Cochrane review: Modification of the home environment for the reduction of injuries

Abstract

BackgroundInjury in the home is extremely common, accounting for around a third of all injuries. The majority of injuries of children under five and people aged 75 and over, occur at home. Multifactorial injury prevention interventions have been shown to reduce injuries in the home. However, few studies have focused specifically on the impact of physical adaptations to the home environment and the effectiveness of such interventions needs to be ascertained.ObjectivesTo review the evidence for the effect on injuries of modification of the home environment with a primary focus on interventions to reduce physical hazards.Search strategyWe searched The Cochrane Library, MEDLINE, EMBASE, National Research Register and other specialised databases. We also scanned conference proceedings and reference lists. In addition, we contacted experts and trialists in the field. The searches were not restricted by language or publication status. The searches were last updated in December 2004.Selection criteriaRandomised controlled trials.Data collection and analysisAll abstracts were screened by two authors for relevance, outcome and design. Two authors independently assessed methodological quality and extracted data from each eligible study.Main resultsWe found 18 published and one unpublished trials. Trials were not sufficiently similar to allow pooling of data by statistical analyses, so this review takes a narrative form. Studies were divided into three groups based on the primary population sample; children (five studies), older people (14 studies) and the general population/mixed age group (no studies). None of the studies focusing on children demonstrated a reduction in injuries that might have been due to environmental adaptation in the home; one study reported a reduction in injuries and in hazards but the two could not be linked. Of the 14 included studies in older people, none demonstrated a reduction in injuries due to hazard reduction, although two demonstrated a reduction in falls that could be due to hazard reduction.Authors' conclusionsThere is insufficient evidence to determine the effects of interventions to modify environmental home hazards. Further interventions to reduce hazards in the home should be evaluated by adequately designed randomised controlled trials measuring injury outcomes. Recruitment of large study samples to measure effect must be a major consideration for future trials.Plain language summaryMore evidence is needed to show whether or not altering the physical home environment by removing potential hazards reduces injuries.Injuries in the home are very common. Most of the injuries of older people and children under five occur at home. Many people are encouraged to alter their home to try to reduce such injuries. Common alterations include the installation of locks on cupboards and covers on electrical sockets, improvement of lighting in halls and stairways, and the removal of rugs and other falls hazards. The review found that there is insufficient evidence from trials to show that such changes reduce the number of injuries in the home but does not conclude that these interventions are ineffective. Home alterations need to be evaluated by larger and better designed trials.

Unintentional Injury, Supervision, and Discourses on Childproofing Devices

“…This trend in homeownership and income matches our finding that higher income families possess more safety devices. If accepted as given that these products are the “best method” in toddler supervision (which, as stated in the review of childproofing literature, they are not: see Kendrick et al 2007, 2013; Lyons et al 2006), the lack of financial resources hampers access to the objects necessary to transform the environment and the discursively constructed acceptable space for exploring toddlers.…”

“…Yet despite the implicit connections between childproofing equipment and child safety, there appears to be no direct evidence to support that childproofing the home reduces injury (Kendrick et al 2007, 2013; Lyons et al 2006). Why, then, does childproofing continue to be an important part of parenting and injury prevention?…”

Accidents Increase in Inadequate Housing Conditions: A Cross-Sectional Study from Turkey

“…Lyons et al in their systematic review in 2006, concluded that there was insufficient evidence to conclude that modifying the physical environment in the home will definitely reduce the injuries (with the exception of the provision and promotion of smoke alarm ownership, which was excluded from the review) as injuries occur as a result of complex interactions between individuals and the environment and can always be considered multifactorial in nature. They stated that the quality and size of the studies were not sufficiently good or large to reach definitive conclusions (Lyons et al, 2006). DiGuiseppi et al, in their scientific review in 2010, aimed to inform decisions about which policies were likely to result in the best and most efficient use of resources to address structural deficiencies and to illuminate where further research was needed to allow informed policy decisions to be made.…”

Infant injuries from child restraint safety seat misuse at British Columbia Children’s Hospital

“…Frequently parents lack the knowledge of effective safety measures to prevent injuries to children, and consequently misuse protective safety devices. 16,17 Caregivers could benefi t from education on proper CRS use by messages placed in a variety of accessible settings. Potential settings include primary care offi ces, community-based organizations, child care settings, emergency departments, maternity wards and commercial outlets and point of sale locations.…”