What makes a moving and handling people guideline work? : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Manawatū, New Zealand

Appendix 2 was removed to comply with copyright, but it may be accessed via: Lidegaard, M., Olsen, K.B., and Legg, S.J. (2019, April ). How was a national moving and handling people guideline intended to work? The underlying programme theory. Evaluation and Program Planning, 73, 163–75. https://doi.org/10.1016/j.evalprogplan.2019.01.002Moving and handling of people (MHP) is a major reason for developing musculoskeletal disorders (MSD) in the healthcare sector worldwide. To reduce MSD from MHP, many national and state level guidelines targeting MHP have been developed. However, little is known about their impact on injury claims rates, how they are intended to work, if intended users are aware of and use them, which parts of the guideline are being used, and how they are implemented. Therefore, the overarching goal of this thesis was to contribute to understanding what makes a MHP guideline work. It was addressed by examining the effects of introducing the New Zealand Accident Compensation Corporation ‘Moving and Handling People: The New Zealand Guidelines’ (MHPG), using a mixed-methods approach in five sequential studies. An analysis of claims data (Study 1) showed that MHP related claims rates declined before, but increased after the introduction of the MHPG. A study of the MHPG programme theory (Study 2) showed that key actors for implementation were MHP coordinators, H&S managers, and therapists. The developers argued for implementing a multifaceted MHP programme where implementation of organisational systems should create the foundation for implementing the core components. A questionnaire analysis (Study 3) showed that a high proportion of MHP coordinators, H&S managers, and therapists were aware of the MHPG, while a high proportion of therapists used it. In contrast, fewer carers were aware of and used it. A second questionnaire analysis (Study 4) showed that more key actors were familiar with and used the core components compared to the organisational systems. A low proportion of actors experienced change after use. Case studies (Study 5) showed that organisational motivation to implement a MHP programme was initiated by MHP related staff injuries. The implementation process was gradual, changing MHP practices during multiple steps, and dependent on a dedicated person to drive implementation. This thesis shows that making a MHP guideline work requires a dedicated actor, with support from management, to facilitate implementation and organisational changes needed. However, many contextual factors affect implementation, ranging from national, e.g. legislation and policies, to individual level, e.g. individuals conducting MHP

The relation of ambulatory heart rate with all-cause mortality among middle-aged men : a prospective cohort study

The aim of this study was to investigate the association between average 24-hour ambulatory heart rate and all-cause mortality, while adjusting for resting clinical heart rate, cardiorespiratory fitness, occupational and leisure time physical activity as well as classical risk factors. A group of 439 middle-aged male workers free of baseline coronary heart disease from the Belgian Physical Fitness Study was included in the analysis. Data were collected by questionnaires and clinical examinations from 1976 to 1978. All-cause mortality was collected from the national mortality registration with a mean follow-up period of 16.5 years, with a total of 48 events. After adjustment for all before mentioned confounders in a Cox proportional hazards regression analysis, a significant increased risk for all-cause mortality was found among the tertile of workers with highest average ambulatory heart rate compared to the tertile with lowest ambulatory heart rate (Hazard ratio = 3.21, 95% confidence interval: 1.22-8.44). No significant independent association was found between resting clinic heart rate and all-cause mortality. The study indicates that average 24-hour ambulatory heart rate is a strong predictor of all-cause mortality independent from resting clinic heart rate, cardiorespiratory fitness, occupational and leisure time physical activity and other classical risk factors among healthy middle-aged workers.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Long Term Effects on Risk Factors for Cardiovascular Disease after 12-Months of Aerobic Exercise Intervention:A Worksite RCT among Cleaners

<div><p>Objectives</p><p>Occupational groups exposed to high occupational physical activity have an increased risk for cardiovascular disease (CVD). This may be explained by the high relative aerobic workload. Enhanced cardiorespiratory fitness reduces the relative aerobic workload. Thus, the aim was to evaluate the 12-months effects of worksite aerobic exercise on risk factors for CVD among cleaners.</p><p>Methods</p><p>One hundred and sixteen cleaners aged 18–65 years were randomized to a group performing aerobic exercise and a reference group receiving lectures. Outcomes were collected at baseline and after 12-months. A repeated measures 2×2 multi-adjusted mixed-model design was applied to compare the between-group differences using intention-to-treat analysis.</p><p>Results</p><p>Between-group differences (<i>p</i><0.05) were found favouring the aerobic exercise group: cardiorespiratory fitness 2.15 (SE 1.03) mlO₂/min/kg, aerobic workload -2.15 (SE 1.06) %HRR, resting HR -5.31 (SE 1.61) beats/min, high sensitive C-reactive protein -0.65 (SE 0.24) μg/ml. The blood pressure was unaltered. Stratified analyses on relative aerobic workload at baseline revealed that those with relative aerobic workloads ≥30% of HRR seems to impose a notable adverse effect on resting and ambulatory blood pressure.</p><p>Conclusion</p><p>This long-term worksite aerobic exercise intervention among cleaners led to several beneficial effects, but also potential adverse effects among those with high relative aerobic workloads.</p><p>Trial Registration</p><p>Controlled-Trials.com <a href="http://www.controlled-trials.com/ISRCTN86682076" target="_blank">ISRCTN86682076</a></p></div

