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Greenhalgh M, Blaauw ER, Crytzer T, Deepak N, Grindle GG, Koontz AM, Cooper RA. Comparison of trunk mechanics and spatiotemporal outcomes in caregivers using a robotic assisted transfer device and a mobile floor lift. J Spinal Cord Med 2023; 46:45-52. [PMID: 34505828 PMCID: PMC9897759 DOI: 10.1080/10790268.2021.1961071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The purpose of this study was to compare trunk mechanics, distance covered, and average instantaneous velocity and acceleration recorded with caregivers performing transfer tasks using a research mannequin with both a prototype robotic assisted transfer device (RATD) and a mobile floor lift. DESIGN Cross-Sectional. SETTING Biomechanics Lab and Human Engineering Research Laboratories. PARTICIPANTS Caregivers (N = 21). INTERVENTION Robotic Assisted Transfer Device. OUTCOME MEASURES Range of flexion-extension, lateral bend, and axial rotation; distance covered; average instantaneous velocity and acceleration. RESULTS Caregivers performing transfers using the RATD as compared to when using the moble floor lift reported significantly smaller range of trunk flexion-extension, lateral bending, and axial rotation, and reported lower pelvic based distance covered and slower average instantaneous velocity and acceleration (P < 0.001). CONCLUSION The design and usability of a RATD indicates design driven mobility advantages over clinical standard mobile floor lifts due to its ability to expand the workspace while further reducing risk factors for low back pain. While the concept is promising, further testing is required to address limitations and confirm the concept for clinical applications.
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Affiliation(s)
- Mark Greenhalgh
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, University Drive, Pittsburgh, Pennsylvania, USA,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Correspondence to: Mark Greenhalgh, Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA15206, USA.
| | - Eline R. Blaauw
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, University Drive, Pittsburgh, Pennsylvania, USA,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Theresa Crytzer
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, University Drive, Pittsburgh, Pennsylvania, USA,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nikitha Deepak
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, University Drive, Pittsburgh, Pennsylvania, USA,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Garrett G. Grindle
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, University Drive, Pittsburgh, Pennsylvania, USA,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia M. Koontz
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, University Drive, Pittsburgh, Pennsylvania, USA,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rory A. Cooper
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, University Drive, Pittsburgh, Pennsylvania, USA,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Greenhalgh M, Blaauw E, Deepak N, St. Lauren M, Cooper R, Bendixen R, Koontz AM, Cooper RA. Clinical and Ergonomic Comparison Between a Robotic Assisted Transfer Device and a Mobile Floor Lift During Caregiver-Assisted Wheelchair Transfers. Am J Phys Med Rehabil 2022; 101:561-568. [PMID: 35594407 PMCID: PMC9123282 DOI: 10.1097/phm.0000000000001867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The robotic assisted transfer device was developed as an updated lift technology to reduce adjustments in posture while increasing capabilities offered by transfer devices. The purpose of this study was to compare the trunk biomechanics of a robotic assisted transfer device and a mechanical floor lift in the transfer of a care recipient by a caregiver during essential transfer tasks. METHODS Investigators enrolled 28 caregiver/care recipient dyads to complete 36 transferring tasks. Surface electromyography for the back muscles and motion data for trunk range of motion were collected for selected surfaces, phase, and direction tasks using a robotic assisted transfer device and a mechanical floor lift. RESULTS Robotic assisted transfer device transfers required significantly smaller range of trunk flexion (P < 0.001), lateral bend (P < 0.001), and axial rotation (P = 0.01), in addition to smaller distance covered (P < 0.001), average instantaneous velocity (P = 0.01), and acceleration (P < 0.001) compared with a mobile floor lift. The robotic assisted transfer device transfers required significantly smaller peak erector spinae (left: P = 0.001; right: P < 0.001) and latissimus dorsi (right: P < 0.001) and integrated erector spinae left (P = 0.001) and latissimus dorsi right (P = 0.01) electromyography signals compared with the floor lift. CONCLUSIONS The robotic assisted transfer device provides additional benefits to mobile floor lifts which, coupled with statistically lower flexion, extension, and rotation, may make them an appealing alternative intervention.
