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