Challenges and best practices during manual handling for patient positioning in long-term care settings: a scoping review

Introduction: Healthcare practitioners (HCPs) are at risk of work-related musculoskeletal disorders (WRMSDs) due to manual handling, with associated staff shortages and reduced quality of healthcare. Whilst manual handling challenges for HCP’s have previously been explored, there is a research-practice gap in handling during positioning. This scoping review maps challenges and practices in manual handling during patient positioning. Method: This scoping review comprised (MEDLINE®, CINAHL, AMED, Scopus, Embase), and grey literature sources, including papers in English published from 1992 to 2025. Results: Of 7,376 unique papers, 118 met the criteria for inclusion. Findings were categorized into injury-associated factors and optimized practices for safety. Repositioning and turning patients into side-lying were reported as the most frequent and challenging tasks compared to other positioning care (e.g., bed mobility, posture management). Available practices had limitations and did not completely remove the risk of excessive exertion from the HCPs. Studies recommended that using a system of low-tech handling devices and optimized techniques to support patient positioning in bed was pivotal to improving outcomes. Discussion: Implementation of common positioning devices (e.g. slide sheet, hoist, pillows/wedges) has fallen short in significantly reducing the incidence of WRMSDs during patient positioning in bed. Emerging evidence supports integrated systems of low-tech handling devices, such as the in-bed sliding systems and wedges. However, further work is needed to quantify the biomechanical impact of these systems on the HCPs and patients.