Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety.
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.
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.
Chantelle C
http://orcid.org/0000-0001-5755-5160
CC
Lachance
Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.
Michal P
MP
Jurkowski
W.A.C. Bennett Library, Simon Fraser University, Burnaby, British Columbia, Canada.
Ania C
AC
Dymarz
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.
Stephen N
SN
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.|Patient Safety and Injury Prevention, Fraser Health Authority, Surrey, British Columbia, Canada.
Fabio
F
Feldman
Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
Andrew C
AC
Laing
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.
Dawn C
DC
Mackey
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D005430:Floors and Floorcoverings; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012449:Safety; D017132:Workplace; D055815:Young Adult