Assistant nurses often develop work-related pain in the back, neck and shoulders because their work involves frequent patient handling and movement. Training in safe patient handling may help reduce pain and injury risk, and biofeedback may further support better work techniques during everyday care work.
This study will test whether workplace-based training in patient handling can reduce musculoskeletal problems among assistant nurses. It will also examine whether adding six weeks of self-managed biofeedback-supported work technique training gives extra benefits compared with patient handling training alone. The study will include 60 assistant nurses with musculoskeletal symptoms, who will be randomly assigned to one of the two training groups. Data will be collected through interviews, physical assessments, questionnaires at baseline, six weeks and six months, and weekly SMS monitoring. Interviews with assistant nurses and managers will also explore how the intervention works in practice, how safe patient handling can be promoted, and what organisational factors support safer working methods.
Female assistant nurses (AN)
Employed in/ work in hospital inpatient care or residential care settings
Employment in south-east Sweden within the counties of Östergötland and Jönköping
Have at least one year of work experience as AN
Currently on sick leave;
Are receiving other ongoing treatment for their musculoskeletal condition
Have a disorder considered unrelated to their work
Parallel
Group A. Patient handling and movement training
Other interventionBoth groups: Participants in Groups A and B will receive individualised ergonomic advice tailored to their work situation and needs. During the first weeks, they will complete a digital educational programme delivered through the county council of Östergötland's educational platform and receive a five-step checklist for safe patient handling and movement (PHM), based on Safe Patient Handling - A Research-Based Guide for an Improved Work Environment. The programme includes theoretical and practical PHM training, with emphasis on risk assessment, safe patient transfers and other physically demanding work tasks. Practical instruction will also be provided in the participants' own workplaces.
Group B: Patient handling and movement training plus biofeedback
Other interventionBiofeedback-supported work technique training (Group B): Participants in Group B will additionally receive six weeks of self-administered work technique training supported by biofeedback (Wergonic AB, Tullinge, Sweden). Wearable inertial measurement unit sensors attached to the trunk and upper arm will monitor working postures during routine care work, particularly movements involving the back and neck/shoulder region (34, 35) (Figure 2). When unfavourable postures are detected, the system provides gentle vibrotactile feedback, which increases with less favourable postures and stops when a more ergonomic posture is adopted. After instruction, participants will use the system independently during normal work to practise less physically demanding work techniques. They will complete at least ten sessions of a minimum of 20 minutes over six weeks, with the option to train more frequently or for longer periods.
Pain intensity
Pain: Overall work-related musculoskeletal disorders current pain intensity in the back/neck/shoulder will be measured using the Numeric Rating Scale (NRS 0-10, higher levels indicate more severe pain). One score for the whole area.
Work technique
Participating AN will receive a weekly SMS question: "How well has your work technique functioned this week in relation to safe patient handling and movement? (0 = not at all well; 10 = very well)."
Health related quality of life
Health-related quality of life will be assessed using the EQ-5D-5L Swedish version (permission to be used Aug. 18, 2026, tracking number 87167). The instrument consists of five questions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression (1 = no problem; 5= unable to extreme problems). The health state is defined by combining one level from each of the five dimensions to an index score (0.31 = the worst to 1 = the best) health state. This is one instrument, the results of the instrument is presented as an index score only according to the EQ manual and as commonly used.
EQ-VAS
EQ-VAS (vertical thermometer) (0 = the worst health you can imagine; 100 = the best health you can imagine). (Permission to be used Aug. 18, 2026, tracking number 87167.)
Neck Disability Index
The impact of neck pain on daily life will be evaluated using the Neck Disability Index (NDI) (percentage from 0% to 100%, with higher scores indicating greater neck-related disability).
QuickDASH-7
Upper limb function will be assessed using the modified QuickDASH-7 (0 = no disability; 100 = most severe disability)
Background data, age
Year of birth (open-ended response)
Implementation outcome, IAM
Implementation outcomes will be assessed at 6-week and 6-month follow-up using Acceptability of Intervention Measure (AIM). The questionnaire comprise four items, answered on 5-point Likert-type scales: (1) Strongly disagree; (2) Disagree; (3) Neither agree nor disagree; (4) Agree; (5) Strongly agree
Evaluation of biofeedback training
Evaluation of biofeedback training (Group B only) at 6-week and 6-month follow-up: Participants will complete two six-item questionnaires on vibrotactile biofeedback. The first assesses usefulness, comfort and motivation, based on the Intrinsic Motivation Inventory, and whether repeated use improves interpretation of vibration signals and work technique. Scores are reported as mean values (1-7) or summed scores (6-43), with higher scores indicating more positive experiences.
Background data from the unit manager, number of employees
At baseline unit managers provide information on the healthcare service unit in which the participating AN is employed, including the number of employees
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Linkoeping University
Lead sponsor
Region Östergötland
Collaborator
Department of Health, Medicin and Caring Science, Linköping University
Collaborator
Region Jönköping County
Collaborator
AFA försäkring
Collaborator
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