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A comparison of floor surfaces for injury prevention in care settings: impact forces and horizontal pulling force required to move wheeled equipment

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Abstract

Summary

Shock-absorbing flooring is one potential solution to prevent fall-related injuries. No standards exist to characterize shock-absorbing healthcare flooring. This study explores two mechanical tests for impact force reduction and horizontal force required to move wheeled objects. An appropriately designed rubber underlay can reduce peak impact by 25% compared with 1% with standard vinyl.

Introduction

Severe falls often occur in hospitals and care homes. Shock-absorbing flooring is one potential solution to prevent fall-related injuries; however, no standards exist for characterizing flooring as an injury prevention measure. Shock-absorbing flooring use in high-risk settings may influence both patients (injury-saving potential) and staff (manoeuvring equipment). We aimed to explore two tests to characterize floors, to determine shock absorbency and horizontal pulling force required to move wheeled objects.

Methods

Mechanical testing was performed according to the Canadian Standards Association Z325 Hip Protectors document. This test was developed for hip protectors but is applicable to compliant surfaces that form part of the floor. Tests were performed on commercially available floor materials (suitable for care settings) to assess the force required to initiate movement of a wheeled object across the floor. We explored the relationships between horizontal force required to pull wheeled objects, impact force, floor thickness, and core material.

Results

Considerable differences were identified between floor samples in their ability to reduce the peak impact force (range 0.7–25%). A peak force reduction of up to 25% can be achieved with a specially designed rubber underlay. Horizontal pulling force increased with floor thickness but was lower for rubber floors. There was no direct relationship between impact attenuation and horizontal pulling force. Whilst thickness and core material explain some variations (66.5% for wheel movement; 82.3% for impact), other unmeasured factors clearly influence floor performance.

Conclusions

These results can inform the development of flooring and the establishment of standards needed to underpin practice, research, and development in this field.

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Acknowledgements

We would like to thank the flooring manufacturers who provided test samples for use in this project. Thank you to Mr. Ngianga Kandala who provided statistical support and review of this manuscript.

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Authors and Affiliations

  1. School of Engineering, Cardiff University Queen’s Buildings, The Parade, Cardiff, CF24 3AA, UK

    B. E. Keenan & S. L. Evans

  2. Science Division, Health & Safety Executive (HSE), Harpur Hill, Derbyshire, Buxton, SK17 9JN, UK

    K. Hallas

  3. School of Health & Care Professions, University of Portsmouth, Hampshire, Portsmouth, PO1 2PR, UK

    A. K. Drahota

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Contributions

All authors were involved in the study and preparation of the manuscript. The material within has not been and will not be submitted for publication elsewhere. Authors’ contributions are as follows: SLE and BEK designed the study. BEK designed the mould, made the silicone, and conducted the mechanical impact testing. KH conducted the push/pull testing. SLE, BEK, AKD and KH analysed the data. BEK and AKD prepared the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to B. E. Keenan.

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Conflicts of interests

Dr. Drahota and Dr. Keenan are currently working on a systematic review entitled ‘The SAFEST Review: The Shock-Absorbing Flooring Effectiveness SysTematic Review including older adults and staff in care settings’ funded by the National Institute for Health Research (17/148/11). The present laboratory study is ineligible for inclusion in this review of human participant data.

In 2015, Dr. Drahota was involved in a collaborative funding application with Polyflor for some SBRI Healthcare innovation funding. The application was short-listed but unsuccessful. AD has no stake in this company.

Five flooring manufacturers delivered free samples to use in this exploratory project, some of which were supplied in confidence because they are not designed for this purpose. The authors have no stake in any of these companies.

Mr. Hallas has undertaken unrelated testing work for the flooring manufacturer Polyflor under contract with the Health and Safety Executive and related resistance to wheel movement testing for the flooring manufacturer Tarkett under contract with the Health and Safety Executive.

Prof Evans is involved in the Technical Committee on Hip Protectors for the CSA Z325 standard.

Dr. Keenan and Prof Evans have previously undertaken commercial testing of hip protectors which is referenced in this paper but have no conflicts of interest for the work presented here.

Disclaimer

This publication and the work it describes were co-funded by Cardiff University, the University of Portsmouth and the Health and Safety Executive. Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

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Keenan, B.E., Hallas, K., Drahota, A.K. et al. A comparison of floor surfaces for injury prevention in care settings: impact forces and horizontal pulling force required to move wheeled equipment. Osteoporos Int 31, 2383–2394 (2020). https://doi.org/10.1007/s00198-020-05520-y

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