A comparison of floor surfaces for injury prevention in care settings: impact forces and horizontal pulling force required to move wheeled equipment

Keenan, Bethany E.; Hallas, Kevin; Drahota, Amy; Evans, Samuel Lewin

doi:10.1007/s00198-020-05520-y

Cited by 6 publications

(5 citation statements)

References 39 publications

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“…These findings are consistent with Lachance et al [21], who concluded that while novel compliant flooring materials such as SmartCells and Sorbashock can attenuate the impact force considerably, conventional surfaces cannot notably reduce the exerting force to the hip during a fall. Similarly, Keenan et al [84] concluded that conventional flooring can only provide negligible impact on the force attenuation, and novel flooring materials such as rubber with a honeycomb structure can attenuate the impact force up to 25%. Also, Abdul Yamin et al [26] stated that there is not an obvious difference in terms of trend, magnitude, and maximum GRF resulting from running on different flooring materials, and Simpson et al [25] reported that GRF max ranges from 11.9 to 12.4 kN for four different flooring materials.…”

Section: Discussionmentioning

confidence: 98%

Effect of Impact Velocity, Flooring Material, and Trochanteric Soft-Tissue Quality on Acetabular Fracture during a Sideways Fall: A Parametric Finite Element Approach

et al. 2021

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A low-energy acetabular fracture, as a result of falling from standing height, is common among elderly patients and the number of cases is increasing rapidly in developed countries. Several biomechanical factors contribute to the incidence, severity, and type of acetabular fractures, such as body configuration at the impact moment or bone and soft-tissue quality. The current parametric study developed a comprehensive finite element model of the pelvic girdle and simple representation of the whole body and investigated the effects of impact velocity, conventional indoor/outdoor flooring material, and trochanteric soft-tissue stiffness on an acetabular fracture. Our results show that whereas the impact velocity has a substantial influence on the incidence and type of acetabular fracture, the effects of conventional flooring materials and trochanteric soft-tissue quality are not remarkable. It seems that other factors such as the quality of bone (healthy vs. osteoporotic), the thickness of trochanteric soft-tissue, and body configuration at the impact are more critical in the occurrence and type of the acetabular fracture. These results can be valuable in the prevention of acetabular fractures and the design of protective measures such as hip pads or novel flooring materials.

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Section: Discussionmentioning

confidence: 98%

Effect of Impact Velocity, Flooring Material, and Trochanteric Soft-Tissue Quality on Acetabular Fracture during a Sideways Fall: A Parametric Finite Element Approach

et al. 2021

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“…[32][33][34][35][36][37][38][39][40][41][43][44][45][46][47][48]67,130,[135][136][137][138][139][140][141][142][143][144][145][146][147][148][149] The high-quality data relating to the ineffectiveness of novel flooring in care homes for reducing injury rates 50 is counterintuitive to laboratory studies, which often indicate the superior shock absorbency in these floors and their comparability to hip protectors in terms of impact absorption. 26,37,136 Without an overlay, the novel underlay used in the care home trial (SmartCells) has been demonstrated to attenuate peak force by up to 33.7%, compared with 2 mm of rigid flooring, in a simulated fall to the hip, 33 and by 80% in a simulated fall to the back of the head. 35 Explanatory factors for the negative findings in this review and their disconnect from the wider laboratory-based research may relate to: l the underlying assumptions of laboratory-based research associated with (1) the biofidelity of test systems, (2) the types of fall-related impacts simulated and (3) the type of impact required to sustain injury (and, conversely, the degree of impact attenuation required to prevent injury) l co-interventions (e.g.…”

Section: Potential Biases In the Review Processmentioning

confidence: 99%

Shock-absorbing flooring for fall-related injury prevention in older adults and staff in hospitals and care homes: the SAFEST systematic review

