Evaluation of MSOT students’ didactic knowledge and practice vs. real-time performance in manual patient transfers

Abstract

BACKGROUND:

Due to the nature of its occupations, the healthcare industry recognizes that manually lifting, transferring, and handling patients are high-risk activities and leading factors for work-related musculoskeletal disorders. Research studies highlight that students are not receiving adequate training in manual patient transfer.

OBJECTIVE:

The objective of this study was to examine the procedural knowledge in patient transfer of second-year Master of Science in Occupational Therapy students and their practical skills in performing a manual patient transfer.

METHODS:

This observational, cross-sectional study included 23 occupational therapy students. Students completed the transfer technique knowledge assessment and subsequently performed a real-time manual patient transfer.

RESULTS:

No significant association was found between the participants’ knowledge and performance in MPT (x²(2) = 0.578, p = 0.749). All students scored highly on the knowledge assessment (μ= 9.3, SD =±1.02); however, the performance on real-time manual patient transfer was moderate (μ= 11.57, SD =±3.37) for the majority of students.

CONCLUSION:

A gap exists between the results of students’ knowledge and practice versus real-time performance in manual patient transfer. The practical training students receive on manual patient transfers in the academic setting may not equip them with the necessary skills and techniques to perform safe transfers.

Keywords

Academic training musculoskeletal pain education occupational injuries occupational therapy

1 Introduction

Occupational therapy tasks within healthcare settings involve demanding physical activities such as patient transfers. Patient handling techniques are taught to occupational therapy students as part of their academic educational program. However, students are a particularly vulnerable group at risk of developing musculoskeletal disorders. Because of the potential for harm to both the patient and the occupational therapy student, transferring a patient may be deemed a high-risk maneuver [1]. During fieldwork education, healthcare students demonstrate inadequate understanding and awareness of body mechanics and safe patient handling techniques and guidelines [2 –4]. As the result, this may increase the rate of current and future on-the-job musculoskeletal injuries [5 –7]. Furthermore, a gap may exist between healthcare student knowledge of safe and correct patient handling techniques, which is received duringtheir academic education, and the application of patient handling skills by healthcare students in actual clinical settings during fieldwork training [3, 8].

Most accredited occupational therapy educational programs address patient handling in lectures and laboratory-based experiences emphasizing safe body mechanics [9]. However, the teaching methods involving limited student involvement and hands-on learning reduce the students’ abilities to transfer knowledge into practice. The ability of students to convey patient transfer knowledge and to improve self-efficacy over time is to expand on active participation and observation of dependent patient transfer [10]. Giles et al. [11] assessed occupational therapy student preparedness for level II fieldwork through comprehensive practical exams (CPE) using simulated patients and reflective video analysis. Giles et al. [11] found that CPE helped create a mental shift from normal didactic work to integrated clinical work. Additionally, student feedback reflected a need for clinical preparation in a simulated setting with greater expectations (i.e., experiential learning) as the students’ progress through coursework (i.e., situated learning). Giles’ study supports the use of reflective video analysis (i.e., reflective practice) to identify strengths and areas for improvement before starting occupational therapy level II fieldwork [11]. Freeburg [12] introduces an approach that creates a culture of practice in the classroom through consistently engaging students in practical work regarding what they learn. Slusser et al. [9] highlight that the curricular content of occupational therapy programs must include and emphasize no-lift and limited-lift policies, revised NIOSH lifting equation (RNLE), and instructions on mechanical lift devices.

Occupational therapy is an example of a frequently tasked profession with manual patient handling (MPH) and related activities [13 –15]. Universities that offer accredited entry-level occupational therapy programs must provide their students with the most current knowledge and skills, as well as develop methods to ensure their transition into practice to prepare to practice occupational therapists for the demands of the clinical setting [8 , 11].

