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