Three Safe Patient Handling and Mobility (SPHM) Myths Debunked

Patient transfers are a routine part of all therapy interventions. These might involve assisting someone from a wheelchair to a mat table or parallel bars or helping a child into a gait trainer. However, these transfers put therapists and caregivers at high risk for work-related injuries, particularly lower back pain.¹ Statistics show that injury rates significantly increase for caregivers who engage in manual patient lifting, transferring, and repositioning activities beyond the 35-lb patient lifting maximum recommended by the National Institute of Occupational Safety and Health (NIOSH).^2,3 The consequences extend beyond pain and disability. Injured therapists may miss work, struggle to provide adequate patient care, and sometimes leave the profession entirely.^3,4

Strong research linking manual patient lifting to injury risk gave rise to the Safe Patient Handling and Mobility (SPHM) movement. SPHM advocates the use of powered lifts, mechanical aids, and transfer devices to replace all unnecessary and hazardous manual approaches in patient care and rehabilitation. Major healthcare organizations have adopted SPHM principles – including the Veterans’ Administration, the Association of Rehabilitation Nurses, the American Physical Therapy Association, and the American Occupational Therapy Association. These organizations recognize that safe patient lifting equipment effectively reduces on-the-job injuries.⁵ Despite this support from major organizations, safe patient handling has seen slow adoption.⁶ This likely stems from three common misconceptions.

Three Safe Patient Handling Myths

1. Body Mechanics Will Protect You

In the past, physical therapy, occupational therapy, and nursing schools focused on teaching manual lifting techniques. Educators believed that proper body mechanics could prevent injury during transfers, regardless of the patient’s or caregiver’s size or strength. This approach is fundamentally flawed. Current biomechanical research shows that good body mechanics alone cannot prevent work-related musculoskeletal disorders.

Landmark research by Marras and colleagues measured the forces acting on caregivers’ spines during patient transfers. Even experienced caregivers using standard techniques, such as a two-person transfer with a gait belt or a one-person “hug” transfer, regularly exceeded safe spinal force limits.⁷ Therapists face even greater risks during therapeutic activities like prolonged gait training sessions, as they expose their spinal tissues to high mechanical loads for extended periods.^1,5,8,9

Additional research by Daynard confirmed these findings and showed that safe patient handling devices significantly reduced peak spinal compression values during the transfers.¹⁰ Further studies reinforced that SPHM equipment prevents far more injuries than manual lifting techniques.^5,11,12

Body mechanics still matter. Maintaining proper posture is a good habit and supports safe patient care – especially when positioning and assisting patients into and out of lifting devices. However, believing proper body mechanics alone can prevent injuries is a dangerous myth that puts caregivers at unnecessary risk.

2. Professional Awareness Will Protect You

Therapists often prioritize their patients’ needs above their own health and safety.^5,13 Their use of SPHM technology remains surprisingly low.⁶ One reason may be that therapists, perhaps subconsciously, believe their extensive knowledge of musculoskeletal injuries protects them during patient transfers.¹³

The statistics tell a different story. Surveys show that as many as 91% of practicing therapists experience work-related musculoskeletal injuries sometime during their career.^1,4 Back pain leads these injuries and can be directly linked to manual lifting and transfer techniques.^1,14,15 These injuries drive one in six therapists to leave the profession, while others must change work settings.^16,17

When therapists work through pain, patient care suffers. Campo and colleagues conducted revealing interviews showing how injured therapists adapt their practice. One therapist admitted: “Sometimes you find yourself using or doing other things with the patients so you don’t have to transfer them.” Another confessed: “I hate to admit it, but my 4-6 pm patients might be getting gypped.”¹⁸

Working in pain leads to substandard intervention and decreased quality of care.^{4,15,16,18,19} Although expertise in the treatment of musculoskeletal problems is valuable, it cannot prevent therapist injuries.^15,16,20 This makes mechanical aids essential, not optional, for safe patient handling.

3. Use of SPHM Techniques Is Not Consistent with Therapy Goals

Effective therapy requires active patient participation to achieve the best functional outcomes. Many therapists worry that using mechanical aids will substitute for skill development, making patients overly dependent on equipment.⁶ However, research shows the opposite is true.

One rehabilitation department studied this concern directly. They evaluated 47 patients at admission and discharge before implementing a SPHM program, then evaluated 47 additional patients after implementation. Patients using safe handling equipment out-performed the others in every area tested: sit-to-stand transfers, toilet transfers, tub transfers, locomotion, and stairs. Rather than hindering recovery, SPHM programs actually improved functional outcomes.²¹ Additional research confirmed these findings, showing that SPHM programs increase both treatment options for therapists and participation opportunities for clients.^22-24

Patients report feeling safer and more comfortable when positioned in SPHM devices. One study found that patients using safe handling devices experienced lower depression levels, improved bladder control, higher activity engagement, reduced fall risk, and increased daytime alertness.

Joyce Julien, a physical therapist at St. Elizabeth Healthcare in Kentucky, explains the shift in thinking: “Therapists need to be open-minded towards SPHM. There was some hesitancy thinking that SPHM promotes dependency because everyone is lifted and we don’t do rehab. But with implementing the use of equipment, we found that patients feel safer being moved and we can go on with rehabilitation successfully.”

Evidence-based SPHM policies are now being integrated into rehab facilities, clinics, hospitals, and schools. Therapists play a crucial role in this transformation by dispelling myths about safe patient handling. This creates safer environments that benefit both therapists and patients – the ultimate goal of quality healthcare.

References

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