In studying patient-transfer tasks, objective data such as biomechanics and kinematics of body motions and muscular activities in healthcare students is limited [16]. Larsen, Butler, Lawson, and Roediger [17] point out that retention of information and transferring academic knowledge into clinical application requires further investigation to identify methods and strategies for connecting learning and application. Thus, methods of teaching the skills and knowledge of patient transfer and converting them into real practice must be examined. If students’ skills and knowledge of patient transfer are superficial, their competence and confidence levels in performing patient transfer may be questionable. Problems in teaching traditional manual patient transfer must be identified, improved, and corrected. Therefore, the purpose of this study was to examine the second-year Master of Science in Occupational Therapy (MSOT) students’ procedural knowledge of patient transfer and their practical skills in performing a real patient transfer. The results of this study were intended for health sciences education programs that teach patient transfer to students. The results might further education and training to improve the transition of knowledge and learning of patient transfer into real practice.

2 Methods

2.1 Design and participants

The present study is an observational cross-sectional study where participants were examined at one point in time. The main variables of the investigation were knowledge and performance of manual patient transfer (MPT; continuous variables).

Students were recruited from the Florida International University’s Master of Science in Occupational Therapy program (MSOT) by convenience sampling to assess student knowledge and performance in patient transfers. Inclusion criteria were as follows: 1) currently enrolled as MSOT students; 2) aged between 18 and 65 years, and 3) enrolled in an academic course in ergonomics and manual patient transfers. Subjects with a current diagnosis of musculoskeletal disorders were excluded from the study. All recruited students who participated in the study were in the second year of the program, semester five, and the final semester of didactic coursework before clinical fieldwork. Prior to this semester, the curriculum included courses covering movement and kinesiology and two semesters encompassing musculoskeletal disorders (lectures with concurrent practice laboratories). All students had engaged in a four-week clinical experience during the third semester; however, it did not include the opportunity to perform transfers. Students were enrolled in a class and laboratory learning about assessment and interventions with adults with neuromotor disabilities. Training in the use of MPTs was covered in various contexts and with a variety of populations. All laboratories consisted of groups of 14–16 students who worked together during the semester. Instructors of the adult rehabilitation courses (lectures and laboratories) discussed and demonstrated various transfer types, safety, body mechanics of a transfer, transfer tools, and the amount and level of assistance. University facilities included access to various tools, such as wheelchairs, transfer devices, and a full medical simulation center. Students were able to self-select partners but were encouraged to attempt activities with a variety of their peers. Laboratory practice was performed using peers as the identified “patient” and included repeated student-to-student transfers. The laboratory instructor provided demonstration and feedback to students as they performed their activities, developed a rubric for assessing competencies and administered the practicums to assess these competencies (including transfer competencies). All study participants had previously passed a practicum where they demonstrated the correct use of a one-person assist transfer from a wheelchair to a chair or mat.

2.2 Procedure

The screening tool (part I) was distributed via email to all MSOT students during the Spring semester who recently completed a course in ergonomics and manual patient transfers during the previous Fall semester and in their final semester at the university. Students, who met the inclusion criteria of the screening tool and were interested in participating in the study, attended one of two scheduled sessions and signed the participant consent form. Subsequently, each participant was briefed and asked to complete part II. Following completion, each participant was asked to perform a standing-pivot transfer in a private room and was evaluated using part III of the research instrument. Lastly, participants received free lunches at the site as an incentive.

The researchers trained two investigators only to administer and score the observation-based checklist. The training included matching the transfer steps with the list and observing anatomical parts based on positions such as the back, hips, knees, and feet. The investigators were trained to score the checklist by checking “yes” if the step was observed and “no” if the step was not. Then, adding the number of “yes” was to determine the final score. During both testing dates, the two investigators administered the transfer technique knowledge assessment, a paper-and-pencil assessment that required no training, and the observation-based checklist. To ensure reliability, the two investigators observed and checked the real-time performance of the transfer on the observation-based checklist. The two investigators reviewed the transfers via a video recording to verify their observations with one additional investigator and confirm their final score. The principal researchers analyzed the data, discussed the results, and concluded.

Safety measures were implemented to protect the student and the patient. A private room was used for the evaluation to avoid distractions and to stay focused on the transfer activity. The standing-pivot transfer was performed in the center of the room, providing appropriate space for the pivot. Objects around the transfer area or on the floor were removed that might disrupt the transfer. The floor was checked for smoothness to ease the transfer activity but not slippery or rough to cause a fall. Appropriate lighting was ensured, and the temperature was set at 72° F (22° C) to avoid sweating hands and forearms, prevent slipping, and maintain comfort.

