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The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention

The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention
The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention

Background: shock-absorbing flooring may minimise impact forces incurred from falls to reduce fall-related injuries; however, synthesized evidence is required to inform decision-making in hospitals and care homes.

Methods: this is a Health Technology Assessment mixed methods systematic review of flooring interventions targeting older adults and staff in care settings. Our search incorporated the findings from a previous scoping review, MEDLINE, AgeLine, and Scopus (to September 2019) and other sources. Two independent reviewers selected, assessed, and extracted data from studies. We assessed risk of bias using Cochrane and Joanna Briggs Institute tools, undertook meta-analyses, and meta-aggregation.

Results: 20 of 22 included studies assessed our outcomes (3 Randomised Controlled Trials (RCTs); 7 observational; 5 qualitative; 5 economic), on novel floors (N = 12), sports floors (N = 5), carpet (N = 5), and wooden sub-floors (N = 1). Quantitative data related to 11,857 patient falls (9 studies), and 163 staff injuries (1 study). One care home-based RCT found a novel underlay produced similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to a plywood underlay with vinyl overlay and concrete sub-floors. Very low-quality evidence suggested that shock-absorbing flooring may reduce injuries in hospitals (Rate Ratio 0.55, 95% CI 0.36 to 0.84, 2 studies; 27.1% vs. 42.4%; Risk Ratio (RR) = 0.64, 95% CI 0.44 to 0.93, 2 studies) and care homes (26.4% vs. 33.0%; RR 0.80, 95% CI 0.70 to 0.91, 3 studies), without increasing falls. Economic evidence indicated that if injuries are fewer and falls not increased, then shock-absorbing flooring would be a dominant strategy. Fracture outcomes were imprecise; however, hip fractures reduced from 30 in 1000 falls on concrete to 18 in 1000 falls on wooden sub-floors (OR 0.59, 95% CI 0.45 to 0.78; one study; very low-quality evidence). Staff found moving wheeled equipment harder on shock-absorbing floors leading to workplace adaptations. Very low-quality evidence suggests staff injuries were no less frequent on rigid floors.

Conclusion: evidence favouring shock-absorbing flooring is uncertain and of very low quality. Robust research following a core outcome set is required, with attention to wider staff workplace implications.

TRIAL REGISTRATION: PROSPERO CRD42019118834 .

Accidental Falls/prevention & control, Aged, Floors and Floorcoverings, Fractures, Bone/prevention & control, Hospitals, Humans
1471-2318
Drahota, Amy
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Felix, Lambert M
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Raftery, James
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Keenan, Bethany E
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Lachance, Chantelle C
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Mackey, Dawn C
7948c2bf-d250-48fb-ac36-0300468fd8a0
Markham, Chris
66b08732-4a9d-486c-a252-da3f52a47f74
Laing, Andrew C
ac763cda-5445-45e8-b324-8f56debe8bcf
Drahota, Amy
cab2a5ec-7f58-47f6-8f8a-54ef7fefa3ec
Felix, Lambert M
708c68ec-7431-4037-a4fb-2261b9231ea7
Raftery, James
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Keenan, Bethany E
e70768bd-020e-4a76-9f54-841e3bd21691
Lachance, Chantelle C
c5f42df3-12e2-4615-9fb7-2f542bea22d4
Mackey, Dawn C
7948c2bf-d250-48fb-ac36-0300468fd8a0
Markham, Chris
66b08732-4a9d-486c-a252-da3f52a47f74
Laing, Andrew C
ac763cda-5445-45e8-b324-8f56debe8bcf

Drahota, Amy, Felix, Lambert M, Raftery, James, Keenan, Bethany E, Lachance, Chantelle C, Mackey, Dawn C, Markham, Chris and Laing, Andrew C (2022) The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention. BMC Geriatrics, 22 (1), [32]. (doi:10.1186/s12877-021-02670-4).

Record type: Article

Abstract

Background: shock-absorbing flooring may minimise impact forces incurred from falls to reduce fall-related injuries; however, synthesized evidence is required to inform decision-making in hospitals and care homes.

