Caregivers should consider using Turn Assist and other aids such as mechanical lifts or sliding sheets especially when turning patients requires lateral repositioning.

Head‐of‐bed (HOB) elevation is a common clinical practice in hospitals causing the patient's body to slide down in bed because of gravity. This migration effect likely results in tissue shearing between the sacrum and the support surface, which increases the risk for pressure injuries. StayInPlace (HillRom Inc.) is a commercial migration‐reduction technology (MRT) incorporated in intensive care bedframes. Yet, the effects of migration‐reduction on tissue shear stresses during HOB elevation are unknown. We analysed relationships between migration and resulting sacral soft tissue stresses by combining motion analysis and three‐dimensional finite element modelling of the buttocks. Migration data were collected for 10 subjects, lying supine on two bedframe types with and without MRT, and at HOB elevations of 45°/65°. Migration data were used as displacement boundary conditions for the modelling to calculate tissue stress exposures. Migration values for the conventional bed were 1.75‐ and 1.6‐times greater than those for the migration‐reduction bed, for elevations of 45° and 65°, respectively (P < .001). The modelling showed that the farther the migration, the greater the tissue stress exposures. Internal stresses were 1.8‐fold greater than respective skin stresses. Our results, based on the novel integrated experimental‐computational method, point to clear biomechanical benefits in minimising migration using MRT.

These results suggest that subjective reports of discomfort were not sufficiently sensitive to detect differences among mats for the experimental conditions tested. Behavioral responses, specifically weight-shifting between feet, may provide a more sensitive alternative to subjective reports.

BackgroundWork‐related fatigue of the lower extremities is a known cause of lost productivity and significant employer costs. Common workplace solutions to reduce fatigue levels include anti‐fatigue matting, shoe orthoses, or sit/stand work stations. However, assessment of these anti‐fatigue measures within the workplace has been limited.MethodsThis was a cross sectional study in an automotive assembly plant on employees with at least 6 months tenure. Subject data were collected via questionnaires including Likert‐scale questions to define fatigue severity. Jobs were evaluated for lower extremity ergonomic exposures via videotaping, pedometers, interviews, and industrial engineering records.ResultsLower extremity fatigue at the end of the work day was associated with a higher prevalence of smoking, rheumatoid arthritis, job dissatisfaction, use of shoes with firmer outsoles, and increased time on the job spent standing or walking. Supervisor support and increased time spent on carpet were protective. Lower extremity fatigue that interfered with activities outside of work had additional risk factors including higher BMI, prior diagnosis of osteoarthritis, and increased hours per week spent working.ConclusionsWhile these results identify carpet as being protective against lower extremity fatigue, no similar relationship was identified for anti‐fatigue mats. No adverse relationship was found between hard surfaces such as concrete and lower extremity fatigue. Given the high costs associated with work‐related fatigue, future areas for potential intervention include smoking cessation, specific shoe recommendations, and enhancing psychosocial aspects of work such as supervisor support. Am. J. Ind. Med. 54:216–223, 2011. © 2010 Wiley‐Liss, Inc.

An increased risk is associated with higher metatarsal pressure and increased time spent walking. These findings suggest several options for primary and secondary prevention strategies. The use of shoe orthoses with a medial longitudinal arch and metatarsal pad as well as including optional sit/stand workstations may be helpful.