Original publication: 2011 | Research programme final report
Source authors: Amy Drahota, Derek Ward, Dia Soilemezi, Julie Udell, Nicholas Latimer, Kevin Hallas, Simon Dixon, Steve Thorpe, Taraneh Dean, Julian Minns and Martin Severs
About this research
Preventing falls is essential, but not every fall can be avoided. For older hospital patients, the physical consequences can be severe, particularly where frailty, reduced mobility or existing medical conditions increase vulnerability.
The HIP-HOP study — Helping Injury Prevention in Hospitalised Older People — investigated whether changing the hospital floor could reduce the consequences of falls without introducing new difficulties or hazards.
Led by researchers at the University of Portsmouth, it was a pioneering multidisciplinary programme combining clinical research with independent mechanical testing, health economics and qualitative interviews.
How the research was conducted
Eight wards caring for older patients took part. Four were allocated to have an 8.3 mm foam-backed vinyl floor fitted in a designated patient bay; four continued using their existing floors. 571 patients were enrolled across the study, with approximately one year of follow-up after the new flooring was installed.
Researchers recorded falls and injuries, assessed floors for slip resistance and impact absorption over time, modelled cost-effectiveness and interviewed staff, patients and visitors. The intervention floor was Tarkett Omnisports EXCEL, originally developed for sports applications.
The design was a pilot cluster randomised controlled trial: the intervention was allocated at ward/bay level, and the work was intended to estimate effects and develop the methods for a larger study.
Key findings
The new floor provided considerably greater mechanical shock absorption.
HSL used a portable impact test apparatus to examine the floor in situ. The intervention floor produced lower peak deceleration measurements than conventional flooring and maintained its impact-absorbing performance throughout the monitoring period.
The injury results were encouraging but inconclusive.
During follow-up, eight patients in the intervention group sustained fall-related injuries, compared with twelve in the control group. The adjusted injury incidence rate ratio was 0.46, with a wide 95% confidence interval of 0.11–1.97. This was a signal of possible benefit, not proof of a 54% reduction.
There were no moderate or major injuries in the intervention group, compared with six in the control group, but numbers were too small to draw definitive conclusions.
The effect on falls required further investigation.
The estimated adjusted incidence rate ratio for falls was 1.33 (95% confidence interval 0.44–4.03). This was compatible with multiple explanations, including random variation, reporting or allocation differences and potential actual effects of the surface on movement.
The shock-absorbing floor did not have lower measured slip resistance.
Pendulum testing found no important deterioration in the intervention flooring's slip resistance. Under wet conditions it was slightly less slippery than the control floors, although all surfaces were still classified as having high slip potential when wet.
Staff experienced practical disadvantages.
Healthcare staff reported difficulty pushing beds and other wheeled equipment across the softer flooring. One reported back injury associated with this difficulty did not require medical treatment. The findings underlined the need to consider staff safety alongside possible patient benefit.
What makes the research valuable
The study examined a potential safety intervention using several kinds of evidence. It did not assume that a more shock-absorbent material automatically produced better clinical outcomes.
The team defined clinical outcomes, addressed consent and ethical approval, used standardised collection methods, monitored changes to the floor and interviewed the people who actually worked and lived with the intervention. It also considered possible sources of bias and the limitations of a small trial.
The distinction between demonstrating a beneficial material property and proving an improvement in real-world safety is one of the lasting contributions of the study.
Why it matters
HIP-HOP shows why a successful safety innovation must perform well across several requirements. A floor intended to protect vulnerable patients also needs appropriate grip, hygienic cleanability and workable conditions for staff.
It is a strong example of experimental engineering measurements being integrated into a broader, rigorous evaluation of a real-world safety question.
Original research
Drahota, A., Ward, D., Soilemezi, D., Udell, J., Latimer, N., Hallas, K., Dixon, S., Thorpe, S., Dean, T., Minns, J. and Severs, M. (2011). Pilot Cluster Randomised Controlled Trial of Flooring to Reduce Injuries from Falls in Elderly Care Units: Final Report. The HIP-HOP Flooring Study. Funded by the Dunhill Medical Trust. ClinicalTrials.gov: NCT00817869.
Research note: This is the co-authored 2011 final report, which is different from the HIP-HOP clinical study protocol and the later journal publication. The pilot was not powered to establish definitive injury or fall effects.
Original source and further reading
University of Portsmouth final-report record