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Table 3 Summary of findings for shock-absorbing flooring versus rigid flooring in care homes

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

Outcomes Anticipated absolute effectsa (95% CI) Relative effect (95% CI) Total sample size (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 3 per 1000 (2 to 4) Rate ratio 0.91 (0.62 to 1.32) 213,854 person days (1 RCT) HIGH This study compared a novel underlay with vinyl overlay and concrete sub-floor, to a plywood underlay with vinyl overlay and concrete sub-floor.
All studies 3 per 1000 3 per 1000 (2 to 4) Rate ratio 0.91 (0.62 to 1.32) 308,981 person days (2 studies) VERY LOW Data are missing from one observational study (novel vs rigid floors), at high risk of bias which did not report on this outcome.
Falls rate per 1000 person days
Randomised controlled trials 8 per 1000 10 per 1000 (7 to 14) Rate ratio 1.21 (0.87 to 1.68) 213,854 person days (1 RCT) MODERATE This study compared a novel underlay with vinyl overlay and concrete sub-floor, to vinyl with a plywood underlay and concrete sub-floor.
All studies 8 per 1000 7 per 1000 (4 to 13) Rate ratio 0.87 (0.47 to 1.62) 308,981 person days (2 studies) VERY LOW  
Number of falls with injury
All studies b 330 per 1000 264 per 1000 (231 to 300) RR 0.80 (0.70 to 0.91) 2800 falls (3 studies) VERY LOW If 330 out of 1000 resident falls resulted in injury on a rigid floor, then very low-quality evidence suggests that 66 fewer injurious falls would occur a shock-absorbing floor (95% CI: 99 fewer to 30 fewer injurious falls).
Number of fractures
Randomised controlled trials 58 per 1000 44 per 1000 (18 to 106) OR 0.74 (0.29 to 1.92) 357 participants (1 RCT) LOW These data (on novel flooring versus vinyl on plywood underlay) are too imprecise to offer any certainty over this outcome.
All studies b 11 per 1000 7 per 1000 (3 to 16) OR 0.61 (0.26 to 1.48) 2074 falls (2 studies) VERY LOW These data are too imprecise to offer any certainty over this outcome.
Number of hip fractures
Randomised controlled trials 12 per 1000 11 per 1000 (2 to 76) OR 0.94 (0.13 to 6.74) 357 participants (1 RCT) LOW These data (on novel flooring versus vinyl on plywood underlay) are too imprecise to offer any certainty over this outcome.
All studies b 2 per 1000 3 per 1000 (2 to 4) OR 1.17 (0.77 to 1.80) 8548 falls (2 studies) VERY LOW These data are too heterogeneous to offer any certainty over this outcome.
Number of fallers
Randomised controlled trials 676 per 1000 697 per 1000 (602 to 798) RR 1.03 (0.89 to 1.18) 357 participants (1 RCT) HIGH This study compared a novel underlay with vinyl overlay and concrete sub-floor, to vinyl with a plywood underlay and concrete sub-floor.
Adverse events
All studies There was no evidence to suggest an increase in force-induced musculoskeletal injuries in care home staff Not reported
(1 study)
VERY LOW Personal communication. Nested pre-post design in RCT study.
  1. a The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk taken from the comparison group of the RCT data 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]