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Gustavsson J, Nilson F, Bonander C. Compliant sports floors and fall-related injuries: evidence from a residential care setting and updated meta-analysis for all patient care settings. Inj Prev 2023; 29:283-289. [PMID: 36564164 PMCID: PMC10423535 DOI: 10.1136/ip-2022-044713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Compliant flooring may prevent fall injuries in residential care, but evidence is inconclusive. We investigate compliant sports floors and fall-related injuries in a residential care setting and update a meta-analysis from a recent systematic review on compliant flooring. METHODS A non-randomised study comparing outcomes in a residential care unit that installed sports flooring in bedrooms with four units with regular flooring in a Norwegian municipality (n=193). Data on falls were collected for a period of 46 months (323 falls on sports flooring; 414 on regular flooring). Outcomes were injurious falls per person bed-day, falls per person bed-day and injury risks per fall. Confounding was adjusted for using Andersen-Gill proportional hazards and log-binomial regression models. Random-effects inverse variance models were used to pool estimates. RESULTS Injurious fall rates were 13% lower in the unit with sports flooring (adjusted HR (aHR): 0.87 (95% CI: 0.55 to 1.37)). There was limited evidence of adverse effects on fall rates (aHR: 0.93 (95% CI: 0.63 to 1.38)) and the injury risk per fall was lower in fall events that occurred on sports floors (adjusted relative risk (RR): 0.75 (95% CI: 0.53 to 1.08)). Pooling these estimates with previous research added precision, but the overall pattern was the same (pooled RR for injurious falls: 0.66 (95% CI: 0.39 to 1.12); fall rates: 0.87 (95% CI: 0.68 to 1.12); injury risks per fall: 0.71 (95% CI: 0.52 to 0.97)). CONCLUSION Sports floors may be an alternative to novel shock-absorbing floors in care settings; however, more research is needed to improve precision.
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Affiliation(s)
- Johanna Gustavsson
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden
- Centre for Public Safety, Karlstads Universitet, Karlstad, Sweden
| | - Finn Nilson
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden
- Centre for Public Safety, Karlstads Universitet, Karlstad, Sweden
| | - Carl Bonander
- Centre for Public Safety, Karlstads Universitet, Karlstad, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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2
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Poupin P, Ansoborlo M, Caille A, Dibao-Dina C, Fougère B, Giraudeau B. Management of death-related noncompleters in cluster randomized trials carried out in nursing homes: a methodological review. J Clin Epidemiol 2022; 151:132-142. [PMID: 35963566 DOI: 10.1016/j.jclinepi.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/22/2022] [Accepted: 08/04/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND A noncompleter is defined as a participant who leaves a trial before the end of the planned follow-up. Research in nursing homes is highly exposed to this problem because of high death rates. OBJECTIVES The aim of this trial is to assess the statistical management of noncompleters in cluster randomized trials carried out in nursing homes. STUDY DESIGN AND SETTING A methodological review of published cluster randomized trials. RESULTS We selected 37 articles. For 22 (59%) trials, the design was closed-cohort (i.e., participants included all at the same time when randomizing clusters). In those 22 closed-cohort trials, the median follow-up was 6.5 months (interquartile range 4-12). The median noncompleter rate was 19.5% and the median noncompletions due to death was 73.2%. In only one trial were the baseline characteristics of completers and noncompleters compared. Strategies to deal with noncompleters were an inflation of the planned sample size (11 trials), the use of repeated measurements of the outcome (12 trials), and the use of imputation methods when analyzing data (7 trials). CONCLUSION In cluster randomized trials of nursing homes, noncompleters are managed as for any missing data, but they are essentially due to death. Methodological and statistical developments and guidance are needed.
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Affiliation(s)
- Pierre Poupin
- Division of Geriatric Medicine, Tours University Hospital, Tours, France; INSERM CIC 1415, Tours University Hospital, Tours, France.
| | | | - Agnès Caille
- INSERM CIC 1415, Tours University Hospital, Tours, France; Tours University, Nantes University, INSERM, SPHERE U1246, Tours, France
| | | | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France; Education, Ethics, Health (EA 7505), Tours University, Tours, France
| | - Bruno Giraudeau
- INSERM CIC 1415, Tours University Hospital, Tours, France; Tours University, Nantes University, INSERM, SPHERE U1246, Tours, France
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3
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Tatemoto T, Sugiura T, Kumazawa N, Ii T, Kitamura S, Tanabe S, Hirayama Y, Shimomura H, Mizuno K, Otaka Y. Shock-absorbing effect of flooring-adopted mechanical metamaterial technology and its influence on the gait and balance of older adults. Inj Prev 2022; 28:410-414. [PMID: 35387842 PMCID: PMC9510406 DOI: 10.1136/injuryprev-2021-044450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/18/2022] [Indexed: 12/02/2022]
Abstract
Objective To elucidate the performance of a shock-absorbing floor material with a mechanical metamaterial (MM-flooring) structure and its effect on the gait and balance of older adults. Methods The drop-weight impact was applied to evaluate the shock-absorbing performance. The falling weight was adjusted equivalent to the energy exerted on the femur of an older woman when she falls, which was evaluated on the MM-flooring and six other flooring materials. Nineteen healthy people over the age of 65 years participated in the gait and balance evaluations. The timed up and go and two-step tests were adopted as gait performance tests, and the sway-during-quiet-balance test with force plates and the functional reach test (FRT) were adopted as balance tests. All the participants underwent these tests on the MM-flooring, shock-absorbing mat and rigid flooring. Results The shock-absorbing performance test revealed that MM-flooring has sufficient shock-absorbing performance, and suggesting that it may reduce the probability of fractures in the older people when they fall. The results of the gait performance test showed that the participants demonstrated the same gait performance on the MM-flooring and the rigid floor. In the quiet standing test, MM-flooring did not affect the balance function of the participants to the same extent as the rigid floor, compared with the shock-absorbing mat. In the FRT, no significant differences were found for any of the flooring conditions. Conclusions MM-flooring has the potential to prevent fractures attributed to falls and does not affect the gait or balance of older adults.
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Affiliation(s)
- Tsuyoshi Tatemoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.,Department of Rehabilitation, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | | | - Nobuhiro Kumazawa
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Takuma Ii
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Shin Kitamura
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | | | | | - Koji Mizuno
- Department of Mechanical Systems Engineering, School of Engineering, Nagoya University, Nagoya, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Hwang JS, Kim SH. Severe Ground Fall Injury Associated with Alcohol Consumption in Geriatric Patients. Healthcare (Basel) 2022; 10:healthcare10061111. [PMID: 35742162 PMCID: PMC9222245 DOI: 10.3390/healthcare10061111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022] Open
Abstract
This study investigated characteristics of geriatric patients sustaining ground fall injury related to alcohol consumption and analyzed factors associated with the severity of such injuries in both alcohol- and non-alcohol-related cases. We retrospectively reviewed geriatric patients sustaining ground falls who were admitted to six university hospitals from 2011 to 2018. Patients were classified into alcohol and non-alcohol groups. Their general characteristics, clinical characteristics, and factors of injury severity were analyzed. A total of 31,177 patients were reviewed. Factors significantly associated with alcohol-related ground-fall injuries were: male, 65~84 years old, injury time other than 06:00~11:59, transportation to emergency department (ED) by ambulance and from other hospitals, injured in residential facilities, transportation areas, public or commercial facilities, activities other than paid or unpaid, non-slippery floor, obstacles, concrete floor, and absence of lights. Factors associated with severe injury after ground fall in alcohol-related cases were: male, injury time at between 06:00 and 17:59, transportation to the ED via ambulance from other hospitals, injured in residential facility, and slippery floor. Risk factors for severity in alcohol-related geriatric fall injury included: male sex, daytime injury, transportation by ambulance, injury in a residential facility, and slippery floor condition. Prophylactic measures and therapeutic interventions by ED teams are needed for the management of such cases.
