Review methods: The critical appraisal included six systematic reviews. The realist synthesis
included 47 studies that provided descriptive information about programme mechanisms.
Results: Five of the six systematic reviews covered interventions involving either staff
training or training and equipment supply. One review covered multi-component
interventions. All concluded that training staff by itself was ineffective. There were
differing conclusions regarding the effectiveness of training and equipment interventions
and multi-component programmes. The reviews provided little information about the
content of programme components. The realist synthesis noted the need for management
commitment and support, and six core programme components; a policy requiring safe
transfer practices, ergonomic assessment of spaces where people are transferred, transfer
equipment including lifts, specific risk assessment protocols, adequate training of all care
staff, and coordinators coaches or resource staff. These programme components are likely
to be synergistic; omitting one component weakens the impact of the other components.
Conclusions: Five systematic reviews provided little information regarding the core
components of effective programmes. Given the absence of experimental trials for multicomponent
programmes, the best available evidence for the effectiveness of multicomponent
programmes is from pre-post studies and large-scale surveys. The realist
synthesis provided detailed information about the core components for effective
programmes. Further studies, which include qualitative data, are needed to provide
evidence about the specific mechanisms through which components contribute to
effective patient handling programmes.