Feasibility of Compliant Flooring in Long-Term Care: Results from a Stakeholder Symposium

Lachance, Chantelle C.; Mackey, Dawn C.

doi:10.1017/s0714980817000551

Cited by 8 publications

(7 citation statements)

References 35 publications

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“…Our findings address stakeholder calls for knowledge about the influence of compliant flooring on balance and falls [18] by showing that the compliant flooring we examined did not affect risk for falls. Previously, a 1-year cluster randomized controlled trial in geriatric wards at eight hospitals suggested a small increase in rate of falls and risk of falling on compliant relative to control flooring [24].…”

Section: Discussionsupporting

confidence: 65%

“…Past studies have been limited, however, by retrospective and/or nonrandomized designs and insufficient sample sizes to examine the effect of compliant flooring on the most serious and costly fall-related injuries. LTC stakeholders and injury prevention researchers have called for evidence on the clinical effectiveness of compliant flooring from randomized trials [15,17,18].…”

Section: Introductionmentioning

confidence: 99%

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The Flooring for Injury Prevention (FLIP) Study of compliant flooring for the prevention of fall-related injuries in long-term care: A randomized trial

et al. 2019

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Background Fall-related injuries exert an enormous health burden on older adults in long-term care (LTC). Softer landing surfaces, such as those provided by low-stiffness “compliant” flooring, may prevent fall-related injuries by decreasing the forces applied to the body during fall impact. Our primary objective was to assess the clinical effectiveness of compliant flooring at preventing serious fall-related injuries among LTC residents. Methods and findings The Flooring for Injury Prevention (FLIP) Study was a 4-year, randomized superiority trial in 150 single-occupancy resident rooms at a single Canadian LTC site. In April 2013, resident rooms were block randomized (1:1) to installation of intervention compliant flooring (2.54 cm SmartCells) or rigid control flooring (2.54 cm plywood) covered with identical hospital-grade vinyl. The primary outcome was serious fall-related injury over 4 years that required an emergency department visit or hospital admission and a treatment procedure or diagnostic evaluation in hospital. Secondary outcomes included minor fall-related injury, any fall-related injury, falls, and fracture. Outcomes were ascertained by blinded assessors between September 1, 2013 and August 31, 2017 and analyzed by intention to treat. Adverse outcomes were not assessed. During follow-up, 184 residents occupied 74 intervention rooms, and 173 residents occupied 76 control rooms. Residents were 64.3% female with mean (SD) baseline age 81.7 (9.5) years (range 51.1 to 104.6 years), body mass index 25.9 (7.7) kg/m 2 , and follow-up 1.64 (1.39) years. 1,907 falls were reported; 23 intervention residents experienced 38 serious injuries (from 29 falls in 22 rooms), while 23 control residents experienced 47 serious injuries (from 34 falls in 23 rooms). Compliant flooring did not affect odds of ≥1 serious fall-related injury (12.5% intervention versus 13.3% control, odds ratio [OR]: 0.98, 95% CI: 0.52 to 1.84, p = 0.950) or ≥2 serious fall-related injuries (5.4% versus 7.5%, OR: 0.74, 95% CI: 0.31 to 1.75, p = 0.500). Compliant flooring did not affect rate of serious fall-related injuries (0.362 versus 0.422 per 1,000 bed nights, rate ratio [RR]: 1.04, 95% CI: 0.45 to 2.39, p = 0.925; 0.038 versus 0.053 per fall, RR: 0.81, 95% CI: 0.38 to 1.71, p = 0.560), rate of falls with ≥1 serious fall-related injury (0.276 versus 0.303 per 1,000 bed nights, RR: 0.97, 95% CI: 0.52 to 1.79, p = 0.920), or time to first serious fall-related injury (0.237 versus 0.257, hazard ratio [HR]: 0.92, 95% CI: 0.52 to 1.62, p = 0.760). Compliant flooring did not affect any secondary outcome in this study. Study limitations included the following: findings were specific to 2.54 cm SmartCells compliant flooring installed in LTC resident rooms, standard fall and injury prevention interventions were in us...

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

The Flooring for Injury Prevention (FLIP) Study of compliant flooring for the prevention of fall-related injuries in long-term care: A randomized trial

et al. 2019

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“…To avoid duplication of effort, we will build on the search already conducted in a scoping review17 which completed its search in May 2016. The clinical12 16 18–26 38–46 and cost-effectiveness11 21 26 40 41 47–63 records identified in the scoping review will be assessed for inclusion in the current review. We will continue the search from May 2016 to present, and will not apply any language restrictions.…”

Section: Methodsmentioning

confidence: 99%

“…There is no core outcome set specifically for flooring interventions; however we have considered the common outcome data set for fall injury prevention trials in community-dwelling populations59 and the international consensus statement for trials on hip protectors 60. Recognising the unique features of our review and through stakeholder engagement61 and discussion with our public involvement group, we have prioritised the following outcome measures:…”

Section: Methodsmentioning

confidence: 99%

Protocol for the SAFEST review: the Shock-Absorbing Flooring Effectiveness SysTematic review including older adults and staff in hospitals and care homes

et al. 2020

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Open accessCL, AL and DM were all involved in the conception and design of the project, and revising the protocol content. JR contributed to the design of the health economics component and revising the protocol. LF contributed to the design of the Summary of Findings Tables component, and drafting of this manuscript. AD, BK, CL and JR were co-applicants on the original funding proposal to HTA. All authors are also Advisory Board members and have read and approved the manuscript.

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“…outcome sets (and their differences in foci with the current review), discussions with our public involvement group, wider stakeholder engagement activities 66 and the peer review comments we received on our protocol. 67 Following these considerations, we opted to focus on the following outcome measures, in the following order of priority: l primary outcomes -1. injurious falls rate per 1000 person-days 2. falls rate per 1000 person-days l secondary outcomes -3. number of falls resulting in injuries (e.g.…”

Section: Outcomes and Prioritisationmentioning

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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Feasibility of Compliant Flooring in Long-Term Care: Results from a Stakeholder Symposium

Cited by 8 publications

References 35 publications

The Flooring for Injury Prevention (FLIP) Study of compliant flooring for the prevention of fall-related injuries in long-term care: A randomized trial

The Flooring for Injury Prevention (FLIP) Study of compliant flooring for the prevention of fall-related injuries in long-term care: A randomized trial

Protocol for the SAFEST review: the Shock-Absorbing Flooring Effectiveness SysTematic review including older adults and staff in hospitals and care homes

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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