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Affiliation(s)
| | - Sun Hyu Kim
- Correspondence: ; Tel.: +82-52-250-8405; Fax: +82-52-250-8071
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Morris ME, Webster K, Jones C, Hill AM, Haines T, McPhail S, Kiegaldie D, Slade S, Jazayeri D, Heng H, Shorr R, Carey L, Barker A, Cameron I. Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age Ageing 2022; 51:6581612. [PMID: 35524748 PMCID: PMC9078046 DOI: 10.1093/ageing/afac077] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital. DESIGN Systematic review and meta-analysis. PARTICIPANTS Hospitalised adults. INTERVENTION Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches. OUTCOME MEASURES Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR). RESULTS There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias. CONCLUSION Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.
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Affiliation(s)
- Meg E Morris
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia,The Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Victoria, Australia,Address correspondence to: Meg E. Morris, La Trobe University, Bundoora, Victoria 3186, Australia.
| | - Kate Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Cathy Jones
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Anne-Marie Hill
- Western Australian Centre for Health & Ageing, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia Australia,Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Debra Kiegaldie
- Holmesglen Institute and Monash University, Melbourne, Victoria, Australia
| | - Susan Slade
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Dana Jazayeri
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Hazel Heng
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Ronald Shorr
- Geriatric Research Education and Clinical Center, Malcom Randall VAMC, Department of Epidemiology, University of Florida, Gainesville, FL, USA,Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Leeanne Carey
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Anna Barker
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia,Silver Chain, Melbourne, Victoria, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and The University of Sydney, Sydney, NSW, Australia
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC, Farrell-Savage K, Okunribido O. Shock-absorbing flooring for fall-related injury prevention in older adults and staff in hospitals and care homes: the SAFEST systematic review. Health Technol Assess 2022; 26:1-196. [PMID: 35089119 DOI: 10.3310/zowl2323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Lambert M Felix
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Southampton, UK
| | | | | | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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7
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC. The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention. BMC Geriatr 2022; 22:32. [PMID: 34991466 PMCID: PMC8739972 DOI: 10.1186/s12877-021-02670-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
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 .
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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK.
| | - Lambert M Felix
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK
| | - Bethany E Keenan
- School of Engineering, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - Chantelle C Lachance
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive East, Burnaby, British Columbia, V5A 1S6, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, B.C. Matthews Hall, Waterloo, Ontario, N2L 3G1, Canada
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Designing a Patient Room as a Fall Protection Strategy: The Perspectives of Healthcare Design Experts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168769. [PMID: 34444514 PMCID: PMC8392568 DOI: 10.3390/ijerph18168769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022]
Abstract
Despite decades of research into patient falls, there is a dearth of evidence about how the design of patient rooms influences falls. Our multi-year study aims to better understand how patient room design can increase stability during ambulation, serving as a fall protection strategy for frail and/or elderly patients. The aim of this portion of the study was to ascertain the architect’s perspective on designing a room to mitigate the risk of falls, as well as to evaluate the face validity of a predictive algorithm to assess risk in room design using the input of a design advisory council (AC). The purpose of this paper is to provide insight into the design process and decision-making for patient rooms; summarize the impressions of industry experts about the configurations and layout of the patient rooms tested in a preliminary augmented reality model; establish the face validity of modeled heat maps depicting risk; and report the results of a pre-meeting and post-meeting survey of expert opinions. Feedback was coded using human factors/ergonomic (HF/E) design principles, and the findings will be used to guide further development of an “optimal” prototype room for human subject testing. The results confirm the challenges that architects face as they balance competing priorities and reveal how a participatory process focusing on preventing falls can shift assumptions about design strategies, especially subtle changes (e.g., toilet orientation).
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Pati D, Valipoor S, Lorusso L, Mihandoust S, Jamshidi S, Rane A, Kazem-Zadeh M. The Impact of the Built Environment on Patient Falls in Hospital Rooms: An Integrative Review. J Patient Saf 2021; 17:273-281. [PMID: 31157738 DOI: 10.1097/pts.0000000000000613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of this study were to identify and evaluate scientific evidence examining the impact of the built environment on patient falls in hospital rooms. METHODS An integrative review (IR) with a systematic literature search was performed using the patient, intervention, comparison, outcome framework. We searched CINAHL, PsychINFO, PubMED, and Web of Science databases. The search included peer-reviewed studies from 1990 to 2017 written in English. An additional hand search was also conducted. Selected articles were reviewed and rated based on a hierarchical categorization, comprising six evidence levels, developed by the American Association of Critical-Care Nurses and adapted for evidence-based design systematic literature reviews. RESULTS After a multitiered process, 30 articles met the selection criteria. Thematic areas were created based on the examined elements of the physical environment including patient room configuration and available space, bathroom configuration, bathtub and shower, door, bed height and bed rail, flooring, floor mats, patient chair, lighting, toilet, handrail, grab bars, intravenous pole, sink, ceiling lift, and wheelchair and walking aids. Findings of studies on each element are discussed in detail. CONCLUSIONS Some environmental elements have not been examined in past relational or causal studies, and the level of evidence for the examined attributes is not high enough to gain robust confidence in healthcare design decision-making. Because of the low level of evidence for several environmental elements, conclusions must be taken with caution. More studies using quantitative, relational, or causal designs are recommended to develop actionable interventions on patient falls in hospital rooms.