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Affiliation(s)
- Mark Greenhalgh
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Eline Blaauw
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Nikitha Deepak
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Matthew St. Lauren
- Uniformed Services University of the Health Sciences, Bethesda Naval Station, Bethesda, MD
- Walter Reed National Military Medical Center, Bethesda Naval Station, Bethesda, MD
| | - Rosemarie Cooper
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center of Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Roxanna Bendixen
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Alicia M Koontz
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Rory A Cooper
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center of Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC, Farrell-Savage K, Okunribido O. Shock-absorbing flooring for fall-related injury prevention in older adults and staff in hospitals and care homes: the SAFEST systematic review. Health Technol Assess 2022; 26:1-196. [PMID: 35089119 DOI: 10.3310/zowl2323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Injurious falls in hospitals and care homes are a life-limiting and costly international issue. Shock-absorbing flooring may offer part of the solution; however, evidence is required to inform decision-making. OBJECTIVES The objectives were to assess the clinical effectiveness and cost-effectiveness of shock-absorbing flooring for fall-related injury prevention among older adults in care settings. REVIEW METHODS A systematic review was conducted of experimental, observational, qualitative and economic studies evaluating flooring in care settings targeting older adults and/or staff. Studies identified by a scoping review (inception to May 2016) were screened, and the search of MEDLINE, AgeLine and Scopus (to September 2019) was updated, alongside other sources. Two independent reviewers assessed risk of bias in duplicate (using Cochrane's Risk of Bias 2.0 tool, the Risk Of Bias In Non-randomized Studies - of Interventions tool, or the Joanna Briggs Institute's qualitative tool). RESULTS Of the 22 included studies, 20 assessed the outcomes (three randomised controlled trials; and seven observational, five qualitative and five economic studies) on novel floors (n = 12), sports floors (n = 5), carpet (n = 5) and wooden subfloors (n = 1). Quantitative data related to 11,857 patient/resident falls (nine studies) and 163 staff injuries (one study). Qualitative studies included patients/residents (n = 20), visitors (n = 8) and staff (n = 119). Hospital-based randomised controlled trial data were too imprecise; however, very low-quality evidence indicated that novel/sports flooring reduced injurious falls from three per 1000 patients per day on vinyl with concrete subfloors to two per 1000 patients per day (rate ratio 0.55, 95% confidence interval 0.36 to 0.84; two studies), without increasing falls rates (two studies). One care home-based randomised controlled trial found that a novel underlay produces similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to those of a plywood underlay with vinyl overlays and concrete subfloors. Very low-quality data demonstrated that, compared with rigid floors, novel/sports flooring reduced the number of falls resulting in injury in care homes (26.4% vs. 33.0%; risk ratio 0.80, 95% confidence interval 0.70 to 0.91; three studies) and hospitals (27.1% vs. 42.4%; risk ratio 0.64, 95% confidence interval 0.44 to 0.93; two studies). Fracture and head injury outcomes were imprecise; however, hip fractures reduced from 30 per 1000 falls on concrete to 18 per 1000 falls on wooden subfloors in care homes (odds ratio 0.59, 95% confidence interval 0.45 to 0.78; one study; very low-quality evidence). Four low-quality economic studies concluded that shock-absorbing flooring reduced costs and improved outcomes (three studies), or increased costs and improved outcomes (one study). One, more robust, study estimated that shock-absorbing flooring resulted in fewer quality-adjusted life-years and lower costs, if the number of falls increased on shock-absorbing floors, but that shock-absorbing flooring would be a dominant economic strategy if the number of falls remained the same. Staff found moving wheeled equipment more difficult on shock-absorbing floors, leading to workplace adaptations. Staff injuries were observed; however, very low-quality evidence suggests that these are no less frequent on rigid floors. LIMITATIONS Evidence favouring shock-absorbing flooring is of very low quality; thus, much uncertainty remains. CONCLUSIONS Robust evidence is lacking in hospitals and indicates that one novel floor may not be effective in care homes. Very low-quality evidence indicates that shock-absorbing floors may be beneficial; however, wider workplace implications need to be addressed. Work is required to establish a core outcome set, and future research needs to more comprehensively deal with confounding and the paucity of hospital-based studies, and better plan for workplace adaptations in the study design. STUDY REGISTRATION This study is registered as PROSPERO CRD42019118834. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Lambert M Felix
