Are non-slip socks really 'non-slip'? An analysis of slip resistance

Background. Non-slip socks have been suggested as a means of preventing accidental falls due to slips. This study compared the relative slip resistance of commercially available non-slip socks with other foot conditions, namely bare feet, compression stockings and conventional socks, in order to determine any traction benefit. Methods. Phase one involved slip resistance testing of two commercially available non-slip socks and one compression-stocking sample through an independent blinded materials testing laboratory using a Wet Pendulum Test. Phase two of the study involved in-situ testing among healthy adult subjects (n = 3). Subjects stood unsupported on a variable angle, inclined platform topped with hospital grade vinyl, in a range of foot conditions (bare feet, non-slip socks, conventional socks and compression stockings). Inclination was increased incrementally for each condition until slippage of any magnitude was detected. The platform angle was monitored using a spatial orientation tracking sensor and slippage point was recorded on video. Results. Phase one results generated through Wet Pendulum Test suggested that non-slip socks did not offer better traction than compression stockings. However, in phase two, slippage in compression stockings was detected at the lowest angles across all participants. Amongst the foot conditions tested, barefoot conditions produced the highest slip angles for all participants indicating that this foot condition provided the highest slip resistance. Conclusion. It is evident that bare feet provide better slip resistance than non-slip socks and therefore might represent a safer foot condition. This study did not explore whether traction provided by bare feet was comparable to 'optimal' footwear such as shoes. However, previous studies have associated barefoot mobilisation with increased falls. Therefore, it is suggested that all patients continue to be encouraged to mobilise in appropriate, well-fitting shoes whilst in hospital. Limitations of this study in relation to the testing method, participant group and sample size are discussed

The role of extrinsic factors in the causation and prevention of falls, and fall-related injury among older people in hospital

Falls are a leading cause of harm to older hospital patients. This thesis focused on an under-explored area within the broader field of research, namely the extrinsic causes of inpatient falls. A pair of preliminary exploratory studies yielded two themes for prospective investigation, namely the improvement of inpatient footwear and of hospital night lighting. Subsequent developmental studies ultimately led to a world-first ward-based pilot controlled trial of modified night-lighting. This thesis considerably advances the inpatient fall prevention literature, confirms the feasibility of environmental interventions to reduce falls, and provides a firm foundation for more definitive preventative trials in the future

A critical review of the effectiveness of environmental assessment and modification in the prevention of falls amongst community dwelling older people

Introduction: The potential of environmental assessment and modification to reduce falls has recently received attention within the gerontology literature. Research investigating the clinical effectiveness of this intervention in falls prevention reports conflicting results. Discrepancies are due to variation in the risk profile of study participants and the health care background of the person providing the environmental intervention or the intensity of the intervention provided. Method: The purpose of this paper is to compare and contrast two systematic reviews, which include meta-analyses, of environmental interventions for falls prevention in community dwelling older people, using the critical appraisal skills programme tool for systematic reviews. Findings: Both reviews found that: environmental assessment and modification was effective in falls prevention; intervention was effective with high but not low risk participants; and that high intensity environmental assessment was effective, whereas low intensity intervention was not. Environmental interventions which were delivered by occupational therapists were deemed high intensity, probably because their underpinning theoretical frameworks focus on the impact of the environment on function. Conclusion: We discuss possible reasons why occupational therapist led environmental assessment and modification is clinically effective in falls prevention, for people at high risk of falls, whereas non occupational therapist led intervention is not

A critical review of the effectiveness of environmental assessment and modification in the prevention of falls amongst community dwelling older people

Introduction: The potential of environmental assessment and modification to reduce falls has recently received attention within the gerontology literature. Research investigating the clinical effectiveness of this intervention in falls prevention reports conflicting results. Discrepancies are due to variation in the risk profile of study participants and the health care background of the person providing the environmental intervention or the intensity of the intervention provided. Method: The purpose of this paper is to compare and contrast two systematic reviews, which include meta-analyses, of environmental interventions for falls prevention in community dwelling older people, using the critical appraisal skills programme tool for systematic reviews. Findings: Both reviews found that: environmental assessment and modification was effective in falls prevention; intervention was effective with high but not low risk participants; and that high intensity environmental assessment was effective, whereas low intensity intervention was not. Environmental interventions which were delivered by occupational therapists were deemed high intensity, probably because their underpinning theoretical frameworks focus on the impact of the environment on function. Conclusion: We discuss possible reasons why occupational therapist led environmental assessment and modification is clinically effective in falls prevention, for people at high risk of falls, whereas non occupational therapist led intervention is not

Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: a protocol for a pilot trial