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Affiliation(s)
- Debajyoti Pati
- From the Department of Design, College of Human Sciences, Texas Tech University, Lubbock, Texas
| | - Shabboo Valipoor
- Department of Interior Design, College of Design, Construction and Planning, University of Florida
| | - Lesa Lorusso
- Department of Interior Design, College of Design, Construction and Planning, University of Florida
| | - Sahar Mihandoust
- From the Department of Design, College of Human Sciences, Texas Tech University, Lubbock, Texas
| | - Saman Jamshidi
- From the Department of Design, College of Human Sciences, Texas Tech University, Lubbock, Texas
| | - Apoorva Rane
- From the Department of Design, College of Human Sciences, Texas Tech University, Lubbock, Texas
| | - Mahshad Kazem-Zadeh
- Rinker School of Construction Management, College of Design, Construction and Planning, University of Florida, Gainesville, Florida
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10
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Kim SH, Kim S, Cho GC, Lee JH, Park EJ, Lee DH. Characteristics of fall-related head injury versus non-head injury in the older adults. BMC Geriatr 2021; 21:196. [PMID: 33743590 PMCID: PMC7981902 DOI: 10.1186/s12877-021-02139-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to examine the characteristics of older adults patients who suffered a head injury after a ground-level fall in comparison to non-head injury patients as well as the factors associated with severity in those with head injury only. Methods Patients were classified into two groups, the head injury group and the non-head injury group. The characteristics were compared and factors associated with head injury were evaluated. Factors relating to severe injury in the head injury group were also investigated. Results The head injury group comprised 42 % of a study subjects. Male sex; fall time of 18:00–23:59; fall location of medical facility, transportation area, and public or commercial facility; fall in an outdoor area; fall during daily activity; alcohol ingestion; fall from stairs; non-slippery floor conditions; concrete flooring; sloped flooring; and presence of obstacles on the floor were risk factors for head injury in the older adults after a ground-level fall. Male sex and age over 70 years; fall time of 00:00–05:59; fall in a residential facility; fall in an indoor area; fall during daily activity; fall from stairs; non-slippery floor conditions; and presence of obstacles on the floor were factors associated with severe injury in the head injury group. Conclusions Male sex with advanced age, indoor fall, and the presence of obstacles on the floor were risk factors for severe injury in the head injury group in older adults individuals who suffered a ground-level fall. It is necessary to develop appropriate ground-level fall prevention programs by evaluating the individual and environmental characteristics of older adults patients.
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Affiliation(s)
- Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, 44033, Ulsan, Republic of Korea.
| | - Sunpyo Kim
- Department of Emergency Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Republic of Korea
| | - Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Jung Park
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University, Seoul, Republic of Korea
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11
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Keenan BE, Hallas K, Drahota AK, Evans SL. A comparison of floor surfaces for injury prevention in care settings: impact forces and horizontal pulling force required to move wheeled equipment. Osteoporos Int 2020; 31:2383-2394. [PMID: 32647950 DOI: 10.1007/s00198-020-05520-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
UNLABELLED Shock-absorbing flooring is one potential solution to prevent fall-related injuries. No standards exist to characterize shock-absorbing healthcare flooring. This study explores two mechanical tests for impact force reduction and horizontal force required to move wheeled objects. An appropriately designed rubber underlay can reduce peak impact by 25% compared with 1% with standard vinyl. INTRODUCTION Severe falls often occur in hospitals and care homes. Shock-absorbing flooring is one potential solution to prevent fall-related injuries; however, no standards exist for characterizing flooring as an injury prevention measure. Shock-absorbing flooring use in high-risk settings may influence both patients (injury-saving potential) and staff (manoeuvring equipment). We aimed to explore two tests to characterize floors, to determine shock absorbency and horizontal pulling force required to move wheeled objects. METHODS Mechanical testing was performed according to the Canadian Standards Association Z325 Hip Protectors document. This test was developed for hip protectors but is applicable to compliant surfaces that form part of the floor. Tests were performed on commercially available floor materials (suitable for care settings) to assess the force required to initiate movement of a wheeled object across the floor. We explored the relationships between horizontal force required to pull wheeled objects, impact force, floor thickness, and core material. RESULTS Considerable differences were identified between floor samples in their ability to reduce the peak impact force (range 0.7-25%). A peak force reduction of up to 25% can be achieved with a specially designed rubber underlay. Horizontal pulling force increased with floor thickness but was lower for rubber floors. There was no direct relationship between impact attenuation and horizontal pulling force. Whilst thickness and core material explain some variations (66.5% for wheel movement; 82.3% for impact), other unmeasured factors clearly influence floor performance. CONCLUSIONS These results can inform the development of flooring and the establishment of standards needed to underpin practice, research, and development in this field.
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Affiliation(s)
- B E Keenan
- School of Engineering, Cardiff University Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK.
| | - K Hallas
- Science Division, Health & Safety Executive (HSE), Harpur Hill, Derbyshire, Buxton, SK17 9JN, UK
| | - A K Drahota
- School of Health & Care Professions, University of Portsmouth, Hampshire, Portsmouth, PO1 2PR, UK
| | - S L Evans
- School of Engineering, Cardiff University Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
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12
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Abstract
Introduction: Low impact flooring (LIF) has shown potential for reducing fall-related injuries for older people in residential care or hospital environments. However, the increased rolling resistance when moving equipment on these floors has raised concerns that staff injuries may increase.Methods: LIF was trialled on one Older Persons Health ward for 2.5 years. Reported staff injuries were monitored during and following the trial. Numbers of staff injured on the LIF ward were compared with three other similar and adjacent OPH wards without LIF for the duration of the trial ('concurrent control' evaluation). At the trial conclusion the LIF ward moved to a different hospital that had standard flooring. This enabled a further 'during and after' evaluation where numbers of staff injured from the LIF ward during the trial were compared with those reported afterwards by the same ward staff without LIF.Results: There was no difference in the numbers of staff injured in the LIF ward compared with the concurrent control wards (28 LIF vs 30 control; p = 0.44). The number of staff with injuries in the LIF ward also did not significantly alter when those staff moved to a new ward without LIF (45 after vs 28 before; p = 0.11).Conclusion: There was no change in the numbers of staff with injuries during the LIF trial in an Older Persons Health ward. This small study suggests LIF appears safe for both patients and staff.Implications for rehabilitationFalls in hospital are common with patient injuries occurring in approximately 20-30% of falls.Low impact (compliant) flooring may reduce fall-related injuries in hospitals and residential care.Low impact flooring has an increased rolling resistance, which has the potential to increase staff injuries when moving equipment.This study found no change in the number of staff injured during a low impact flooring trial providing some reassurance that these floors are safe for staff.
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Affiliation(s)
- H C Hanger
- Canterbury District Health Board, Geriatrician, Burwood Hospital, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tim J Wilkinson
- Canterbury District Health Board, Geriatrician, Burwood Hospital, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand
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13
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Ekbrand H, Ekman R, Thodelius C, Möller M. Fall-related injuries for three ages groups - Analysis of Swedish registry data 1999-2013. JOURNAL OF SAFETY RESEARCH 2020; 73:143-152. [PMID: 32563386 DOI: 10.1016/j.jsr.2020.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 02/17/2019] [Accepted: 02/25/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The objective of this study was to analyze which factors (including factors pertaining to the individual, the household, and the local area) increase the risk of fall injuries for the three age groups with the highest risk for fall injuries in Sweden. METHOD The study combined longitudinal data covering the period 1999-2013 from several different official registries from Statistics Sweden as well as from the Swedish health care system and fitted the models to data using mixed model regressions. RESULTS Three age groups had a markedly heightened risk for fall injuries: 1-3-year olds, 12-14 year olds, and the elderly (65+). The home was the most common location for fall injuries, as about 40% of all fall injuries occur in the home. Only for the elderly strong predictors for fall injuries were found, and these were: age, single household, and special housing. CONCLUSIONS There is preventive potential in the special residences for the elderly and disabled. People living in these special residences make up a strongly selected group that needs extra safe environments. Our findings indicate that their needs are currently not meet. Practical applications: Design of special residences for the elderly and disabled should aim at reducing the consequences of falling.
