacilitatepositivetrainingtransfer).We’vebeenexperimentingwithtrainingfirefighterstorecognizehazards/risksassociatedwiththeirtasks,andlearningtoadapttheirworktasks,environmentsandsystems(usingergonomiccontrols/strategies),andbyadaptingtheirmovementstrategiestoregulatethestressorsimposedonthebodywithoutnegativelyimpactingperformance/safety.Ourinitialresultsarepromising,butwehavealotofanalyseslefttofinish.

10

SomeofthemostpromisingworkisbeingdoneonthistopicisthatdonebyDr.Dutta’steam.They’recombiningdidacticteachingandexperientiallearningmethodstogetherwith“wearables”tofacilitatelearninginrealisticpracticesettings.Biofeedback(vibrotactileand/oraudio)isbeingusedtoalertperformersabouttheirspinalmotionsduringvariouspatienthandlingscenariosinasimulatedhome-livingenvironment.Thisbiofeedbackapproachiscombinedwitheducationandteachingaboutthereasonswhycontrollingspinemotionduringphysicallydemandinghandlingactivitiescanhelpbuildlow-backresilienceandmaintainhealth.

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Theirinitialresultsareextremelypromising.They’veshownthatusingtheirmulti-modaltechniquecannotonlyfacilitatedesiredchangesinmovementstrategies,butthatthesechangesaresustainedover2months!

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Evaluation referstotheongoingmonitoringandcriticalreviewoftrainingprocesses,outcomesandimpacts.Processevaluationfocusesonjudgingthequalityoftraininganditsdelivery,andconsistsofindicatorsthattraining:reachesandengagesintendedworkers;isdosedsufficientlytobuildandmaintainrequisiteskillsandcompetencies;andleadstoexpectedchangesinworkpractices.Outcomeevaluationfocusesontheultimategoal(s)oftraining,commonlyevidencedbyreducednumber,severityandimpactofMSDswithoutnegativelyimpactingworkerororganizationalperformancebenchmarks(impacts).Priortodesigningandimplementingtraining,itiscriticaltoagreeontheevaluationindicators,howandwhentheywillbeassessed,andbywhom.

keytasksassesstrainingprocesses,outcomesandvalue

tipsfinalizeevaluationplanbefore trainingstartsidentifyqualityimprovementopportunities(ongoingfeedbackonprocesses)allowtime(behaviourchangeslowprocess)

commonmistakesworkerreactions,learningandbehaviourseldomevaluated(appropriately)

commonchallengesinsufficientresourcesmaintainingcontrolsandobjectivity

13

Manualhandlersshouldreceivehigh-qualitytrainingtopreventandmanagetheassociatedmusculoskeletalhealthrisks.Trainingprogramsareineffectiveiftheyfailtodevelopandmaintainrequisitecompetenciesandskillsoftheseworkersto:recognizeandinterprettheirhealthhazardsandrisks;andadapttheirworksituationsandbodilymovementsaccordingly.Generalguidelinesfordeveloping,deliveringandevaluatinghigh-qualitymanualhandlingtrainingareprovidedonnextslide,buttrainingshouldbetailoredtoaccommodatestakeholderneedsandwants(identifiedviaathoroughassessment).

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