We know it doesn't work: Why do we still use how to lift training for the prevention of musculoskeletal disorders?

Musculoskeletal disorders (MSDs) have a complex aetiology. How to lift training (HTLT) does not address this complexity, is an ineffective prevention strategy but remains widely utilised. This study explores the extent to which HTLT is utilised and the beliefs of employers and work health and safety (WHS) providers to this approach as an MSD prevention strategy. Method: An online questionnaire was distributed to employers and WHS providers to collect quantitative and qualitative information on the extent to which HTLT was being used and the beliefs about its use in MSD prevention. Results: A total of 1507 responses were analysed (1271 employers, 236 WHS providers). Over 70% of participants had used HTLT in an MSD prevention program in the past 2 years. For employers the belief that HTLT is necessary under WHS legislation (OR 1.755, CI 1.135,2.712) was associated with the use of HTLT. For providers, the belief that HTLT is necessary for MSD prevention programs (OR 1.57 CI 1.10, 2.25) or if the service was requested (OR 3.88 CI 1.78,8.45) were associated with HTLT delivery. Conclusions: HTLT remains highly prevalent in MSD prevention despite strong evidence that lifting training is ineffective and does not address WHS legislative requirements. Strategies to reduce HTLT use industry and utilise more effective MSD risk management controls will need to bridge the research evidence to practice gap and use implementation science principles to improve the uptake of evidence-based interventions which take a comprehensive systems-based approach to MSD prevention.