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Southampton, UK
| | | | | | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC. The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention. BMC Geriatr 2022; 22:32. [PMID: 34991466 PMCID: PMC8739972 DOI: 10.1186/s12877-021-02670-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Shock-absorbing flooring may minimise impact forces incurred from falls to reduce fall-related injuries; however, synthesized evidence is required to inform decision-making in hospitals and care homes. METHODS This is a Health Technology Assessment mixed methods systematic review of flooring interventions targeting older adults and staff in care settings. Our search incorporated the findings from a previous scoping review, MEDLINE, AgeLine, and Scopus (to September 2019) and other sources. Two independent reviewers selected, assessed, and extracted data from studies. We assessed risk of bias using Cochrane and Joanna Briggs Institute tools, undertook meta-analyses, and meta-aggregation. RESULTS 20 of 22 included studies assessed our outcomes (3 Randomised Controlled Trials (RCTs); 7 observational; 5 qualitative; 5 economic), on novel floors (N = 12), sports floors (N = 5), carpet (N = 5), and wooden sub-floors (N = 1). Quantitative data related to 11,857 patient falls (9 studies), and 163 staff injuries (1 study). One care home-based RCT found a novel underlay produced similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to a plywood underlay with vinyl overlay and concrete sub-floors. Very low-quality evidence suggested that shock-absorbing flooring may reduce injuries in hospitals (Rate Ratio 0.55, 95% CI 0.36 to 0.84, 2 studies; 27.1% vs. 42.4%; Risk Ratio (RR) = 0.64, 95% CI 0.44 to 0.93, 2 studies) and care homes (26.4% vs. 33.0%; RR 0.80, 95% CI 0.70 to 0.91, 3 studies), without increasing falls. Economic evidence indicated that if injuries are fewer and falls not increased, then shock-absorbing flooring would be a dominant strategy. Fracture outcomes were imprecise; however, hip fractures reduced from 30 in 1000 falls on concrete to 18 in 1000 falls on wooden sub-floors (OR 0.59, 95% CI 0.45 to 0.78; one study; very low-quality evidence). Staff found moving wheeled equipment harder on shock-absorbing floors leading to workplace adaptations. Very low-quality evidence suggests staff injuries were no less frequent on rigid floors. CONCLUSION Evidence favouring shock-absorbing flooring is uncertain and of very low quality. Robust research following a core outcome set is required, with attention to wider staff workplace implications. TRIAL REGISTRATION PROSPERO CRD42019118834 .
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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK.
| | - Lambert M Felix
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK
| | - Bethany E Keenan
- School of Engineering, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - Chantelle C Lachance
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive East, Burnaby, British Columbia, V5A 1S6, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, B.C. Matthews Hall, Waterloo, Ontario, N2L 3G1, Canada
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Blaauw ER, Greenhalgh M, Vegter R, Bass S, Kulich H, Grindle GG, Cooper R, Koontz AM, Cooper RA. Assessment of Muscle Activation of Caregivers Performing Dependent Transfers With a Novel Robotic-Assisted Transfer Device Compared With the Hoyer Advance. Am J Phys Med Rehabil 2021; 100:885-894. [PMID: 33315611 DOI: 10.1097/phm.0000000000001665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to compare muscle activity in caregivers while using a novel robotic-assisted transfer device (Strong Arm) to a clinical standard of care (Hoyer Advance). DESIGN A quasi-experimental design was used in which 20 caregivers (33 ± 15 yrs old) performed transfers with three surfaces (toilet, bench, and shower chair) with the Strong Arm and Hoyer Advance. Transfer completion time (seconds), peak percentage surface electromyography (EMG), and integrated EMG of the bilateral erector spinae, latissimus dorsi, pectoralis major and anterior deltoid were measured. RESULTS Caregivers required less transfer time when transferring from wheelchair to surface using the Hoyer Advance (P = 0.011, f = 0.39). For the lower back, significantly lower peak percentage EMGs were found using Strong Arm in 50% and for the integrated EMG in 25% of the cases, with the remaining cases showing no significant differences. For the shoulder, significantly lower peak percentage EMG values were found using Strong Arm in 19% of transfers and lower integrated EMG was found in 25% of transfers when using the Hoyer Advance, with the remaining cases showing no significant differences. CONCLUSION Although back muscle activation during Strong Arm transfers is statistically, but not clinically, lower, additional features that couple with significantly lower muscle activation make it an alternative to the clinical standard for further research and possible clinical applicability.