On the day of the MPT, video recording was set up to accurately assess participant performance, increase internal validity, and decrease bias. To improve internal validity and control all factors related to the patient, the transfer involved the same 26-year-old male with cerebral palsy. John (pseudonym) was previously known to the occupational therapy department, and John had no employment or association with the department except occasionally presenting discussions to students about his experience with disability. The patient consented to participation in the study. John required minimal assistance; therefore, the researcher focused on the students following the transfer steps. Before performing the MPT, students were instructed on the patient’s condition and asked to perform a standing-pivot transfer. Subsequently, the patient provided feedback regarding each student’s performance. Students did not observe nor reflect on their performance. Participating students were reimbursed with a complimentary meal, and the volunteer patient was reimbursed with a $25 movie gift card. This research protocol complied with the tenets of the Declaration of Helsinki of 1964 and its later amendments or comparable ethical standards [18].

2.3 Instrumentation

Instruments were parts from assessments developed and published by Murphy and Norman [19] and Potter et al. [20]. Reliability and validity were not published by the authors. The assessments combined and formed three parts. Part I included a screening tool and a demographic questionnaire to gather general information about the study participants. Part II included the transfer technique knowledge assessment to determine the student’s current knowledge of safety and proper biomechanics and ergonomic principles during manual patient transfer [19]. The assessment was in a true-false format with 10 items. A correct answer was scored with 1 and an incorrect answer with 0. Part III comprised an 18-item observation-based checklist to determine the application of knowledge on safety, procedure, and biomechanics, and ergonomic principles by students during a real-time manual patient transfer [20]. Furthermore, part III included section I (six items): preparation for manual patient transfer; section II (eight items): body alignment during patient transfer; and section III (four items): continuation of manual patient transfer. Item performance was scored “yes = 1” and failure to perform as “no = 0.” A score of 14–18 (>75%) was considered high performance, 9–13 (≥50–74%) as moderate performance, and 0–8 (<50%) as poor performance.

2.4 Data analysis

The Statistical Package for the Social Sciences (SPSS-24) was used for analyses. Data from Parts I, II, and III of the research instrument was analyzed using descriptive statistics. The Chi-Square Test of independence was conducted to examine the association between knowledge and performance of MPT. In addition, the Chi-Square Test of independence was used to examine the association between Sections I, II, and III of the observation-based checklist. The alpha level was set at p≤0.05.

3 Results

Twenty-three (96%) out of twenty-four students from the MSOT program participated in the present study. Participation age ranged from 24–49 (μ= 28.4, SD = 7.2), with 21 (91%) females and two (9%) males. The screening tool (part I) showed that a prior injury was reported by 13% (n = 3) of participants, prior education in MPT besides the current course in ergonomics and MPT was reported by 96% (n = 22), and previous experience in MPT was reported by 87% (n = 20).

3.1 Student knowledge in manual patient transfer

The results of the knowledge assessment (μ= 9.3, SD=±1.02) are presented in Table 1. No participant scored low (0%), two participants scored moderate (9%), and twenty-one participants scored high (91%). Fourteen participants (61%) answered all questions correctly (10/10), whereas two participants (9%) answered 7 of 10 correctly, which was the lowest score. The question answered most often incorrectly (n = 4, 17%) was related to assistive technology knowledge.

Table 1
MSOT Students’ performance on the Transfer Technique Knowledge Assessment

N = 23

Topic Correct n

Use of chair alarms 83% 19

Lift away from center of gravity 87% 20

Injury to client 87% 20

Position of gait belt 91% 21

Use of assistive devices 91% 21

Back injury and body mechanics 91% 21

Brakes on wheeled transfers equipment 100% 23

Explaining transfer procedure 100% 23

Attention to good body mechanics 100% 23

Who performs patient transfer 100% 23

	N = 23
Use of chair alarms	83%	19
Lift away from center of gravity	87%	20
Injury to client	87%	20
Position of gait belt	91%	21
Use of assistive devices	91%	21
Back injury and body mechanics	91%	21
Brakes on wheeled transfers equipment	100%	23
Explaining transfer procedure	100%	23
Attention to good body mechanics	100%	23
Who performs patient transfer	100%	23

