title: Does the use of small aids during patient handling activities lead to a decreased occurrence of musculoskeletal complaints and diseases? A systematic review.
abstract: OBJECTIVE
  Patient handling increases the risk of musculoskeletal complaints and diseases among healthcare workers. Thus, the use of small aids for patient handling is recommended. Small aids are non-electrical and handy assistive devices that support caregivers during patient handling. To date, there is no evidence about the clinical efficacy of small aids. Hence, the objective of this systematic review was to systematically analyze whether the use of small aids during patient handling leads to a decreased occurrence of musculoskeletal disorders.
  
  
  METHODS
  A systematic literature search was carried out. The review process was done independently by two reviewers. Methodology was assessed with the "Downs and Black checklist" and the "Risk of Bias tool." Quality of evidence was determined with the GRADE method.
  
  
  RESULTS
  One randomized and two non-randomized trials were included. Three comparisons of intervention assessing the lumbar spine and shoulder joint were investigated. A statistically significant improvement of the 7-day prevalence of low back pain and shoulder pain was achieved within the intervention group over time of questionable clinical importance in a study with comparisons made between small aids and usual practice or mechanical aids. No comparison between the intervention group and control group at follow-up was made. Each trial showed an insufficient methodology and a high risk of bias. Quality of evidence was low for disability scores and very low for pain outcomes.
  
  
  CONCLUSIONS
  To date, there is no convincing evidence (from low-quality studies) for the preventability of musculoskeletal complaints and diseases by the use of small aids. The literature also lacks evidence for the opposite. Generalizability of the study results is further debatable due to the different populations and settings that were investigated. Robust, high-quality intervention studies are necessary to clarify the clinical efficacy of small aids in healthcare work.
  CRD42014009767.
authors.affiliation: Medical Faculty Carl Gustav Carus, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. Alice.Freiberg@tu-dresden.de.
authors.forename: A
authors.identifier: http://orcid.org/0000-0001-7668-4734
authors.initials: A
authors.lastname: Freiberg
authors.affiliation: Medical Faculty Carl Gustav Carus, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Euler
authors.affiliation: Medical Faculty Carl Gustav Carus, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Girbig
authors.affiliation: Institute for Health Service Research in Dermatology and Nursing, University Clinics Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.|Department of Occupational Health Research, German Social Accident Insurance Institution for the Health and Welfare Service, Pappelallee 33-37, 22089, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Nienhaus
authors.affiliation: Department of Occupational Health Research, German Social Accident Insurance Institution for the Health and Welfare Service, Pappelallee 33-37, 22089, Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Freitag
authors.affiliation: Medical Faculty Carl Gustav Carus, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Seidler
mesh_terms: D006801:Humans; D017116:Low Back Pain / Q000517:prevention & control; D055805:Moving and Lifting Patients / Q000295:instrumentation*; D009140:Musculoskeletal Diseases / Q000517:prevention & control*; D009784:Occupational Diseases / Q000517:prevention & control*; D016272:Occupational Health; D020069:Shoulder Pain / Q000517:prevention & control
keywords: Ergonomics; Healthcare worker; Musculoskeletal; Small aids; Systematic review