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

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.

Finite Element Analysis of Energy-Absorbing Floors for Reducing Head Injury Risk during Fall Accidents

“…The results suggest that the safety floors effectively absorb substantial impact energy without increasing footfall deflections. Numerous reports [13,58,59] compared the reduction in head linear kinematics, including peak force and HIC, and determined the protective performance. The results in terms of reduction in angular kinematics and brain strain in this study further illustrate the potential for brain injury risk reduction of EAFs.…”

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

“…The first seven prioritised outcomes have been incorporated into our summary of findings tables (which headline the findings for each comparison; see Chapter 3), and these outcomes formed the basis of our risk-of-bias and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessments. The quantitative outcomes (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) are reported in Chapter 3, qualitative outcomes (11) are reported in Chapter 4 and economic outcomes (12) are reported in Chapter 5. Process outcomes (13) are reported when available as part of the studies included in Chapters 3 and 4.…”

“…FIGURE 2 The PRISMA flow diagram. Reproduced from Drahota et al1 © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.…”

“…1 © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.…”

Minimizing fall-related injuries in at-risk older adults: The falling safely training (FAST) study protocol

“…For instance, fall-related traumatic brain injuries result from hitting the head on the ground or other surface with sufficient force to cause a disruption of brain function [ 9 ]. Public health programs aiming to prevent fall-related injuries have consistently employed strategies to reduce falls [ 10 , 11 ] and have not directly targeted the fundamental variable for injury prevention, namely, impact force [ 12 ]. Particularly, reducing the impact forces acting on the hip or head would be beneficial in decreasing the risk of severe injuries, such as hip fractures or traumatic brain injury.…”