3.2 Student real-time performance in manual patient transfer

Based on the observation-based checklist, the average overall performance was 11.57±3.37, which indicated a moderate level of overall average performance at 60.6%, with 13% low, 57% moderate, and 30% high patient transfer performance. Examining performance at each section separately (Table 2), the average performance for section I (preparation for manual patient transfer) was 6.09±1.16, which indicated a moderate performance at 68%. The most neglected procedure was a failure to position the chair next to the bed (n = 17, 74%). The average performance for section II (body alignment during manual patient transfer) was 4.52±2.25, which indicated moderate level performance at 56.5%. The most ignored biomechanics principles were the use of leg muscles instead of back muscles (n = 17, 74%), bending of knees and hips to 90 degrees (n = 16, 70%), and maintaining natural spinal alignment (n = 15, 65%). Finally, the average performance for section III (continuation of manual patient transfer) was 2.96±1.06, which indicated a moderate level performance at 74%. The most ignored safety procedure was not guiding the patient to sit (n = 7, 39%).

Table 2
MSOT Students’ Performance on the Observation-Based Checklist

Task Order Performed

Preparation (Section I)

(01) Positions chair next to bed. 26% *

(04) Instructs pt. on placement of arms. 56%

(06) Allows pt. to steady himself. 65%

(05) Asks pt. to stand and moves to upright position. 78%

(03) Face Pt. and braces feet and knees against pt.’s

feet and knee. 83%

(02) Apply Transfer Belt. 100%

Body Alignment (Section II)

(08) Uses leg muscles instead of back muscles. 26%

(12) Bends knees and hips to 90 degrees. 30%

(09) Maintain natural spinal alignment. 35% **

(11) Position Pt. at level of muscles being used. 56%

(07) Bends hips and knees to 90 and grasps belt. 61%

(10) Keeps a wide stance with one foot forward. 74%

(14) Shift weight from side to side (not by twisting). 83%

(13) Shift body weight by moving feet. 87%

Continuation (Section III)

(17) Has pt. flex hips &knees as lowers self to chair. 61%

(16) Positions pt. to sit and hands on arms of chair. 70%

(15) Instructs pt. to pivot. 74%

(18) Assists pt. to comfortable position in chair. 91%

Task Order	Performed
Preparation (Section I)
(01) Positions chair next to bed.	26% *
(04) Instructs pt. on placement of arms.	56%
(06) Allows pt. to steady himself.	65%
(05) Asks pt. to stand and moves to upright position.	78%
(03) Face Pt. and braces feet and knees against pt.’s
feet and knee.	83%
(02) Apply Transfer Belt.	100%
Body Alignment (Section II)
(08) Uses leg muscles instead of back muscles.	26% **
(12) Bends knees and hips to 90 degrees.	30% **
(09) Maintain natural spinal alignment.	35% **
(11) Position Pt. at level of muscles being used.	56%
(07) Bends hips and knees to 90 and grasps belt.	61%
(10) Keeps a wide stance with one foot forward.	74%
(14) Shift weight from side to side (not by twisting).	83%
(13) Shift body weight by moving feet.	87%
Continuation (Section III)
(17) Has pt. flex hips &knees as lowers self to chair.	61%
(16) Positions pt. to sit and hands on arms of chair.	70%
(15) Instructs pt. to pivot.	74%
(18) Assists pt. to comfortable position in chair.	91%

*Most not performed steps during preparation for manual patient transfer. **Most not applied biomechanics principles for body alignment during patient transfer.

3.3 Student knowledge vs. performance

The Chi-square test of independence showed no statistically significant association between the participants’ knowledge and performance in MPT (x²(2) = 0.578, p = 0.749). In addition, there was no significant association between the participants’ knowledge and real-time performance in Section I (preparation for MPT), Section II (body alignment during MPT), or Section III (continuation of MPT). A basic comparison between participant knowledge and performance in MPT, however, showed that 13% (n = 3) of participants performed poorly (≤39%) despite scoring high on knowledge. Also, 57% (n = 13) of participants performed moderately (50–72%) despite scoring high on knowledge, and 30% (n = 7) of participants performed well in knowledge assessment (≥78%) and patient transfer.