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Affiliation(s)
- Eline R Blaauw
- From the Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (ERB, MG, SB, HK, GGG, RC, AMK, RAC); School of Health and Rehabilitation Sciences (ERB, MG, SB, HK, GGG, RC, AMK, RAC) and Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences (MG, SB, HK, GGG, RC, AMK, RAC), University of Pittsburgh, Pittsburgh, Pennsylvania; and University of Groningen, University Medical Centre Groningen, Centre for Human Movement Sciences, Groningen, the Netherlands (ERB, RV)
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Keenan BE, Hallas K, Drahota AK, Evans SL. A comparison of floor surfaces for injury prevention in care settings: impact forces and horizontal pulling force required to move wheeled equipment. Osteoporos Int 2020; 31:2383-2394. [PMID: 32647950 DOI: 10.1007/s00198-020-05520-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
UNLABELLED 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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Affiliation(s)
- B E Keenan
- School of Engineering, Cardiff University Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK.
| | - K Hallas
- Science Division, Health & Safety Executive (HSE), Harpur Hill, Derbyshire, Buxton, SK17 9JN, UK
| | - A K Drahota
- School of Health & Care Professions, University of Portsmouth, Hampshire, Portsmouth, PO1 2PR, UK
| | - S L Evans
- School of Engineering, Cardiff University Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
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Abstract
Introduction: Low impact flooring (LIF) has shown potential for reducing fall-related injuries for older people in residential care or hospital environments. However, the increased rolling resistance when moving equipment on these floors has raised concerns that staff injuries may increase.Methods: LIF was trialled on one Older Persons Health ward for 2.5 years. Reported staff injuries were monitored during and following the trial. Numbers of staff injured on the LIF ward were compared with three other similar and adjacent OPH wards without LIF for the duration of the trial ('concurrent control' evaluation). At the trial conclusion the LIF ward moved to a different hospital that had standard flooring. This enabled a further 'during and after' evaluation where numbers of staff injured from the LIF ward during the trial were compared with those reported afterwards by the same ward staff without LIF.Results: There was no difference in the numbers of staff injured in the LIF ward compared with the concurrent control wards (28 LIF vs 30 control; p = 0.44). The number of staff with injuries in the LIF ward also did not significantly alter when those staff moved to a new ward without LIF (45 after vs 28 before; p = 0.11).Conclusion: There was no change in the numbers of staff with injuries during the LIF trial in an Older Persons Health ward. This small study suggests LIF appears safe for both patients and staff.Implications for rehabilitationFalls in hospital are common with patient injuries occurring in approximately 20-30% of falls.Low impact (compliant) flooring may reduce fall-related injuries in hospitals and residential care.Low impact flooring has an increased rolling resistance, which has the potential to increase staff injuries when moving equipment.This study found no change in the number of staff injured during a low impact flooring trial providing some reassurance that these floors are safe for staff.
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Affiliation(s)
- H C Hanger
- Canterbury District Health Board, Geriatrician, Burwood Hospital, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tim J Wilkinson
- Canterbury District Health Board, Geriatrician, Burwood Hospital, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand
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Lachance CC, Korall AMB, Russell CM, Feldman F, Robinovitch SN, Mackey DC. Hand forces exerted by long-term care staff when pushing wheelchairs on compliant and non-compliant flooring. APPLIED ERGONOMICS 2018; 71:95-101. [PMID: 29764620 DOI: 10.1016/j.apergo.2018.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 06/08/2023]
Abstract
Purpose-designed compliant flooring and carpeting have been promoted as a means for reducing fall-related injuries in high-risk environments, such as long-term care. However, it is not known whether these surfaces influence the forces that long-term care staff exert when pushing residents in wheelchairs. We studied 14 direct-care staff who pushed a loaded wheelchair instrumented with a triaxial load cell to test the effects on hand force of flooring overlay (vinyl versus carpet) and flooring subfloor (concrete versus compliant rubber [brand: SmartCells]). During straight-line pushing, carpet overlay increased initial and sustained hand forces compared to vinyl overlay by 22-49% over a concrete subfloor and by 8-20% over a compliant subfloor. Compliant subflooring increased initial and sustained hand forces compared to concrete subflooring by 18-31% when under a vinyl overlay. In contrast, compliant flooring caused no change in initial or sustained hand forces compared to concrete subflooring when under a carpet overlay.