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Affiliation(s)
- Hans Ekbrand
- University of Gothenburg, Box 100, SE-405 30 Gothenburg, Sweden.
| | - Robert Ekman
- Chalmers University of Technology, SE-412 96 Gothenburg, Sweden.
| | | | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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Drahota A, Felix LM, Keenan BE, Lachance CC, Laing A, Mackey DC, Raftery J. Protocol for the SAFEST review: the Shock-Absorbing Flooring Effectiveness SysTematic review including older adults and staff in hospitals and care homes. BMJ Open 2020; 10:e032315. [PMID: 32071174 PMCID: PMC7044972 DOI: 10.1136/bmjopen-2019-032315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/07/2019] [Accepted: 01/22/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Falls in hospitals and care homes are a major issue of international concern. Inpatient falls are the most commonly reported safety incident in the UK's National Health Service (NHS), costing the NHS £630 million a year. Injurious falls are particularly life-limiting and costly. There is a growing body of evidence on shock-absorbing flooring for fall-related injury prevention; however, no systematic review exists to inform practice. METHODS AND ANALYSIS We will systematically identify, appraise and summarise studies investigating the clinical and cost-effectiveness, and experiences of shock-absorbing flooring in hospitals and care homes. Our search will build on an extensive search conducted by a scoping review (inception to May 2016). We will search electronic databases (AgeLine, CINAHL, MEDLINE, NHS Economic Evaluation Database, Scopus and Web of Science; May 2016-present), trial registries and grey literature. We will conduct backward and forward citation searches of included studies, and liaise with study researchers. We will evaluate the influence of floors on fall-related injuries, falls and staff work-related injuries through randomised and non-randomised studies, consider economic and qualitative evidence, and implementation factors. We will consider risk of bias, assess heterogeneity and explore potential effect modifiers via subgroup analyses and sensitivity analyses. Where appropriate we will combine studies through meta-analysis. We will use the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach to evaluate the quality of evidence and present the results using summary of findings tables, and adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. ETHICS AND DISSEMINATION We will follow the ethical principles of systematic review conduct, by attending to publication ethics, transparency and rigour. Our dissemination plan includes peer-reviewed publication, presentations, press release, stakeholder symposium, patient video and targeted knowledge-to-action reports. This review will inform decision-making around falls management in care settings and identify important directions for future research. PROSPERO REGISTRATION NUMBER CRD42019118834.
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Affiliation(s)
- Amy Drahota
- School of Health & Care Professions, University of Portsmouth, Portsmouth, Hampshire, UK
| | - Lambert M Felix
- School of Health & Care Professions, University of Portsmouth, Portsmouth, Hampshire, UK
| | - Bethany E Keenan
- School of Engineering, Cardiff University, Cardiff, South Glamorgan, UK
| | - Chantelle C Lachance
- School of Health & Care Professions, University of Portsmouth, Portsmouth, Hampshire, UK
| | - Andrew Laing
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - James Raftery
- Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
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Mackey DC, Lachance CC, Wang PT, Feldman F, Laing AC, Leung PM, Hu XJ, Robinovitch SN. The Flooring for Injury Prevention (FLIP) Study of compliant flooring for the prevention of fall-related injuries in long-term care: A randomized trial. PLoS Med 2019; 16:e1002843. [PMID: 31233541 PMCID: PMC6590787 DOI: 10.1371/journal.pmed.1002843] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/29/2019] [Indexed: 11/18/2022] Open
Abstract
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/m2, 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 use throughout the study and may have influenced the observed effect of compliant flooring, and challenges with concussion detection in LTC residents may have prevented estimation of the effect of compliant flooring on fall-related concussions. CONCLUSIONS In contrast to results from previous retrospective and nonrandomized studies, this study found that compliant flooring underneath hospital-grade vinyl was not effective at preventing serious fall-related injuries in LTC. Future studies are needed to identify effective methods for preventing fall-related injuries in LTC. TRIAL REGISTRATION ClinicalTrials.gov: NCT01618786.
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Affiliation(s)
- Dawn C. Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- * E-mail:
| | - Chantelle C. Lachance
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Peiwei T. Wang
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Clinical Quality & Patient Safety, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Andrew C. Laing
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Pet M. Leung
- New Vista Society Care Home, Burnaby, British Columbia, Canada
| | - X. Joan Hu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Stephen N. Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
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16
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Lai FHY, Yan EWH, Mackenzie L, Fong KNK, Kranz GS, Ho ECW, Fan SHU, Lee ATK. Reliability, validity, and clinical utility of a self-reported screening tool in the prediction of fall incidence in older adults. Disabil Rehabil 2019; 42:3098-3105. [PMID: 30860929 DOI: 10.1080/09638288.2019.1582721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: The Chinese HomeFAST self-reported screening tool was developed to measure the number of hazards and the risk of home falls and other accidents for community-living older adults.Methods: This reliability, validity, and clinical utility study consisted of three phases. The tool's linguistic validity was established in the first phase of study, with a panel of domiciliary healthcare experts. In the second phase, the instrument yielded inter-rater reliability between community-living older adults and a group of experienced occupational therapists. Furthermore, in the third phase of study, factor analysis of the Chinese Home-FAST self-reported screening tool was conducted.Results: There was good linguistic validity, test-retest reliability and good to excellent internal consistency of the Chinese Home-FAST self-reported screening tool among older adults living in the community. Moreover, a structure with three factors - namely "Home Environment and Furniture," "Capability in Activities of Daily Living," and "Use of Devices" - was yielded from categorical principal components analysis. Clinically, the incidence of falls among this group of recruited older adults in a six-month period was 18%. The identification of seven or more hazards was associated with prediction of unplanned fall-related hospital admission with sensitivity of 83.33% and specificity of 95.83%. Conclusion: The Chinese HomeFAST self-reported screening tool is thus demonstrated to be a valid and reliable tool for measuring home hazards and can predict home falls in Chinese-speaking older adults.Implications for rehabilitationTo develop an easily understandable screening tool for older adults.Older adults can perform home safety screening on their own, and can identify potential risk of falls and other accidents at home.This can serve as a communication tool between older adults and healthcare professionals.Identified hazards can be reported to healthcare professionals for further intervention.This validated instrument can help healthcare professionals to identify higher-risk older adults in the community and thus to better prioritize their provision of professional services.
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Affiliation(s)
- Frank H Y Lai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Elaine W H Yan
- Occupational Therapy Department, Kowloon Hospital, Hong Kong
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Lidcombe NSW, Australia
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Eric C W Ho
- Occupational Therapy Department, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Silvia H U Fan
- Occupational Therapy Department, Tai Po Hospital, Hong Kong
| | - Alice T K Lee
- Occupational Therapy Department, TWGHs Jockey Club Rehabilitation Complex, Hong Kong
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Sittichoke C, Buasord J, Boripuntakul S, Sungkarat S. Effects of Compliant Flooring on Dynamic Balance and Gait Characteristics of Community-dwelling Older Persons. J Nutr Health Aging 2019; 23:665-668. [PMID: 31367732 DOI: 10.1007/s12603-019-1211-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Compliant flooring while providing the impact force attenuation in the event of falls, its low stiffness characteristic might impair balance and gait which consequently resulted in an increase in the risk of falling. OBJECTIVE To investigate the effects of compliant flooring on dynamic balance and gait performance of older adults under challenging conditions. DESIGN AND PARTICIPANTS A cross-sectional designed with repeated measured. Thirty five community-dwelling older adults (mean age 74.91 ± 6.51 yrs) participated in this study. MEASUREMENT Modified Dynamic Gait Index (mDGI) and Timed Up and Go (TUG) were used to assess dynamic balance. Spatio-temporal gait parameters were measured under comfortable and maximal speed. All tests were administered on the vinyl and compliant flooring in random order. RESULTS The time taken to complete TUG and the mDGI scores were similar between the two flooring types (p ≥ 0.05). Overall, gait characteristics were comparable when walking on the compliant and vinyl flooring for both speeds except for swing time, step time, and cadence. CONCLUSION The present study demonstrated that compliant flooring did not significantly affect dynamic balance and had minimal effects on gait characteristics. The compliant flooring appears to be safe for installing in self-ambulating older adult's home.
