Effect of the "EMS Back-Up" Ergonomic Program on Paramedics' Manual Handling Safety.

Technical proficiency is measured using the 9-item Standardized Manual Handling Checklist v3.0. Each item is scored on a 3-point scale (0 = not achieved, 1 = partially achieved, 2 = fully achieved). The total score is calculated by summing the scores of all 9 items, resulting in a range from 0 to 18. A higher total score indicates a higher level of technical proficiency and safer manual patient handling performance.

Borg CR10 Scale (0-10), assessing the subjective physical effort during task execution.

Theoretical knowledge is assessed via a 12-item multiple-choice and true/false questionnaire focusing on biomechanics, injury prevention, and the SAFE handling process. Each correct answer is awarded 1 point. The total score ranges from 0 to 12. A higher score represents a greater understanding of occupational safety and ergonomic principles related to patient handling.

Readiness for behavioral change is assessed using a 5-point scale corresponding to the TTM stages: 1 = Pre-contemplation, 2 = Contemplation, 3 = Preparation, 4 = Action, and 5 = Maintenance. The result is reported as the mean stage score across 5 specific behavioral items (C1-C5). The score ranges from 1 to 5, where a higher numerical value indicates a more advanced stage of readiness for adopting safe manual handling behaviors.

Perceived self-efficacy is measured using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) based on two specific items (D10, D11) regarding the ability to perform and lead safe handling techniques. The outcome is the mean of these items, ranging from 1 to 5. A higher score reflects a higher level of confidence in performing safe manual handling tasks.