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Table 2 Summary of findings for shock-absorbing flooring versus rigid flooring in hospitals

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

Outcomes Anticipated absolute effects a (95% CI) Relative effect (95% CI) Total sample size (No. of studies) Quality of the evidence (GRADE) Comments
Risk with rigid flooring Risk with shock-absorbing flooring
Injurious falls rate per 1000 person days
Randomised controlled trials 3 per 1000 2 per 1000 (1 to 6) Rate ratio 0.58 (0.18 to 1.91) 9085 person days (1 RCT) LOW These data (on sports flooring) are too imprecise to offer any certainty for this outcome.
All studies 3 per 1000 2 per 1000 (1 to 3) Rate ratio 0.55 (0.36 to 0.84) 25,989 person days (2 studies) VERY LOW If 3 injurious falls a day occur in 1000 inpatients on a rigid floor, then very low-quality evidence suggests there would be one fewer injurious fall a day on a shock-absorbing floor (95% CI: 2 fewer to about the same number).
Falls rate per 1000 person days
Randomised controlled trials 7 per 1000 8 per 1000 (5 to 13) Rate ratio 1.07 (0.64 to 1.81) 9085 person days (1 RCT) LOW These data (on sports flooring) are too imprecise to offer any certainty for this outcome.
All studies 7 per 1000 6 per 1000 (5 to 8) Rate ratio 0.88 (0.71 to 1.09) 25,989 person days (2 studies) VERY LOW If 7 falls a day occur in 1000 inpatients on a rigid floor, then very low-quality evidence suggests that between 2 fewer falls and 1 more fall would occur a day on a shock-absorbing floor.
Number of falls with injury
All studies b 424 per 1000 165 per 1000 (64 to 433) RR 0.39 (0.15 to 1.02) 559 falls (3 studies) VERY LOW If 424 out of 1000 inpatient falls resulted in an injury on a rigid floor, then very low-quality evidence suggests 259 fewer injurious falls would occur on a shock-absorbing floor (95% CI: 360 fewer to 9 more injurious falls). A sensitivity analysis removing a study on carpets with high risk of bias, removes the heterogeneity and increases the precision of the effect for novel/sports floors (RR = 0.64, 95% CI 0.44 to 0.93).
Number of fractures
Randomised controlled trials 9 per 1000 3 per 1000 (0 to 69) OR 0.33 (0.01 to 8.13) 448 participants (1 RCT) LOW These data (on sports flooring) are too imprecise to offer any certainty for this outcome.
All studies 9 per 1000 3 per 1000 (0 to 16) OR 0.28 (0.04 to 1.77) 626 participants (2 studies) VERY LOW These data (on sports and novel flooring) are too imprecise to offer any certainty for this outcome.
Number of hip fractures
Randomised controlled trials 4 per 1000 1 per 1000 (0 to 32) OR 0.33 (0.01 to 8.15) 448 participants (1 RCTs) LOW These data (on sports flooring) are too imprecise to offer any certainty for this outcome.
All studies 4 per 1000 4 per 1000 (1 to 25) OR 0.88 (0.12 to 6.47) 626 participants (2 studies) VERY LOW These data (on sports and novel flooring) are too imprecise to offer any certainty.
Number of fallers
Randomised controlled trials 99 per 1000 223 per 1000 (56 to 895) RR 2.25 (0.56 to 9.04) 502 participants (2 RCTs) VERY LOW These data (on sports flooring and carpet) are too imprecise to offer any certainty.
Adverse events
Randomised controlled trials Staff raised concerns about moving wheeled equipment on sports floor. One staff member pulled lower back on the intervention floor over 12 months follow-up. Not reported
(1 study)
VERY LOW  
Observational studies No evidence to suggest higher risk of injury on intervention flooring (28 injuries in 30 months) compared to three concurrent control wards (30 injuries per ward) or a post-intervention control site (45 injuries in 30 months). Not reported
(1 study)
VERY LOW  
  1. aThe risk with shock-absorbing flooring (and its 95% confidence interval) is based on the assumed risk with standard flooring (taken from Drahota 2013 [14]) and the pooled relative effect of the intervention (and its 95% CI). b These data should be interpreted with caution as the denominator (falls) used in the calculation of RR is count data. All data contributing to this outcome are considered observational. CI: Confidence interval; OR: Odds ratio; RR: Risk ratio. Suggested definitions for grades of evidence have been published elsewhere [79]