Background: Falls among hospitalised patients impose a considerable burden on health systems globally and prevention is a priority. Some patient-level interventions have been effective in reducing falls, but others have not. An alternative and promising approach to reducing inpatient falls is through the modification of the hospital physical environment and the night lighting of hospital wards is a leading candidate for investigation. In this pilot trial, we will determine the feasibility of conducting a main trial to evaluate the effects of modified night lighting on inpatient ward level fall rates. We will test also the feasibility of collecting novel forms of patient level data through a concurrent observational sub-study. Methods/design: A stepped wedge, cluster randomised controlled trial will be conducted in six inpatient wards over 14 months in a metropolitan teaching hospital in Brisbane (Australia). The intervention will consist of supplementary night lighting installed across all patient rooms within study wards. The planned placement of luminaires, configurations and spectral characteristics are based on prior published research and pre-trial testing and modification. We will collect data on rates of falls on study wards (falls per 1000 patient days), the proportion of patients who fall once or more, and average length of stay. We will recruit two patients per ward per month to a concurrent observational sub-study aimed at understanding potential impacts on a range of patient sleep and mobility behaviour. The effect on the environment will be monitored with sensors to detect variation in light levels and night-time room activity. We will also collect data on possible patient-level confounders including demographics, pre-admission sleep quality, reported vision, hearing impairment and functional status. Discussion: This pragmatic pilot trial will assess the feasibility of conducting a main trial to investigate the effects of modified night lighting on inpatient fall rates using several new methods previously untested in the context of environmental modifications and patient safety. Pilot data collected through both parts of the trial will be utilised to inform sample size calculations, trial design and final data collection methods for a subsequent main trial

Predictors of fracture from falls reported in hospital and residential care facilities: A cross-sectional study

Objectives: Fall-related fractures are associated with substantial human and economic costs. An improved understanding of the predictors of fall-related fractures in healthcare settings would be useful in developing future interventions. The objective of this study was to identify such predictors by exploring associations between fall-related factors and fracture outcomes through logistic regression analysis of routinely collected fall incident data. Design: Retrospective cross-sectional study. Setting: 197 public healthcare facilities in Queensland, Australia. Participants: We included data from incident reports completed after falls among admitted adult hospital patients (n=24 218 falls, 229 fractures) and aged-care residents (n=8980 falls, 74 fractures) between January 2007 and November 2009. Primary and secondary outcomes: The outcomes of interest were fall-related predictors of fracture. Results: Hospital patients who reported to have been screened for their risk of falling at admission were less likely to fracture after a fall (OR: 0.60, 95% CI 0.41 to 0.89) than those who had not been screened. Further, falls from standing (OR: 2.08, 95% CI 1.22 to 3.55) and falls while walking (OR: 1.86, 95% CI 1.32 to 2.62) were associated with higher fracture odds than falls during other activities. In line with these results, falls while reaching in standing (OR: 3.51, 95% CI 1.44 to 8.56) and falls while walking (OR: 2.11, 95% CI 1.24 to 3.58) were also predictive of fracture in the adjusted residential care model. Conclusions: Our findings indicate that screening of hospital patients for their risk of falling may contribute towards the prevention of fall-related injury. Falls from upright postures appear to be more likely to result in fractures than other falls in healthcare settings. Further prospective research is warranted

Point prevalence of sub-optimal footwear features among ambulant older hospital patients: implications for fall prevention

Objective. The aim of the present study was to establish the point prevalence of 'suboptimal' features in footwear reported to have been used by older hospital patients when ambulating, and to explore underpinning factors for their choice of footwear. Method. Across-sectional investigation was undertaken on 95 of 149 eligible in-patients across 22 high fall-risk wards in a large metropolitan hospital in Brisbane, Australia. Results. Over70%of participants experienced an unplanned admission. Although most participants had access to some form of footwear in hospital (92%), nearly all reported ambulating in footwear with 'suboptimal' features (99%). Examples included slippers (27%), backless slippers (16%) or bare feet (27%). For patients who ambulated in bare feet, only one-third reported 'lack of access to footwear' as the primary cause, with others citing foot wounds, pain,oedema and personal choice as the main reason for bare foot ambulation. Conclusions. Admitted patients frequently use footwear with 'suboptimal' features for ambulation in hospital. While some footwear options (for example well-fitting slippers) could be suited for limited in-hospital ambulation, others are clearly hazardous and might cause falls. Since footwear choices are influenced by multiple factors in this population, footwear education strategies alone may be insufficient to address the problem of hazardous footwear in at-risk patients. Footwear requirements may be more effectively addressed within a multidisciplinary team approach encompassing foot health, mobility and safety