Background A promising strategy for reducing the incidence and severity of fall-related injuries in long-term care (LTC) is to decrease the ground surface stiffness, and the subsequent forces applied to the body parts at impact, through installation of compliant flooring that does not substantially affect balance or mobility. Definitive evidence of the effects of compliant flooring on fall-related injuries in LTC is lacking. The Flooring for Injury Prevention (FLIP) Study is designed to address this gap.
Methods The FLIP Study is a 4-year, parallel-group, 2-arm, randomised controlled superiority trial of flooring in 150 resident rooms at a LTC site. The primary objective is to determine whether compliant flooring reduces serious fall-related injuries relative to control flooring. Intervention (2.54 cm SmartCells compliant; 74 rooms) and control (2.54 cm plywood; 76 rooms) floorings were installed over the top of existing concrete floors and covered with identical 2.00 mm vinyl. The primary outcome is serious fall-related injury, defined as any impact-related injury due to a fall in a study room that results in Emergency Department visit or hospital admission. Secondary outcomes include minor fall-related injury, any fall-related injury, falls, number of fallers, fractures, and healthcare utilisation and costs for serious fall-related injuries. Randomisation of study rooms, and residents in rooms, was stratified by residential unit, and flooring assignments were concealed. Outcome ascertainment began September 2013.
Discussion Results from the FLIP Study will provide evidence about the effects of compliant flooring on fall-related injuries in LTC and will guide development of safer environments for vulnerable older adults.
Trial registration number NCT01618786.
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Contributors CCL participated in study design, coordination and data collection, and helped to draft and revise the manuscript. FF helped to conceive the study, obtained funding, participated in study design and oversight, and helped to revise the manuscript. ACL helped to conceive of the study, participated in study design and helped to revise the manuscript. PML participated in study design and oversight, coordination and data collection, and helped to revise the manuscript. SNR helped to conceive the study, obtained funding, participated in study design and oversight, and helped to revise the manuscript. DCM is the principal investigator and helped to conceive the study, obtained funding, participated in study design, coordination, data collection, statistical analysis planning, and oversight, and drafted and revised the manuscript. All authors read and approved the final manuscript.
Funding The study has received funding from the Canadian Institutes of Health Research (grant TIR-103945 to SNR); AGE-WELL, Inc., a Canadian National Centre for Excellence; Fraser Health Authority; Centre for Hip Health and Mobility; and New Vista Society Care Home. In addition, SATech provided SmartCells flooring, flooring installation materials (eg, adhesive, tape and transitions), and labour for flooring installation. CCL is supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship and an AGE-WELL Graduate Student and Postdoctoral Award in Technology and Aging. DCM is supported by a Michael Smith Foundation for Health Research Scholar Award.
Competing interests SNR was a paid biomechanical consultant to SATech in 2008 for evaluating the force reduction provided by SmartCells flooring. He has no current links to the company.
Ethics approval The protocol for this study was approved by the Research Ethics Boards at Simon Fraser University (2013s0525) and the Fraser Health Authority (FHREB 2012-059).
Provenance and peer review Not commissioned; internally peer reviewed.