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Affiliation(s)
- C Sittichoke
- Somporn Sungkarat, Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand, 50200; E-mail address: ; Tel. + 66 53 949 249; Fax. +66 53 946 042
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Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; 9:CD005465. [PMID: 30191554 PMCID: PMC6148705 DOI: 10.1002/14651858.cd005465.pub4] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. OBJECTIVES To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. SELECTION CRITERIA Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. DATA COLLECTION AND ANALYSIS One review author screened abstracts; two review authors screened full-text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. MAIN RESULTS Thirty-five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low-quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.Care facilitiesSeventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low-quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low-quality evidence).There is low-quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).There is moderate-quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low-quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low-quality evidence).HospitalsThree trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low-quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low-quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low-quality evidence).Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low-quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.
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Affiliation(s)
- Ian D Cameron
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Suzanne M Dyer
- DHATR Consulting120 Robsart StreetParksideSouth AustraliaAustralia5063
| | - Claire E Panagoda
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health DistrictSt LeonardsNSWAustralia2065
| | - Geoffrey R Murray
- Illawarra Shoalhaven Local Health DistrictAged Care, Rehabilitation and Palliative CareWarrawongAustralia
| | - Keith D Hill
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesGPO Box U1987PerthWestern AustraliaAustralia6845
| | - Robert G Cumming
- Sydney Medical School, University of SydneySchool of Public HealthRoom 306, Edward Ford Building (A27)Fisher RoadSydneyNSWAustralia2006
| | - Ngaire Kerse
- University of AucklandDepartment of General Practice and Primary Health CarePrivate Bag 92019AucklandNew Zealand
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A quasi-experimental evaluation of compliant flooring in a residential care setting. PLoS One 2018; 13:e0201290. [PMID: 30048517 PMCID: PMC6062098 DOI: 10.1371/journal.pone.0201290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/12/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fall injuries affect the lives of older people to a substantial degree. This quasi-experimental observational study investigates the potential fall injury reducing effect of a compliant flooring in a residential care setting. METHODS The allocation of the compliant flooring was non-random. Data on fall-events and individual characteristics were collected in a residential care unit during a period of 68 months. The primary outcome was the fall injury rate per fall, and a logistic regression analysis was used to test for the effect of complaint flooring. Falls per 1000 bed days was the secondary outcome, used to measure the difference in fall risk on compliant flooring versus regular flooring. RESULTS The event dataset is an unbalanced panel with repeated observations on 114 individuals, with 70% women. The mean age was 84.9 years of age, the average Body Mass Index (BMI) was 24.7, and there was a mean of 6.57 (SD: 15.28) falls per individual. The unadjusted effect estimate showed a non-significant relative risk injury reduction of 29% per fall (RR 0.71 [95% CI: 0.46-1.09]) compared to regular flooring. Re-estimating, excluding identified outliers, showed an injury risk reduction of 63% (RR 0.37 [95% CI: 0.25-0.54]). Falls per 1000 bed days showed that individuals living in apartments with compliant flooring had a fall rate of 5.3 per 1000 bed days compared to a fall rate of 8.4 per 1000 bed days among individuals living in regular apartments. This corresponds to an incidence rate ratio (IRR) of 0.63 (95% exact Poisson CI: 0.50-0.80). CONCLUSION The results of this non-randomized study indicate that compliant flooring has the potential to reduce the risk of fall injury without increasing the fall risk among older people in a Swedish residential care setting.
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Parke B, Boltz M, Hunter KF, Chambers T, Wolf-Ostermann K, Adi MN, Feldman F, Gutman G. A Scoping Literature Review of Dementia-Friendly Hospital Design. THE GERONTOLOGIST 2018; 57:e62-e74. [PMID: 27831481 DOI: 10.1093/geront/gnw128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/31/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design. This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing independent function while ensuring safety and harm reduction in older people living with dementia. Design and Methods Exploratory iterative design utilizing scoping literature review methodology. Results A total of 28 primary studies plus expert reviewers' narratives on the impact of design and architectural features on independent function of hospitalized older people with dementia were included and evaluated. Items were mapped to key design elements to describe a D-FAC environment. This scoping review project confirms the limited nature of available acute care design evidence on maximizing function. Implications Physical design influences the usability and activity undertaken in a health care space and ultimately affects patient outcomes. Achieving safe quality hospital care for older people living with dementia is particularly challenging. Evidence of design principle effectiveness is needed that can be applied to general medical and surgical units where the bulk of older persons with and without dementia are treated.
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Affiliation(s)
- Belinda Parke
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Marie Boltz
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | | | - Thane Chambers
- JW Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | | | - Mohamad Nadim Adi
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Surrey, British Columbia, Canada.,Seniors Fall and Injury Prevention, Primary Care, Chronic Disease Management and Specialized Seniors, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Gloria Gutman
- Gerontology Department and Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
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Abstract
Compliant flooring aims to prevent fall-related injuries among high-risk older adults in long-term care, but uptake of compliant flooring in this setting is limited. We hosted a one-day stakeholder symposium to identify advantages and disadvantages of implementing compliant flooring in long-term care and the most pressing directions for future research from the perspective of key stakeholders. Twenty-three stakeholders representing health care, industry, and research attended the symposium. Attendees believed the most important advantages of compliant flooring were reducing injuries in residents who have fallen, potential benefits to care staff, and potential increases in quality of life for residents. Attendees perceived the most significant disadvantages of compliant flooring were financial considerations, lack of research evidence, and challenges with installation. Attendees indicated a need for additional research on cost-effectiveness and clinical effectiveness. While stakeholders perceived compliant flooring to add value to long-term care, there are significant informational and financial barriers to uptake.
