The Flooring for Injury Prevention (FLIP) Study of compliant flooring for the prevention of fall-related injuries in long-time period care: A randomized trial

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Fall-related accidents exert a considerable fitness burden on older adults in long-term care (LTC). Softer touchdown surfaces, together with the ones provided by way of low-stiffness “compliant” flooring, may additionally save you fall-related injuries by using reducing the forces carried out to the body for the duration of fall effect. Our number one goal becomes to assess the scientific effectiveness of compliant floors at stopping serious fall-associated injuries among LTC citizens.
Methods and findings
The Flooring for Injury Prevention (FLIP) Study was a four-12 month, randomized superiority trial in one hundred fifty unmarried-occupancy resident rooms at a single Canadian LTC site. In April 2013, resident rooms have been blocked randomized (1:1) to the installation of intervention compliant floors (2.Fifty four cm SmartCells) or inflexible manage flooring (2.54 cm plywood) included with same clinic-grade vinyl. The number one outcome changed into severe fall-related damage over 4 years that required an emergency branch go to or health facility admission and a remedy technique or diagnostic evaluation in the health center. Secondary results covered minor fall-associated injury, any fall-related damage, falls, and fracture. Outcomes had been ascertained with the aid of blinded assessors among September 1, 2013, and August 31, 2017, and analyzed by means of purpose to treat. Adverse results have been not assessed. During follow-up, 184 residents occupied seventy-four intervention rooms, and 173 citizens occupied 76 manipulate rooms. Residents had been sixty four.3% girl with suggesting (SD) baseline age 81.7 (9.Five) years (range 51.1 to 104.6 years), body mass index 25.9 (7.7) kg/m2, and observe-up 1.Sixty-four (1.39) years. 1,907 falls have been suggested; 23 intervention citizens experienced 38 serious injuries (from 29 falls in 22 rooms), at the same time as 23 control citizens experienced 47 severe injuries (from 34 falls in 23 rooms). Compliant floors did no longer have an effect on odds of ≥1 serious fall-associated damage (12.5% intervention as opposed to thirteen.Three% control, odds ratio [OR]: 0.Ninety eight, ninety five% CI: zero.52 to at least one.84, p = 0.950) or ≥2 serious fall-related injuries (five.Four% versus 7.Five%, OR: zero.74, 95% CI: 0.31 to one.Seventy five, p = 0.500). Compliant flooring did not affect the fee of great fall-related injuries (0.362 as opposed to 0.422 in keeping with 1,000 bed nights, price ratio [RR]: 1.04, 95% CI: zero.45 to two.39, p = zero.925; 0.038 as opposed to zero.053 in keeping with fall, RR: zero.Eighty-one, 95% CI: 0.38 to at least one.71, p = 0.560), charge of falls with ≥1 serious fall-related damage (0.276 versus 0.303 per 1,000 mattress nights, RR: zero.97, ninety five% CI: 0.52 to 1.Seventy nine, p = zero.920), or time to first extreme fall-associated damage (0.237 as opposed to 0.257, threat ratio [HR]: 0.92, 95% CI: zero.Fifty two to at least one.Sixty two, p = 0.760). Compliant floors did now not affect any secondary outcome on this have a look at. Study obstacles covered the subsequent: findings had been specific to two.54 cm SmartCells compliant flooring hooked up in LTC resident rooms, trendy fall and damage prevention interventions were in use in the course of the examine and can have influenced the observed impact of compliant flooring, and demanding situations with concussion detection in LTC citizens may additionally have avoided estimation of the effect of compliant flooring on fall-associated concussions.
Conclusions
In contrast to results from preceding retrospective and nonrandomized studies, this observes located that compliant flooring underneath health facility-grade vinyl was no longer powerful at stopping severe fall-associated accidents in LTC. Future research is had to become aware of powerful techniques for stopping fall-related accidents in LTC.

Why changed into this observe accomplished?
Compliant (low-stiffness) floors goals to reduce effect forces at the frame and thereby prevent injuries from falls.
Controlled laboratory research has shown that particular varieties of compliant flooring provide significant quantities of pressure attenuation and power absorption at some point of effect to susceptible locations, consisting of the hip and head, with out impairing stability or mobility at some stage in everyday sports, inclusive of status and taking walks.
Preliminary evidence suggested compliant flooring may be effective at stopping fall-related injuries in lengthy-time period care, but beyond research had been restricted by nonrandomized or retrospective designs and insufficient sample sizes; no randomized trial has tested the effectiveness of compliant flooring at preventing serious fall-related accidents in lengthy-term care.
What did the researchers do and discover?
To our expertise, we conducted the primary randomized trial of compliant floors in long-time period care (FLIP Study). We trust it’s far the most important and maximum methodologically rigorous examine of compliant floors carried out to date.
The compliant floors we studied (SmartCells 2.54 cm below 2 mm health facility-grade vinyl) did no longer lessen the frequency of great fall-associated injuries, minor fall-related injuries, or falls amongst long-time period care residents over 4 years.
What do those findings imply?
Toward the design of more secure residing environments for older adults, our examine demonstrates that set up of the compliant flooring we studied would not increase the chance or charge of falls amongst long-term care residents, but it would additionally no longer reduce the danger or charge of fall-associated injury.
The compliant flooring we investigated isn’t in all likelihood to purpose harm to lengthy-term care citizens, but we were not able to hit upon advantages to citizens primarily based on the metrics we tested.
The consequences of this look at might also tell regulations, packages, and practices for fall harm prevention in lengthy-time period care, but future research is needed to perceive effective methods for lowering morbidity from falls.