FLOORING 100%


90% 80%


70% 60%


50% 40%


20% 30%


10% 0%


Sports floor on concrete


Count of falls with: No Injury


Vinyl on concrete


27


Injury (unclassified) 0 Minor injury


Moderate injury Severe injury


8 0 0


Drahota 2013 19 0 8 4 2


Sports/ novel


floors on concrete


Hanger 2017 114 0


26 4 2


87 0


33 9 3


Hospitals


injury (or somewhere between 237 fewer and 30 fewer injuries per 1,000 falls). One care home-based study also indicated that wooden sub-floors may result in fewer hip fractures than concrete sub- floors. The fact that the evidence is of very low quality is important, as it means we should question its trustworthiness. We also found very low-quality evidence that shock-absorbing floors may make no difference to the number of falls, indicating that patients would be no more unstable on a shock-absorbing floor than on a regular rigid floor. For staff, there is no strong evidence to suggest that their risk of musculoskeletal injuries is increased on more shock-absorbing floors, but we do not know if this is actually attributable to how well staff adapt to shock-absorbing floors, as these floors do increase staff concerns.


What are people’s experiences of using shock-absorbing floors? Five studies have explored people’s experiences of using shock-absorbing flooring in practice. These studies related to 147 people, including 12 inpatients, eight hospital visitors, 84 hospital/hospice staff (across a range of roles), eight care home residents, eight long-term care nurses, and 27 care home managers. These studies indicate that: (1) Shock-absorbing flooring is viewed by many as a potential solution to help protect people from fall-related injuries, with a potential side-effect of improving environmental comfort; (2) Changing a floor has consequences for


the wider system (e.g. affecting the ease of moving equipment), potentially leading to further adaptations and adjustments in behaviours, attitudes, equipment, processes, and staffing, and (3), that installation may be an initial concern, but can be effectively managed. However, cost and funding considerations need to extend beyond the initial purchase and installation, to consider potential adaptations in staffing/processes/equipment, and potential cost-savings from fall-related injury prevention (should the floor be effective).


What do the economic evaluations say? There are five economic studies, which, when taken together, suggest that if shock- absorbing flooring does not increase the number of falls, then it will improve the number of years people live in good health, and will reduce costs in the long-run due to the injuries saved; i.e., it would be a cost- effective strategy. These economic studies were all based on different assumptions, and were of varying quality. They did not, however, factor in the costs of any changes to staffing, processes, or equipment, so are somewhat incomplete.


Implications of these findings for practice? There is very low-quality evidence that shock-absorbing flooring may reduce injuries without increasing falls, and that wooden sub-floors may result in fewer hip fractures than concrete sub-floors. If this


Healey 1994 23 4 0 0 0


17


169 0 0 0


Vinyl on concrete


Carpet & underlay


Vinyl


Novel floor on concrete


Vinyl/lino/ ceramic on


concrete


Gustavsson 2018 111 0


454 0


23 2 3


148 18 15


38 44 0 0 0


Knoefel 2013 37 46 0 0 2


Care homes Figure 5: The proportion of falls that result in different types of injury across different flooring types.


is true, then shock-absorbing floors would result in lower costs and more years lived in good health. The studies confirmed that shock-absorbing flooring has wider workplace implications – it makes it more challenging for staff to move wheeled equipment. Very low-quality evidence indicates both that adaptations can be made to accommodate these challenges, and that there is no overall increased risk of flooring-related staff injuries. It is important to consider the impacts on staffing, equipment, and processes when installing shock-absorbing floors. The evidence is of very low quality, meaning it is uncertain, and that future research may therefore change our understanding.


What about new flooring solutions? Given the uncertainty surrounding current flooring solutions, research and innovation are required to establish the specifications for improved products. Here, we introduce a new two-year project, funded by the Engineering and Physical Sciences Research Council, in which we aim to develop a multi- functional smart floor that will quietly work in the background to prevent falls, detect falls, and protect against injuries, in one integrated solution. In this project we are focusing our attention on passive detection and protection methods, as these are not privacy- invasive approaches, do not require user compliance, and can be easily adopted, even for people that are physically or cognitively impaired. Especially for people


August 2023 Health Estate Journal 61


Novel floor


Regular floor


Novel floor on concrete


Vinyl & plywood on


concrete


Mackey 2019 753 0


227 0


29


602 0


263 0


33


Percentage of falls


Image adapted from DOI: 10.3310/ZOWL2323, under a creative commons license CC by 4.0


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