Defining venous thromboembolism and measuring its incidence using Swedish health registries: a nationwide pregnancy cohort study

OBJECTIVE: To accurately define venous thromboembolism (VTE) in the routinely collected Swedish health registers and quantify its incidence in and around pregnancy. STUDY DESIGN: Cohort study using data from the Swedish Medical Birth Registry (MBR) linked to the National Patient Registry (NPR) and the Swedish Prescribed Drug Register (PDR). SETTING: Secondary care centres, Sweden. PARTICIPANT: 509,198 women aged 15-44 years who had one or more pregnancies resulting in a live birth or stillbirth between 2005 and 2011. MAIN OUTCOME MEASURE: To estimate the incidence rate (IR) of VTE in and around pregnancy using various VTE definitions allowing direct comparison with other countries. RESULTS: The rate of VTE varied based on the VTE definition. We found that 43% of cases first recorded as outpatient were not accompanied by anticoagulant prescriptions, whereas this proportion was much lower than those cases first recorded in the inpatient register (9%). Using our most inclusive VTE definition, we observed higher rates of VTE compared with previously published data using similar methodology. These reduced by 31% (IR=142/100,000 person-years; 95% CI 132 to 153) and 22% (IR=331/100,000 person-years; 95% CI 304 to 361) during the antepartum and postpartum periods, respectively, using a restrictive VTE definition that required anticoagulant prescriptions associated with diagnosis, which were more in line with the existing literature. CONCLUSIONS: We found that including VTE codes without treatment confirmation risks the inclusion of false-positive cases. When defining VTE using the NPR, anticoagulant prescription information should therefore be considered particularly for cases recorded in an outpatient setting

Trends in quality of care among patients with incident heart failure in Denmark 2003-2010:a nationwide cohort study

BACKGROUND: The treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care and clinical outcome of HF patients using indicator monitoring combined with systematic auditing. METHODS: We conducted a nationwide, population-based prospective study using data from the Danish Heart Failure Registry. The registry systematically monitors and audits the use of guideline recommended processes of care at Danish hospital departments treating incident HF patients. We identified patients registered between 2003 and 2010 (n = 24504) and examined changes in use of recommended processes of care and 1-year mortality. RESULTS: The use of the majority of the recommended processes of care increased substantially from 2003 to 2010: echocardiography (from 62.7% to 90.5%; Relative Risk (RR) 1.45 (95% CI, 1.39-1.50)), New York Heart Association classification (from 29.4% to 85.5%; RR 2.91 (95% CI, 2.69-3.14)), betablockers (from 72.6% to 88.3%; RR 1.23 (95% CI, 1.15-1.29)), physical training (from 5.6% to 22.8%; RR 4.04 (95% CI, 2.96-4.52)), and patient education (from 49.3% to 81.4%; RR 1.65 (95% CI, 1.52-1.80)). Use of ACE/ATII inhibitors remained stable (from 92.0% to 93.2%; RR 1.01 (95% CI, 0.99-1.04)). During the same period, 1-year mortality dropped from 20.5% to 12.8% (adjusted Hazard Ratio 0.79 (95% CI, 0.65-0.96). CONCLUSIONS: Use of guideline recommended processes of care has improved among patients with incident HF included in the Danish Heart Failure Registry between 2003 and 2010. During the same period, a decrease in mortality was observed

How do national health guidelines work? A realist analysis of the ACC Moving and Handling People New Zealand Guidelines, 2012

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Use of Guidance Material for Moving and Handling People: Barriers and Facilitators - An Experience Exchange

Presentation of the research project and preliminary findings of questionnaire survey as introduction to a work shop for people interested in improving health and safety related to moving and handling people