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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.
- floors and floorcoverings
- accidental falls
- wounds and injuries
- hospitals
- residential facilities
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Twitter @AmyDrahota
Contributors AD is Principal Investigator (guarantor) of the project, and was involved in the project conception and design, and drafting of the protocol. BK, CL, AL and DM were all involved in the conception and design of the project, and revising the protocol content. JR contributed to the design of the health economics component and revising the protocol. LF contributed to the design of the Summary of Findings Tables component, and drafting of this manuscript. AD, BK, CL and JR were co-applicants on the original funding proposal to HTA. All authors are also Advisory Board members and have read and approved the manuscript.
Funding This report is independent research funded by the National Institute for Health Research (NIHR Health Technology Assessment, 17/148/11 – The SAFEST Review: The Shock-Absorbing Flooring Effectiveness SysTematic Review including older adults and staff in care settings).
Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. The Health & Safety Executive are supporting 10 days of Olanrewaju Okunribido’s time in kind on this project.
Competing interests AD, CL, AL and DM have undertaken studies that will be a part of this review. AD and BK have been collaborating with members of the Health & Safety Executive (2018-present) on some unfunded academic research using a new testing procedure to assess the shock-absorbency of various floor coverings. Five flooring manufacturers delivered free samples to use in the project. AD and BK have no stake in any of these companies. In 2015, AD was involved in a collaborative funding application with Polyflor for some SBRI Healthcare innovation funding. The application was short-listed but unsuccessful. AD has no stake in this company. AL reports grants from SofSurfaces Inc, grants and personal fees from SorbaShock LLC, grants and personal fees from Viconic Sporting, outside the submitted work. AL is a member of an ASTM Work Group (WK38804) whose Technical Contact is the President of SATech. SATech has donated flooring materials to AL's laboratory that have formed the basis of several studies examining the biomechanical effectiveness of compliant flooring (i.e. safety flooring). He has never had (nor does he currently have) any financial links to the company. CL is employed at the Canadian Agency for Drugs and Technologies in Health (CADTH). JR is a member of the NIHR’s HTA/EME editorial board (0.1 wte).
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.