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Cuttler SJ, Barr-Walker J, Cuttler L. Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms. BMJ Open Qual 2017; 6:e000119. [PMID: 29450285 PMCID: PMC5699144 DOI: 10.1136/bmjoq-2017-000119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/30/2017] [Accepted: 10/03/2017] [Indexed: 11/16/2022] Open
Abstract
Background Inpatient falls and subsequent injuries are among the most common hospital-acquired conditions with few effective prevention methods. Objective To evaluate the effectiveness of patient education videos and fall prevention visual signalling icons when added to bed exit alarms in improving acutely hospitalised medical-surgical inpatient fall and injury rates. Design Performance improvement study with historic control. Setting Four medical-surgical units in one US public acute care hospital. Study participants Adult medical-surgical inpatients units. Interventions A 4 min video was shown to patients by trained volunteers. Icons of individual patient risk factors and interventions were placed at patients’ bedsides. Beds with integrated three-mode sensitivity exit alarms were activated for confused patients at risk of falling. Main outcome measures The main outcome measure is the incident rate per 1000 patient days (PDs) for patient falls, falls with any injury and falls with serious injury. The incident rate ratio (IRR) for each measure compared January 2009–September 2010 (baseline) with the follow-up period of January 2015–December 2015 (intervention). Results Falls decreased 20% from 4.78 to 3.80 per 1000 PDs (IRR 0.80, 95% CI 0.66 to 0.96); falls with any injury decreased 40% from 1.01 to 0.61 per 1000 PDs (IRR 0.60, 95% CI 0.38 to 0.94); and falls with serious injury 85% from 0.159 to 0.023 per 1000 PDs (IRR 0.15, 95% CI 0.01 to 0.85). Icons were not fully implemented. Conclusion The first known significant reduction of falls, falls with injury and falls with serious injury among medical-surgical inpatients was achieved. Patient education and continued use of bed exit alarms were associated with large decreases in injury. Icons require further testing. Multicentre randomised controlled trials are needed to confirm the effectiveness of icons and video interventions and exit alarms.
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Affiliation(s)
- Sasha J Cuttler
- Collaborative Alliance for Nursing Outcomes Coordinator, San Francisco General Hospital, San Francisco, California, USA.,Physiological Nursing, University of California San Francisco, San Francisco, California, USA
| | - Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, California, USA
| | - Lauren Cuttler
- Department of Nursing, City College of San Francisco, San Francisco, California, USA
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Jung HY, Kim SH, Lee SC, Kim S, Cho GC, Kim MJ, Lee JS, Han C. Relating factors to severe injury from outdoor falls in older people. Geriatr Gerontol Int 2017; 18:80-87. [PMID: 28776901 DOI: 10.1111/ggi.13144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/16/2017] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
Abstract
AIM The aim of the present study was to evaluate the clinical characteristics, including floor characteristics and factors, related to severe injury from outdoor falls in older adults. METHODS Patients were divided into two groups based on injury severity: the severe group and non-severe group. The clinical and general characteristics were compared between the two groups, and factors associated with severe injury were investigated. RESULTS Approximately 5% (364/7635) of older people involved in outdoor falls were classified into severe injury. The proportion of men and the rate of alcohol ingestion were higher in the severe group compared with that in the non-severe group. Falling from stairs was a more frequent mechanism of fall in the severe group compared with that in the non-severe group. Non-slippery floor condition had a higher proportion in the severe group than that in the non-severe group. Head and neck were the predominantly injured regions in both groups. Discharge was the most common result of emergency department treatment in the non-severe group, whereas admission to intensive care unit was the main result in the severe group. Multivariate logistic analysis showed that male sex and falls from stairs rather than slipping down on the same level were associated with severe injury. CONCLUSIONS Floor characteristics did not influence injury severity; however, the risk of severe injury from outdoor falls in older adults was high in men and those who fell from stairs. Geriatr Gerontol Int 2018; 18: 80-87.
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Affiliation(s)
- Hey Youn Jung
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sang Cheal Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sunpyo Kim
- Department of Emergency Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Sook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Chul Han
- Department of Emergency Medicine, Ewha Womans University, School of Medicine, Seoul, Korea
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Gustavsson J, Rahm G, Jernbro C, Nilson F. Effects of Impact-Absorbing Flooring in Residential Care from the Perspectives of Enrolled Nurses. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/02763893.2017.1335670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johanna Gustavsson
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - GullBritt Rahm
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Carolina Jernbro
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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Clinical Risk Factors for Head Impact During Falls in Older Adults: A Prospective Cohort Study in Long-Term Care. J Head Trauma Rehabil 2017; 32:168-177. [DOI: 10.1097/htr.0000000000000257] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hanger HC. Low-Impact Flooring: Does It Reduce Fall-Related Injuries? J Am Med Dir Assoc 2017; 18:588-591. [PMID: 28279604 DOI: 10.1016/j.jamda.2017.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare fall rates and injuries from falls on low-impact flooring (LIF) compared with a standard vinyl flooring. DESIGN Prospective, observational, nonrandomized controlled study. SETTING Subacute Older Persons Health ward (N = 20 beds). PARTICIPANTS Older inpatients. INTERVENTION Three different types of LIF. MEASUREMENTS All falls in the ward were prospectively monitored using incident reporting, noting location and consequences of each fall. Fall rates (per 1000 bed days) and injuries, were compared between bedroom falls on LIF against those occurring on standard vinyl flooring (controls). RESULTS Over 31 months, there were 278 bedroom falls (from 178 fallers). The bedroom fall rate (falls per 1000 bed days occupied) did not differ between the LIF and control groups (median 15 [IQR 8-18] versus 17 [IQR 9-23], respectively; P = .47). However, fall-related injuries were significantly less frequent when they occurred on LIFs (22% of falls versus 34% of falls on control flooring; P = .02). Fractures occurred in 0.7% of falls in the LIF cohort versus 2.3% in the control cohort. Rolling resistance when moving heavier equipment, such as beds or hoists, was an issue for staff on LIF. CONCLUSIONS LIF significantly reduced fall-related injuries compared with a standard vinyl flooring, whereas they did not alter the overall risk of falling.
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Affiliation(s)
- H Carl Hanger
- Older Persons Health Specialist Service, Canterbury District Health Board; and Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.
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Lachance CC, Jurkowski MP, Dymarz AC, Robinovitch SN, Feldman F, Laing AC, Mackey DC. Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety. PLoS One 2017; 12:e0171652. [PMID: 28166265 PMCID: PMC5293217 DOI: 10.1371/journal.pone.0171652] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background Compliant flooring, broadly defined as flooring systems or floor coverings with some level of shock absorbency, may reduce the incidence and severity of fall-related injuries in older adults; however, a lack of synthesized evidence may be limiting widespread uptake. Methods Informed by the Arksey and O’Malley framework and guided by a Research Advisory Panel of knowledge users, we conducted a scoping review to answer: what is presented about the biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety associated with compliant flooring systems that aim to prevent fall-related injuries in healthcare settings? We searched academic and grey literature databases. Any record that discussed a compliant flooring system and at least one of biomechanical efficacy, clinical effectiveness, cost-effectiveness, or workplace safety was eligible for inclusion. Two independent reviewers screened and abstracted records, charted data, and summarized results. Results After screening 3611 titles and abstracts and 166 full-text articles, we included 84 records plus 56 companion (supplementary) reports. Biomechanical efficacy records (n = 50) demonstrate compliant flooring can reduce fall-related impact forces with minimal effects on standing and walking balance. Clinical effectiveness records (n = 20) suggest that compliant flooring may reduce injuries, but may increase risk for falls. Preliminary evidence suggests that compliant flooring may be a cost-effective strategy (n = 12), but may also result in increased physical demands for healthcare workers (n = 17). Conclusions In summary, compliant flooring is a promising strategy for preventing fall-related injuries from a biomechanical perspective. Additional research is warranted to confirm whether compliant flooring (i) prevents fall-related injuries in real-world settings, (ii) is a cost-effective intervention strategy, and (iii) can be installed without negatively impacting workplace safety. Avenues for future research are provided, which will help to determine whether compliant flooring is recommended in healthcare environments.
