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Harold Finn

Harold Finn, who weighs 250 kg (550 lb), has been admitted to a bariatric medical center for assessment regarding a weight-loss and fitness program. The assessment requires that he spend two nights in the hospital for procedures that involve mild to moderate anesthesia. Harold is unable to walk more than 20 feet independently because of general deconditioning.

From the time his partner drops him off at the medical center until he leaves, what mobility needs must be considered for Harold?

As always, before any mobility effort is attempted, the purpose of the movement needs to be clear. This is especially true in the case of patient transfers. In some cases, a transfer is solely to relocate a person from one place to another and, therefore, may not be a mobility training opportunity. In such a case, how you choose to complete the transfer is dictated by what is safest and most efficient for all involved. When the safety of both the patient and the healthcare professional are the only considerations, the ideal equipment for lifting or moving heavy objects, including people, is rarely the human body.

In recent years, developments in moving and lifting devices have greatly improved options for performing dependent transfers safely in the hospital, in the clinic, and even in the home. Safe patient handling and mobility, or safe patient handling and movement (both abbreviated SPHM and known informally as “no-lift” policies), are practice guides for the use of mechanical lifts and transfer devices to prevent injuries among healthcare workers.

When the transfer is intended as a mobility training session for the patient, manually assisted transfers, covered in Chapter 11, may be appropriate. However, in many cases, SPHM approaches can be effectively integrated into therapeutic exercise and functional mobility training. This chapter serves as a guide for SPHM while performing mechanically assisted transfers during which the individual being transferred is able to contribute little or no lifting power.


Healthcare workers are among the occupations with the highest rates of musculoskeletal injuries.1,2 These injuries are predominantly associated with manual patient handling.1,3 In one study, more than 65% of physical therapists (PTs) and physical therapy assistants (PTAs) experienced work-related pain resulting from patient handling and movement involved in therapeutic activities.4

Although transfers may readily come to mind as a potential source of injury, ergonomic and nursing studies have identified the global areas of patient repositioning and manual lifting as being associated with increased risk of injury to both the lower back and the shoulders.3,5 Specific injury risk parameters include the force necessary to complete the task, the awkwardness of the postures, and the number of repetitions of the task (see Fig. 8-1 and Box 8-1).3


Example of a manual transfer ...

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