Repository logo

The effect of a transfer, lifting and repositioning (TLR) injury prevention program on musculoskeletal injury rates among direct care workers



Journal Title

Journal ISSN

Volume Title




Degree Level



Problem Statement: The burden of musculoskeletal injuries among workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results. Strong evidence for intervention effectiveness is lacking. Specific Aims: The goal of this study was to evaluate the effectiveness of a patient handling injury prevention program implemented in the Saskatoon Health Region (SHR) comparing it with a non-randomized control group, Regina Qu’Appelle Health Region (RQHR), in a pre-post design. Injury rates, lost-time days, and claim costs were the outcomes of interest. Intervention: A Transfer, Lifting and Repositioning (TLR) program, consisting of engineering and administrative ergonomic controls, was implemented in SHR hospitals from 2002-2005. Methods: Data on time loss and non-time loss injuries, lost time days, and claims costs were collected from the SHR and RQHR for corresponding time periods one year pre and one year post-intervention. Age, length of service, profession, and sex were selected as covariates. Full Time Equivalents (FTE) data were collected for each time period. Univariate and multivariate Poisson regression were performed. Results: Rates for all injuries (number of injuries/100 FTE) dropped from 14.68 pre-intervention to 8.1 post-intervention. Control group all injury rates, while overall lower in absolute value, dropped to a lesser degree, from 9.29 to 8.4. Time loss injury rates decreased from 5.3 to 2.51 in the SHR, while they actually increased from 5.87 to 6.46 in the RQHR, for the same intervention periods. Poisson regression showed the greatest reduction in injury rate, both time loss (Rate ratio=0.48, 95% C.I: 0.34-0.68) and non-time loss (Rate Ratio=0.25, 95% C.I: 0.15-0.41) in the smaller long term care facility controlling for hospital size. Analysis of injury rates, incidence rate ratios, and incidence rate differences showed significant differences between the intervention and comparison group for all injuries and time loss injuries. Mean claim cost/injury decreased from $3906.20 to $2200.80 and mean time loss days/claim decreased from 35.87 days to 16.23 days for the SHR. Conclusions: The study provides evidence for the effectiveness of a multi-factor TLR program for direct-care health workers, and emphasizes their implementation, especially in smaller hospitals.



direct care workers, hospital workers, patient handling, musculoskeletal injuries, injury prevention, occupational health, ergonomics



Master of Science (M.Sc.)


Community Health and Epidemiology


Community Health and Epidemiology


Part Of