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

BMC Geriatrics

Dawn C. Mackey¹  Andrew C. Laing²  Lambert M. Felix³  Bethany E. Keenan⁴  Chantelle C. Lachance⁵  Chris Markham⁵  Amy Drahota⁵  James Raftery⁶ 

[1] Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive East, V5A 1S6, Burnaby, British Columbia, Canada;Department of Kinesiology, University of Waterloo, B.C. Matthews Hall, N2L 3G1, Waterloo, Ontario, Canada;International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, UK;School of Engineering, Cardiff University, Queen’s Buildings, The Parade, CF24 3AA, Cardiff, UK;School of Health and Care Professions, University of Portsmouth, St. Andrew’s Court, St. Michael’s Road, PO1 2PR, Portsmouth, UK;Wessex Institute, University of Southampton, Alpha House, Enterprise Road, SO16 7NS, Southampton, UK;

关键词: Accidental falls;    Bone;    Floors and floor coverings;    Fractures, hospitals;    Long-term care;   

DOI  :  10.1186/s12877-021-02670-4

来源: Springer

【 摘 要 】

BackgroundShock-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.MethodsThis 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.Results20 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.ConclusionEvidence 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 registrationPROSPERO CRD42019118834.

【 授权许可】

CC BY