4 Discussion

4.1 Traditional teaching methods of MPT

The current study determined no association between student learning and practice in the classroom (lecture and laboratory) and patient transfer performance. Students were expected to perform well in the knowledge-based assessment. Most students demonstrated adequate procedural and academic knowledge in body mechanics and safety regarding MPT. The knowledge-based assessment may reflect a sound introduction of didactic presentations of patient transfer to students. However, considering the few number of items (10) and low to moderate difficulty levels, the knowledge assessment may not represent an optimal assessment of knowledge. For future studies, we recommend implementing a wide-ranging assessment of knowledge in body mechanics and safety, including patient transfer scenarios and settings, patient transfer techniques and steps, and transfer equipment.

The present study demonstrated a moderate hands-on performance by students on a volunteer patient. As shown by the observation-based checklist, only 30% of participants performed well on the MPT. The low percentage may indicate inappropriate and insufficient patient transfer learning experience in laboratory trials (student-to-student) for students to deliver safe and applicable patient transfers. Similarly, Baird et al. [10] concluded that participation only (students-to-student transfer) was inadequate to prepare students for skillful patient transfer. Furthermore, Giles et al. [11] explained that after students viewed their performance in simulated patient handling, their confidence and readiness for fieldwork experience was transformed, with a mental shift from student to therapist. Moreover, Hodgetts and colleagues [21] underlined that students were very satisfied with the overall procedural knowledge received from occupational therapy professional education. However, students were unsatisfied with the preparation for clinical practice and felt that they did not receive the necessary hands-on technical skills required. In addition, students felt incompetent in handling patients. In addition, Grierson and colleagues [22] highlighted the need for education curricula for health professions to focus on hands-on technical training, including patient transfer and communication skills, as both may impact the students’ perception of their patient handling competency. Moreover, Johnsson and colleagues [23] concluded that students who received additional training with a simulated patient improved in all skills and techniques of MPT and performed much better than students who did not receive additional training. Therefore, lectures and traditional practices on patient transfer may be limited learning methods for providing students with acceptable patient transfer skills.

The results of the observation-based checklist showed no significant association between Sections I, II, and III. However, a close examination of Sections I, II, and III of the observation-based checklist showed that students performed most poorly on Section II, especially on items related to maintaining an erect back and bending hips and knees during the transfer. Despite over 90% of participants answering the questions on proper body mechanics correctly, correct body mechanics was the area where students struggled most during their performance. Maintaining natural spinal alignment and bending the hips and knees to 90 degrees are essential steps for protecting the practitioner from injuries and providing greater stability and force to lift the patient during transfer. Our findings may support previous research conclusions that occupational therapy practitioners and students most commonly experience work-related musculoskeletal disorders (WMSDs) in the lower back, neck, and shoulder [15 , 24–26]. During the real-time transfer, all participants correctly applied the gait belt; however, 39% neglected to grasp it. Correct use of the gait belt may help stabilize a patient, especially when they lose their balance, assist the patient to stand and/or sit, and protect the practitioner from a back injury. Cheung and colleagues [16] concluded that wearing a transfer belt can reduce the incidence of musculoskeletal injury in the lower back.

Patient transfer can be a stressful activity, particularly for students and new practitioners. The presence of stress and anxiety may disturb the transfer process from initiation to completion. Ergonomics Technical Advisory Group (ETAG) explains that simply teaching body mechanics is inadequate for safe patient transfer and preventing musculoskeletal disorders. ETAG instead proposes the following approaches: lift-aid devices and equipment for manual handling, ergonomics management programs, and ergonomics-based prevention programs [27].