Methods: this is a Health Technology Assessment mixed methods systematic review of flooring interventions targeting older adults and staff in care settings. Our search incorporated the findings from a previous scoping review, MEDLINE, AgeLine, and Scopus (to September 2019) and other sources. Two independent reviewers selected, assessed, and extracted data from studies. We assessed risk of bias using Cochrane and Joanna Briggs Institute tools, undertook meta-analyses, and meta-aggregation.

Results: 20 of 22 included studies assessed our outcomes (3 Randomised Controlled Trials (RCTs); 7 observational; 5 qualitative; 5 economic), on novel floors (N = 12), sports floors (N = 5), carpet (N = 5), and wooden sub-floors (N = 1). Quantitative data related to 11,857 patient falls (9 studies), and 163 staff injuries (1 study). One care home-based RCT found a novel underlay produced similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to a plywood underlay with vinyl overlay and concrete sub-floors. Very low-quality evidence suggested that shock-absorbing flooring may reduce injuries in hospitals (Rate Ratio 0.55, 95% CI 0.36 to 0.84, 2 studies; 27.1% vs. 42.4%; Risk Ratio (RR) = 0.64, 95% CI 0.44 to 0.93, 2 studies) and care homes (26.4% vs. 33.0%; RR 0.80, 95% CI 0.70 to 0.91, 3 studies), without increasing falls. Economic evidence indicated that if injuries are fewer and falls not increased, then shock-absorbing flooring would be a dominant strategy. Fracture outcomes were imprecise; however, hip fractures reduced from 30 in 1000 falls on concrete to 18 in 1000 falls on wooden sub-floors (OR 0.59, 95% CI 0.45 to 0.78; one study; very low-quality evidence). Staff found moving wheeled equipment harder on shock-absorbing floors leading to workplace adaptations. Very low-quality evidence suggests staff injuries were no less frequent on rigid floors.

Conclusion: evidence favouring shock-absorbing flooring is uncertain and of very low quality. Robust research following a core outcome set is required, with attention to wider staff workplace implications.

TRIAL REGISTRATION: PROSPERO CRD42019118834 .

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Accepted/In Press date: 19 November 2021
Published date: 6 January 2022
Additional Information: Acknowledgements This review was developed and delivered through the support and guidance of our Advisory Board members: Nadra Ahmed (National Care Association, UK); Margaret Bell (Public Involvement Member, UK); Liz Burden (Public Involvement Member, UK); Dr. Alison Cracknell (Leeds Teaching Hospitals NHS Trust, UK); Kirsten Farrell-Savage (University of Portsmouth, UK); Olanrewaju Okunribido (Health & Safety Executive, UK); Jonathan Stewart (Health Estates and Facilities Management Association [HEFMA], UK); Joleen Tobias (Public Involvement Member, UK); Julie Windsor (NHS England/Improvement, UK); Dr. Anna Winfield (Leeds Teaching Hospitals NHS Trust, UK). Our public involvement members (Margaret Bell, Liz Burden, and Joleen Tobias) additionally supported the protocol development, communication of the risk of bias assessments and GRADE assessments, development of the plain English summary, and dissemination activities. Olanrewaju Okunribido and Kirtsen Farrell-Savage additionally supported data acquisition. We would like to thank Dr. Ngianga Li Kandala for his statistical support and advice, and Dr. H. Carl Hanger and Dr. Johanna Gustavsson for their co-operation, time, and generous supply of unpublished data for incorporation into this review. Funding This report presents independent research funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. The Health & Safety Executive supported 10 days of Olanrewaju Okunribido’s time in kind on this project.
Keywords: Accidental Falls/prevention & control, Aged, Floors and Floorcoverings, Fractures, Bone/prevention & control, Hospitals, Humans

Identifiers

Local EPrints ID: 455482
URI: http://eprints.soton.ac.uk/id/eprint/455482
ISSN: 1471-2318
PURE UUID: 253320f7-5460-49fa-b1fc-cc55289ea054

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Date deposited: 22 Mar 2022 17:47
Last modified: 27 Apr 2022 06:02

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Contributors

Author: Amy Drahota
Author: Lambert M Felix
Author: James Raftery
Author: Bethany E Keenan
Author: Chantelle C Lachance
Author: Dawn C Mackey
Author: Chris Markham
Author: Andrew C Laing

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