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Affiliation(s)
- Chantelle C. Lachance
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michal P. Jurkowski
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ania C. Dymarz
- W.A.C. Bennett Library, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Stephen N. Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Patient Safety and Injury Prevention, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Andrew C. Laing
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Dawn C. Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Lachance CC, Korall AMB, Russell CM, Feldman F, Robinovitch SN, Mackey DC. External Hand Forces Exerted by Long-Term Care Staff to Push Floor-Based Lifts: Effects of Flooring System and Resident Weight. HUMAN FACTORS 2016; 58:927-943. [PMID: 27098263 DOI: 10.1177/0018720816644083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/17/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of flooring type and resident weight on external hand forces required to push floor-based lifts in long-term care (LTC). BACKGROUND Novel compliant flooring is designed to reduce fall-related injuries among LTC residents but may increase forces required for staff to perform pushing tasks. A motorized lift may offset the effect of flooring on push forces. METHOD Fourteen female LTC staff performed straight-line pushes with two floor-based lifts (conventional, motor driven) loaded with passengers of average and 90th-percentile resident weights over four flooring systems (concrete+vinyl, compliant+vinyl, concrete+carpet, compliant+carpet). Initial and sustained push forces were measured by a handlebar-mounted triaxial load cell and compared to participant-specific tolerance limits. Participants rated pushing difficulty. RESULTS Novel compliant flooring increased initial and sustained push forces and subjective ratings compared to concrete flooring. Compared to the conventional lift, the motor-driven lift substantially reduced initial and sustained push forces and perceived difficulty of pushing for all four floors and both resident weights. Participants exerted forces above published tolerance limits only when using the conventional lift on the carpet conditions (concrete+carpet, compliant+carpet). With the motor-driven lift only, resident weight did not affect push forces. CONCLUSION Novel compliant flooring increased linear push forces generated by LTC staff using floor-based lifts, but forces did not exceed tolerance limits when pushing over compliant+vinyl. The motor-driven lift substantially reduced push forces compared to the conventional lift. APPLICATION Results may help to address risk of work-related musculoskeletal injury, especially in locations with novel compliant flooring.
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Affiliation(s)
- Chantelle C Lachance
- Simon Fraser University, Burnaby, CanadaOlder Adult Program, Fraser Health Authority, Surrey, CanadaSimon Fraser University, Burnaby Canada
| | - Alexandra M B Korall
- Simon Fraser University, Burnaby, CanadaOlder Adult Program, Fraser Health Authority, Surrey, CanadaSimon Fraser University, Burnaby Canada
| | | | - Fabio Feldman
- Older Adult Program, Fraser Health Authority, Surrey, Canada
| | - Stephen N Robinovitch
- Simon Fraser University, Burnaby, CanadaOlder Adult Program, Fraser Health Authority, Surrey, CanadaSimon Fraser University, Burnaby Canada
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31
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Taylor E, Hignett S. The SCOPE of Hospital Falls: A Systematic Mixed Studies Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2016; 9:86-109. [PMID: 27240563 DOI: 10.1177/1937586716645918] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This systematic mixed studies review on hospital falls is aimed to facilitate proactive decision-making for patient safety during the healthcare facility design. BACKGROUND Falls were identified by the Centers for Medicare & Medicaid Services as a nonreimbursed hospital-acquired condition (HAC) due to volume and cost, and additional financial penalties were introduced with the 2014 U.S. HAC reduction program. In 2015, the Joint Commission alert identified patient falls as one of the top reported sentinel events, and the Occupational Safety & Health Administration (OSHA) added slips, trips, and falls as a focus for investigators' healthcare inspections. Variations in fall rates at both the hospital and the unit level are indicative of an ongoing challenge. The built environment can act as a barrier or enhancement to achieving the desired results in safety complexity that includes the organization, people, and environment. METHODS The systematic literature review used Medical Subject Heading terms and key word alternates for hospital falls with searches in MEDLINE, Web of Science, and CINAHL. The search was limited to English-language papers. RESULTS Following full-text review, 27 papers were included and critically appraised using an evaluation matrix that included a mixed methods appraisal tool. Themes were coded by broad categories of factors for organization (policy/operations), people (caregivers/staff, patients), and the environment (healthcare facility design). Subcategories were developed to define the physical environment and consider the potential interventions in the context of relative stability. CONCLUSIONS Conditions of hospital falls were identified and evaluated through the literature review. A theoretical model was developed to propose a human factors framework while considering the permanence of solutions.
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Lachance CC, Feldman F, Laing AC, Leung PM, Robinovitch SN, Mackey DC. Study protocol for the Flooring for Injury Prevention (FLIP) Study: a randomised controlled trial in long-term care. Inj Prev 2016; 22:453-460. [PMID: 27044272 DOI: 10.1136/injuryprev-2016-042008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND A promising strategy for reducing the incidence and severity of fall-related injuries in long-term care (LTC) is to decrease the ground surface stiffness, and the subsequent forces applied to the body parts at impact, through installation of compliant flooring that does not substantially affect balance or mobility. Definitive evidence of the effects of compliant flooring on fall-related injuries in LTC is lacking. The Flooring for Injury Prevention (FLIP) Study is designed to address this gap. METHODS The FLIP Study is a 4-year, parallel-group, 2-arm, randomised controlled superiority trial of flooring in 150 resident rooms at a LTC site. The primary objective is to determine whether compliant flooring reduces serious fall-related injuries relative to control flooring. Intervention (2.54 cm SmartCells compliant; 74 rooms) and control (2.54 cm plywood; 76 rooms) floorings were installed over the top of existing concrete floors and covered with identical 2.00 mm vinyl. The primary outcome is serious fall-related injury, defined as any impact-related injury due to a fall in a study room that results in Emergency Department visit or hospital admission. Secondary outcomes include minor fall-related injury, any fall-related injury, falls, number of fallers, fractures, and healthcare utilisation and costs for serious fall-related injuries. Randomisation of study rooms, and residents in rooms, was stratified by residential unit, and flooring assignments were concealed. Outcome ascertainment began September 2013. DISCUSSION Results from the FLIP Study will provide evidence about the effects of compliant flooring on fall-related injuries in LTC and will guide development of safer environments for vulnerable older adults. TRIAL REGISTRATION NUMBER NCT01618786.
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Affiliation(s)
- Chantelle C Lachance
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Fraser Health Authority, Surrey, British Columbia, Canada
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Pet Ming Leung
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
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Barker AL, Morello RT, Wolfe R, Brand CA, Haines TP, Hill KD, Brauer SG, Botti M, Cumming RG, Livingston PM, Sherrington C, Zavarsek S, Lindley RI, Kamar J. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ 2016; 352:h6781. [PMID: 26813674 PMCID: PMC4727091 DOI: 10.1136/bmj.h6781] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. DESIGN Cluster randomised controlled trial. SETTING Six Australian hospitals. PARTICIPANTS All patients admitted to 24 acute wards during the trial period. INTERVENTIONS Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: "falls alert" sign, supervision of patients in the bathroom, ensuring patients' walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. MAIN OUTCOME MEASURES The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. RESULTS During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients' characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95% confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. CONCLUSIONS Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12611000332921.