Sections I and III showed that students’ performance was borderline in preparing the patient and completing the transfer. A comparison of the results of Sections I and III to Section II indicated that students may exert more effort and pay attention to patient safety rather than their own. Paying full attention to patient safety may reduce patient falls; however, neglecting one’s safety may increase injury risk. Students are required to understand that their safety is also a priority and that their health status may influence the quality of healthcare services provided and their productivity level. Additionally, students had difficulties getting the patient to stand up. They did not squat deep sufficiently, thereby placing themselves and the patient at risk of falling. The students had difficulties maintaining the patient in the standing position, and they did not provide the patient an opportunity to stabilize himself after removal from the chair and before proceeding with a rotation towards the other chair. Moreover, most students dropped the patient into the chair upon descent rather than easing him down. The students’ inability to control the transfer was also evident through the students’ use of their back and arm muscles instead of the leg muscles. The inability to control the transfer was of major concern as many students did not check if the transfer surfaces were positioned correctly. Some students were unable to move the patient down over the center of the seat, putting the patient at risk of falling off the side of the chair.

4.2 Diversity in education methods and competency in Patient Handling

Graduate-level occupational therapy programs should provide students with ongoing opportunities for quality hands-on MPT practice with volunteer patients and education in the use of manual transfer equipment. Diemers and colleagues [28] explain that practicing on a real patient provides students the opportunity to observe patient limitations and disease impact, link knowledge with practice, and improve clinical reasoning. Programs should provide students with visual feedback and reflection opportunities through video recording or MPT performance in front of a mirror. Consequently, students can correct themselves, enabling better kinesthetic training, as they would increase awareness of correct versus incorrect body mechanics. Moreover, Rød and colleagues [29] underscore that engaging students in in-simulation with interprofessional teams improve self-confidence and competence during practice and, more likely, in future clinical practice. Also, Hodgetts and collaborators [21] highlight that educational programs must teach students to recognize their competency level and the appropriate tasks that best match their skills, as well as teach students that competency levels increase with time and is an ongoingprocess.

Moreover, NOISH [1], Riccoboni et al. [30], Law et al. [31], and Muona et al. [32] emphasize that using motorless and motorized assistive equipment during a patient transfer reduces the load and force on the body and the chance of developing musculoskeletal disorders. However, Kanaskie and Snyder [33], Lafleur [34], Kayser [35], Galinsky [36] and their colleagues describe that a patient’s physical and cognitive status, age, mass, mobility, and health condition, in addition to facility size, practice area, professionals-to-patient ratio, interprofessional collaboration, time available, and access to equipment, affect the decision to perform whether manual or safe patient transfer. In addition, research studies indicate that not all hospitals and home care settings have available mechanical/motorized patient handling equipment [5 , 38]. In a more recent study, Kayser and colleagues [35] highlight that the prevalence of implementing safe patient handling and mobility devices is low. They suggest a need for studies to further examine the availability of equipment in healthcare facilities and whether healthcare professionals use them if available. Thus, advancing the training of students and professionals on manual patient handling, improving the availability and access of equipment and encouraging their use, and emphasizing prevention programs are needed to continue at this stage. Healthcare education programs should incorporate training programs that encourage safe approaches to handling patients and contribute to preventing MSDs among students and future professionals. Students need to explore and practice using safe patient handling equipment as laws have been enacted to utilize such devices since 2005 in various states in the US [1].

4.3 Future practice with musculoskeletal disorders

Evidence from the literature shows that musculoskeletal disorders among healthcare providers are mainly related to patient handling, and that patient transfer is the leading cause of injury. In occupational therapy, several studies have found a strong association between patient handling and the prevalence of musculoskeletal injuries, with patient transfer as the primary activity of such injuries [15 , 39–42]. Moreover, recent graduates and practitioners with few working years are at the greatest risk for developing WMSDs [15, 40]. Earlier stated research studies highlight that patient handling, including transfers, was the main factor associated with WMSDs among healthcare professionals, including OTs. Thus, this study’s results may suggest the possibility of students developing WMSDs due to underdeveloped skills in patient transfer just prior to entering the profession. Hence, graduate students may join the profession with incompetence in patient transfers that may lead to WMSDs or the possibility of preexisting musculoskeletal disorders due to their educational training in manual patient transfers. Similarly, Morabito et al. [26] fundings supported that OT students experienced WMSDs during their work-based training affecting their daily activities before graduating. They found that 33% of OT student respondents reported WMSDs in the last 12 months. According to our findings, most causes of WMSDs may be due to the need for good training techniques, ergonomic principles, and transfer equipment within the educational program. Occupational therapy students may not be adequately prepared for real-time patient transfer, which positions students for the future risk of WMSDs. One way to prevent WMSDs among occupational therapists may be to begin prevention at the education level. Occupational therapy students should graduate mastering the knowledge and skills of patient transfers.