Drahota

Felix

Raftery

et al. 2022

Health Technol Assess

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Background Injurious falls in hospitals and care homes are a life-limiting and costly international issue. Shock-absorbing flooring may offer part of the solution; however, evidence is required to inform decision-making. Objectives The objectives were to assess the clinical effectiveness and cost-effectiveness of shock-absorbing flooring for fall-related injury prevention among older adults in care settings. Review methods A systematic review was conducted of experimental, observational, qualitative and economic studies evaluating flooring in care settings targeting older adults and/or staff. Studies identified by a scoping review (inception to May 2016) were screened, and the search of MEDLINE, AgeLine and Scopus (to September 2019) was updated, alongside other sources. Two independent reviewers assessed risk of bias in duplicate (using Cochrane’s Risk of Bias 2.0 tool, the Risk Of Bias In Non-randomized Studies – of Interventions tool, or the Joanna Briggs Institute’s qualitative tool). Results Of the 22 included studies, 20 assessed the outcomes (three randomised controlled trials; and seven observational, five qualitative and five economic studies) on novel floors (n = 12), sports floors (n = 5), carpet (n = 5) and wooden subfloors (n = 1). Quantitative data related to 11,857 patient/resident falls (nine studies) and 163 staff injuries (one study). Qualitative studies included patients/residents (n = 20), visitors (n = 8) and staff (n = 119). Hospital-based randomised controlled trial data were too imprecise; however, very low-quality evidence indicated that novel/sports flooring reduced injurious falls from three per 1000 patients per day on vinyl with concrete subfloors to two per 1000 patients per day (rate ratio 0.55, 95% confidence interval 0.36 to 0.84; two studies), without increasing falls rates (two studies). One care home-based randomised controlled trial found that a novel underlay produces similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to those of a plywood underlay with vinyl overlays and concrete subfloors. Very low-quality data demonstrated that, compared with rigid floors, novel/sports flooring reduced the number of falls resulting in injury in care homes (26.4% vs. 33.0%; risk ratio 0.80, 95% confidence interval 0.70 to 0.91; three studies) and hospitals (27.1% vs. 42.4%; risk ratio 0.64, 95% confidence interval 0.44 to 0.93; two studies). Fracture and head injury outcomes were imprecise; however, hip fractures reduced from 30 per 1000 falls on concrete to 18 per 1000 falls on wooden subfloors in care homes (odds ratio 0.59, 95% confidence interval 0.45 to 0.78; one study; very low-quality evidence). Four low-quality economic studies concluded that shock-absorbing flooring reduced costs and improved outcomes (three studies), or increased costs and improved outcomes (one study). One, more robust, study estimated that shock-absorbing flooring resulted in fewer quality-adjusted life-years and lower costs, if the number of falls increased on shock-absorbing floors, but that shock-absorbing flooring would be a dominant economic strategy if the number of falls remained the same. Staff found moving wheeled equipment more difficult on shock-absorbing floors, leading to workplace adaptations. Staff injuries were observed; however, very low-quality evidence suggests that these are no less frequent on rigid floors. Limitations Evidence favouring shock-absorbing flooring is of very low quality; thus, much uncertainty remains. Conclusions Robust evidence is lacking in hospitals and indicates that one novel floor may not be effective in care homes. Very low-quality evidence indicates that shock-absorbing floors may be beneficial; however, wider workplace implications need to be addressed. Work is required to establish a core outcome set, and future research needs to more comprehensively deal with confounding and the paucity of hospital-based studies, and better plan for workplace adaptations in the study design. Study registration This study is registered as PROSPERO CRD42019118834. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 5. See the NIHR Journals Library website for further project information.

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“…On the basis of the results of this study, it was suggested that a structured intervention has the potential to reduce fall incidence and improve quality of life for persons living with a spinal cord injury. Keenan et al (2020) compared floor surfaces for injury prevention in care settings. It was determined that shock-absorbing flooring has the potential to prevent fall-related injuries or decrease the severity of injuries.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Keenan et al (2020) compared floor surfaces for injury prevention in care settings. It was determined that shock-absorbing flooring has the potential to prevent fall-related injuries or decrease the severity of injuries.…”

Section: Literature Reviewmentioning

confidence: 99%

Case Report

Sims¹

2022

Journal of Pediatric Surgical Nursing

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Falls from wheelchairs are common, particularly in persons with a spinal cord injury. Patients who experience falls frequently incur physical and psychological damages. The underlying causes of falls vary, although one of the most important themes is associated with poor balance. Factors that contribute to ineffective balance include poor trunk and abdominal muscle strength, inability to maintain static or dynamic trunk control, diminished sensation, improper equipment usage, muscle spasms, unsafe speed of mobilization, and lack of protective straps. The literature regarding fall prevention of pediatric patients with a spinal cord injury is very limited. Guidance is needed for this vulnerable population to prevent falls from wheelchairs. Instructions for wheelchair safety must be incorporated into patient and family caregiver education. Behavioral change theory provides a framework for this work. This article is intended to close the gap by discussing the incidence of falls, suggesting the provision of teaching self-management, and introducing suggestions for developing an interdisciplinary fall prevention program.

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A comparison of floor surfaces for injury prevention in care settings: impact forces and horizontal pulling force required to move wheeled equipment

Cited by 6 publications

References 39 publications

Effect of Impact Velocity, Flooring Material, and Trochanteric Soft-Tissue Quality on Acetabular Fracture during a Sideways Fall: A Parametric Finite Element Approach

Effect of Impact Velocity, Flooring Material, and Trochanteric Soft-Tissue Quality on Acetabular Fracture during a Sideways Fall: A Parametric Finite Element Approach

Shock-absorbing flooring for fall-related injury prevention in older adults and staff in hospitals and care homes: the SAFEST systematic review

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