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Affiliation(s)
- Chantelle C Lachance
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada; Knowledge Translation Program, Li Ka Shing Institute, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Ontario, Canada.
| | - Alexandra M B Korall
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada; George and Fay Yee Centre for Healthcare Innovation, Third Floor Chown Building, 753 McDermot Avenue, Winnipeg, R3E 0T6, Manitoba, Canada
| | - Colin M Russell
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada; Patient Safety and Injury Prevention, Central City Tower, 400-13450 102nd Ave, Surrey, V3T 5X3, British Columbia, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada.
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Abstract
Compliant flooring aims to prevent fall-related injuries among high-risk older adults in long-term care, but uptake of compliant flooring in this setting is limited. We hosted a one-day stakeholder symposium to identify advantages and disadvantages of implementing compliant flooring in long-term care and the most pressing directions for future research from the perspective of key stakeholders. Twenty-three stakeholders representing health care, industry, and research attended the symposium. Attendees believed the most important advantages of compliant flooring were reducing injuries in residents who have fallen, potential benefits to care staff, and potential increases in quality of life for residents. Attendees perceived the most significant disadvantages of compliant flooring were financial considerations, lack of research evidence, and challenges with installation. Attendees indicated a need for additional research on cost-effectiveness and clinical effectiveness. While stakeholders perceived compliant flooring to add value to long-term care, there are significant informational and financial barriers to uptake.
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Lachance CC, Jurkowski MP, Dymarz AC, Robinovitch SN, Feldman F, Laing AC, Mackey DC. Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety. PLoS One 2017; 12:e0171652. [PMID: 28166265 PMCID: PMC5293217 DOI: 10.1371/journal.pone.0171652] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background Compliant flooring, broadly defined as flooring systems or floor coverings with some level of shock absorbency, may reduce the incidence and severity of fall-related injuries in older adults; however, a lack of synthesized evidence may be limiting widespread uptake. Methods Informed by the Arksey and O’Malley framework and guided by a Research Advisory Panel of knowledge users, we conducted a scoping review to answer: what is presented about the biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety associated with compliant flooring systems that aim to prevent fall-related injuries in healthcare settings? We searched academic and grey literature databases. Any record that discussed a compliant flooring system and at least one of biomechanical efficacy, clinical effectiveness, cost-effectiveness, or workplace safety was eligible for inclusion. Two independent reviewers screened and abstracted records, charted data, and summarized results. Results After screening 3611 titles and abstracts and 166 full-text articles, we included 84 records plus 56 companion (supplementary) reports. Biomechanical efficacy records (n = 50) demonstrate compliant flooring can reduce fall-related impact forces with minimal effects on standing and walking balance. Clinical effectiveness records (n = 20) suggest that compliant flooring may reduce injuries, but may increase risk for falls. Preliminary evidence suggests that compliant flooring may be a cost-effective strategy (n = 12), but may also result in increased physical demands for healthcare workers (n = 17). Conclusions In summary, compliant flooring is a promising strategy for preventing fall-related injuries from a biomechanical perspective. Additional research is warranted to confirm whether compliant flooring (i) prevents fall-related injuries in real-world settings, (ii) is a cost-effective intervention strategy, and (iii) can be installed without negatively impacting workplace safety. Avenues for future research are provided, which will help to determine whether compliant flooring is recommended in healthcare environments.
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Affiliation(s)
- Chantelle C. Lachance
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michal P. Jurkowski
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ania C. Dymarz
- W.A.C. Bennett Library, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Stephen N. Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Patient Safety and Injury Prevention, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Andrew C. Laing
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Dawn C. Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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