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Affiliation(s)
- Anna L Barker
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Renata T Morello
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Caroline A Brand
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Terry P Haines
- Physiotherapy Department, Monash University, Allied Health Research Unit, Monash Health, Kingston Centre, Cheltenham, VIC 3195, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA 6102, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Deakin University, Burwood, VIC 3125, Australia
| | - Robert G Cumming
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | | | - Catherine Sherrington
- George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Silva Zavarsek
- Centre for Health Economics, Monash Business School, Monash University, Clayton, VIC 3800, Australia
| | - Richard I Lindley
- George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Jeannette Kamar
- Northern Hospital, Northern Health, Epping, VIC 3076, Australia
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Chari SR, Smith S, Mudge A, Black AA, Figueiro M, Ahmed M, Devitt M, Haines TP. Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: a protocol for a pilot trial. Pilot Feasibility Stud 2016; 2:1. [PMID: 27965823 PMCID: PMC5154083 DOI: 10.1186/s40814-015-0043-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 12/22/2015] [Indexed: 01/09/2023] Open
Abstract
Background Falls among hospitalised patients impose a considerable burden on health systems globally and prevention is a priority. Some patient-level interventions have been effective in reducing falls, but others have not. An alternative and promising approach to reducing inpatient falls is through the modification of the hospital physical environment and the night lighting of hospital wards is a leading candidate for investigation. In this pilot trial, we will determine the feasibility of conducting a main trial to evaluate the effects of modified night lighting on inpatient ward level fall rates. We will test also the feasibility of collecting novel forms of patient level data through a concurrent observational sub-study. Methods/design A stepped wedge, cluster randomised controlled trial will be conducted in six inpatient wards over 14 months in a metropolitan teaching hospital in Brisbane (Australia). The intervention will consist of supplementary night lighting installed across all patient rooms within study wards. The planned placement of luminaires, configurations and spectral characteristics are based on prior published research and pre-trial testing and modification. We will collect data on rates of falls on study wards (falls per 1000 patient days), the proportion of patients who fall once or more, and average length of stay. We will recruit two patients per ward per month to a concurrent observational sub-study aimed at understanding potential impacts on a range of patient sleep and mobility behaviour. The effect on the environment will be monitored with sensors to detect variation in light levels and night-time room activity. We will also collect data on possible patient-level confounders including demographics, pre-admission sleep quality, reported vision, hearing impairment and functional status. Discussion This pragmatic pilot trial will assess the feasibility of conducting a main trial to investigate the effects of modified night lighting on inpatient fall rates using several new methods previously untested in the context of environmental modifications and patient safety. Pilot data collected through both parts of the trial will be utilised to inform sample size calculations, trial design and final data collection methods for a subsequent main trial. Trial registration Australian New Zealand Clinical Trials Register (ANZCTR): ACTRN12614000615684 (cluster RCT) and ACTRN12614000616673 (observational sub-study). Date Registered: 10 June 2014 (both studies). Protocol version: 1.2 (Dated: 01 June 2014) Anticipated completion: September 2015 Role of Trial Sponsor: The named sponsor for this investigator-initiated trial was the Director of the Royal Brisbane and Women’s Hospital (RBWH) Safety and Quality Unit (Therese Lee, Phone: +61 7 3646 8111). The principal investigators, SC and MA, are employed by the RBWH Safety and Quality Unit. The trial sponsor has no involvement in any aspects of study design, conduct or decision to submit the report for publication. AM and MD are employed by other departments in the same organisation.
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Affiliation(s)
- Satyan R Chari
- Physiotherapy Department, Monash University, Melbourne, Victoria Australia ; Safety and Quality Unit, Metro North Hospital and Health Service (MNHHS), Royal Brisbane and Women's Hospital, Brisbane, Queensland Australia
| | - Simon Smith
- Centre for Accident Research and Road Safety-Queensland (CARRS-Q), Queensland University of Technology (QUT), Brisbane, Queensland Australia ; Faculty of Health, School of Psychology and Counselling, QUT, Brisbane, Queensland Australia
| | - Alison Mudge
- Internal Medicine and Aged Care, MNHHS, Royal Brisbane and Women's Hospital, Brisbane, Queensland Australia
| | - Alex A Black
- School of Optometry and Vision Science, Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Mariana Figueiro
- Lighting Research Centre, Rennsselaer Polytechnic Institute, Troy, New York USA
| | - Muhtashimuddin Ahmed
- Safety and Quality Unit, Metro North Hospital and Health Service (MNHHS), Royal Brisbane and Women's Hospital, Brisbane, Queensland Australia
| | - Mark Devitt
- Architectural and Engineering Services, Metro North Hospital and Health Service (MNHHS), Royal Brisbane and Women's Hospital, Brisbane, Queensland Australia
| | - Terry P Haines
- Physiotherapy Department, Monash University, Melbourne, Victoria Australia ; Allied Health Research Unit, Monash Health, Melbourne, Victoria Australia
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Eldridge SM, Costelloe CE, Kahan BC, Lancaster GA, Kerry SM. How big should the pilot study for my cluster randomised trial be? Stat Methods Med Res 2015; 25:1039-56. [PMID: 26071431 DOI: 10.1177/0962280215588242] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is currently a lot of interest in pilot studies conducted in preparation for randomised controlled trials. This paper focuses on sample size requirements for external pilot studies for cluster randomised trials. We consider how large an external pilot study needs to be to assess key parameters for input to the main trial sample size calculation when the primary outcome is continuous, and to estimate rates, for example recruitment rates, with reasonable precision. We used simulation to provide the distribution of the expected number of clusters for the main trial under different assumptions about the natural cluster size, intra-cluster correlation, eventual cluster size in the main trial, and various decisions made at the piloting stage. We chose intra-cluster correlation values and pilot study size to reflect those commonly reported in the literature. Our results show that estimates of sample size required for the main trial are likely to be biased downwards and very imprecise unless the pilot study includes large numbers of clusters and individual participants. We conclude that pilot studies will usually be too small to estimate parameters required for estimating a sample size for a main cluster randomised trial (e.g. the intra-cluster correlation coefficient) with sufficient precision and too small to provide reliable estimates of rates for process measures such as recruitment or follow-up rates.
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Affiliation(s)
- Sandra M Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Ceire E Costelloe
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Brennan C Kahan
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Gillian A Lancaster
- Postgraduate Statistics Centre, Department of Mathematics and Statistics, University of Lancaster, Lancaster, UK
| | - Sally M Kerry
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Gustavsson J, Bonander C, Andersson R, Nilson F. Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results. Inj Prev 2015; 21:320-4. [DOI: 10.1136/injuryprev-2014-041468] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/08/2015] [Indexed: 11/03/2022]
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Taylor E, Hignett S. Evaluating evidence: defining levels and quality using critical appraisal mixed methods tools. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2014; 7:144-51. [PMID: 24782241 DOI: 10.1177/193758671400700310] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ellen Taylor
- CORRESPONDING AUTHOR: Ellen Taylor, ; (925) 521-9404
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