Effect of transfer, lifting, and repositioning (TLR) injury prevention program on musculoskeletal injury among direct care workers

Timothy R. Black, Syed M. Shah, Angela J. Busch, Judy Metcalfe, Hyun J. Lim

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47 Citations (Scopus)


Musculoskeletal injuries among health care workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results, and strong evidence for intervention effectiveness is lacking. The purpose of our study was to evaluate the effectiveness of a Transfer, Lifting and Repositioning (TLR) program to reduce musculoskeletal injuries (MSI) among direct health care workers. This study was a pre- and post-intervention design, utilizing a nonrandomized control group. Data were collected from the intervention group (3 hospitals; 411 injury cases) and the control group (3 hospitals; 355 injury cases) for periods 1 year pre- and post-intervention. Poisson regression analyses were performed. Of a total 766 TLR injury cases, the majority of injured workers were nurses, mainly with back, neck, and shoulder body parts injured. Analysis of all injuries and time-loss rates (number of injuries/100 full-time employees), rate ratios, and rate differences showed significant differences between the intervention and control groups. All-injuries rates for the intervention group dropped from 14.7 pre-intervention to 8.1 post-intervention. The control group dropped from 9.3 to 8.4. Time-loss injury rates decreased from 5.3 to 2.5 in the intervention group and increased in the control group (5.9 to 6.5). Controlling for group and hospital size, the relative rate of all-injuries and time-loss injuries for the pre- to post-period decreased by 30% (RR = 0.693; 95% CI = 0.60-0.80) and 18.6% (RR=0.814; 95% CI=0.677-0.955), respectively. The study provides evidence for the effectiveness of a multifactor TLR programfor direct care health workers, especially in small hospitals.

Original languageEnglish
Pages (from-to)226-235
Number of pages10
JournalJournal of Occupational and Environmental Hygiene
Issue number4
Publication statusPublished - Apr 2011


  • ergonomics
  • health care workers
  • injury prevention
  • musculoskeletal injuries
  • occupational health
  • transfer, lifting, repositioning program

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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