4.4 Limitations

The twenty-three participants were only recruited from one occupational therapy program. Also, the sample size was small with a limited spread of ages and gender. Therefore, the results may not be generalizable to other institutions, rehabilitation professionals, age, or gender. In this study, a standardized patient was recruited for the participants to perform the transfer. However, research studies have shown that a patient’s age, mass, mobility, and health condition, in addition to the care unit or area, influence the decision to perform the transfer [34, 35]. Thus, a varied patient sample may provide a dynamic understanding of manual and safe patient transfers. Furthermore, knowledge assessment may not reflect an accurate, true knowledge assessment for association with a real-time MPT.

5 Conclusion

Occupational therapy students are at risk of musculoskeletal disorders due to neglecting their safety and proper body mechanics during MPT. A gap exists between knowledge gained through lectures and training and the requirements to perform a real-time MPT. Didactic presentations of MPT are sufficient for students to acquire and retain such information. However, laboratory training (student-to-student) is inadequate to support students’ skills and techniques in performing accurate and safe MPT. Occupational therapy students require further and more in-depth, hands-on experience to master MPT.

5.1 Implications, recommendations, and future research

Our findings may be used to vary the laboratory content for training in MPT. The following suggestions may help students to grasp the skills and techniques of MPT. Varying techniques and methods of patient handling may be required, and skills development and refinement may be best taught through real-time experience. Therefore, advancing the learning process through real patient practice and increasing the time for hands-on experiences are necessary [28]. Moreover, practice emphasis on body alignment during MPT may be required, such as bending the knees and hips, using leg muscles, and maintaining a natural spine [43].

The results of this study direct to several recommendations to further improve MPT practice. Adding more resources for practicing MPT, such as video recording, patient simulation, robot patient, and personalized face-face feedback from the educator to the student, would further advance the learning process [22 , 44–46]. Moreover, managing the frequency of daily patient transfers, encouraging and teaching patients to be more self-reliant, and advancing the use of assistive devices would reduce physical exertion [47]. Training students in patient transfer by experienced clinical instructors is essential [48].

Recent research studies and NIOSH reports have shown that safe patient handling is more effective, reliable, and safer than manual patient handling [1 , 49–51]. Therefore, introducing safe patient handling programs and practicing safe patient transfer using transfer tools and devices, such as sliding boards, air-assisted lateral sliding aids, powered full-body sling lifts, standing assist and repositioning aids, and mechanical lifts would be central to promoting the safety of the students, professionals, and patients [4 , 52]. Practicing and implementing ergonomics-based prevention programs would help reduce injuries and absenteeism, reduce patient injuries, and increase productivity [1 , 53–55]. Finally, enforcing a safe transfer practice policy would support the quality of occupational health among healthcare professionals and improve patient safety [4 , 55].

Further research should be performed to explore knowledge versus competence in MPT that students may have learned after level II fieldwork or during their first year of practice. Students need to gain transfer knowledge and experience in academic laboratories, as not all students are provided such opportunities during level II fieldwork. Also, future research should consider investigating age, gender, mass, policies, and education program outcomes in patient transfers.

Footnotes

ACKNOWLEDGMENTS

The authors would like to thank the occupational therapy students at Florida International University for their contribution to this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Data availability statement

The data used to support the findings of this study are available from the corresponding author upon reasonable request.

Funding

The authors have no funding to disclose.

Ethical approval

The study was approved by the Florida International University (IRB-18-0054).

Informed consent

All participants signed the consent form prior to conducting the study.

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	N = 23
Topic	Correct	n
Use of chair alarms	83%	19
Lift away from center of gravity	87%	20
Injury to client	87%	20
Position of gait belt	91%	21
Use of assistive devices	91%	21
Back injury and body mechanics	91%	21
Brakes on wheeled transfers equipment	100%	23
Explaining transfer procedure	100%	23
Attention to good body mechanics	100%	23
Who performs patient transfer	100%	23