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Fall-related hip fractures are a serious public health issue in older adults. As most mechanistic hip fracture risk prediction models incorporate tissue tolerance, test methods that can accurately characterize the fracture force of the femur (and factors that influence it) are imperative. While bone possesses viscoelastic properties, experimental characterization of rate-dependencies has been inconsistent in the whole-femur literature. The goal of this study was to investigate the influence of experimental paradigm on loading rate and fracture force (both means and variability) during mechanical tests simulating lateral fall loadings on the proximal femur. Six pairs of matched femurs were split randomly between two test paradigms: a 'lower rate' materials testing system (MTS) with a constant displacement rate of 60 mm/s, and a hip impact test system (HIT) comprised of a custom-built vertical drop tower utilizing an impact velocity of 4 m/s. The loading rate was 88-fold higher for the HIT (mean (SD) = 2465.49 (807.38) kN/s) compared to the MTS (27.78 (10.03) kN/s) paradigm. However, no difference in fracture force was observed between test paradigms (mean (SD) = 4096.4 (1272.6) N for HIT, and 3641.3 (1285.8) N for MTS). Within-paradigm variability was not significantly different across paradigms for either loading rate or fracture force (coefficients of variation ranging from 0.311 to 0.361). Within each test paradigm, significant positive relationships were observed between loading rate and fracture force (HIT adjusted R2 = 0.833, p = 0.007; MTS adjusted R2 = 0.983, p < 0.0001). Overall, this study provides evidence that energy-based impact simulators can be a valid method to measure femoral bone strength in the context of fall-related hip fractures. This study motivates future research to characterize potential non-linear relationships between loading rate and fracture threshold at both macro and microscales.
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Acidentes por Quedas , Fêmur , Teste de Materiais , Suporte de Carga , Humanos , Fêmur/fisiologia , Idoso , Masculino , Testes Mecânicos , Feminino , Fenômenos Biomecânicos , Fraturas do Fêmur/fisiopatologia , Idoso de 80 Anos ou mais , Estresse Mecânico , Fraturas Proximais do FêmurRESUMO
Hip fractures are a severe health concern among older adults. While anthropometric factors have been shown to influence hip fracture risk, the low fidelity of common body composition metrics (e.g. body mass index) reduces our ability to infer underlying mechanisms. While simulation approaches can be used to explore how body composition influences impact dynamics, there is value in experimental data with human volunteers to support the advancement of computational modeling efforts. Accordingly, the goal of this study was to use a novel combination of subject-specific clinical imaging and laboratory-based impact paradigms to assess potential relationships between high-fidelity body composition and impact dynamics metrics (including load magnitude and distribution and pelvis deflection) during sideways falls on the hip in human volunteers. Nineteen females (<35 years) participated. Body composition was assessed via DXA and ultrasound. Participants underwent low-energy (but clinically relevant) sideways falls on the hip during which impact kinetics (total peak force, contract area, peak pressure) and pelvis deformation were measured. Pearson correlations assessed potential relationships between body composition and impact characteristics. Peak force was more strongly correlated with total mass (r = 0.712) and lean mass indices (r = 0.510-0.713) than fat mass indices (r = 0.401-0.592). Peak deflection was positively correlated with indices of adiposity (all r > 0.7), but not of lean mass. Contact area and peak pressure were positively and negatively associated, respectively, with indices of adiposity (all r > 0.49). Trochanteric soft tissue thickness predicted 59 % of the variance in both variables, and was the single strongest correlate with peak pressure. In five-of-eight comparisons, hip-local (vs. whole body) anthropometrics were more highly associated with impact dynamics. In summary, fall-related impact dynamics were strongly associated with body composition, providing support for subject-specific lateral pelvis load prediction models that incorporate soft tissue characteristics. Integrating soft and skeletal tissue properties may have important implications for improving the biomechanical effectiveness of engineering-based protective products.
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Composição Corporal , Tamanho Corporal , Fraturas do Quadril , Humanos , Feminino , Composição Corporal/fisiologia , Adulto , Tamanho Corporal/fisiologia , Fraturas do Quadril/fisiopatologia , Acidentes por Quedas , Quadril/fisiologia , Fenômenos BiomecânicosRESUMO
OBJECTIVE: This article presents the National Healthcare Safety Network (NHSN)'s approach to automation for public health surveillance using digital quality measures (dQMs) via an open-source tool (NHSNLink) and piloting of this approach using real-world data in a newly established collaborative program (NHSNCoLab). The approach leverages Health Level Seven Fast Healthcare Interoperability Resources (FHIR) application programming interfaces to improve data collection and reporting for public health and patient safety beginning with common, clinically significant, and preventable patient harms, such as medication-related hypoglycemia, healthcare facility-onset Clostridioides difficile infection, and healthcare-associated venous thromboembolism. CONCLUSIONS: The NHSN's FHIR dQMs hold the promise of minimizing the burden of reporting, improving accuracy, quality, and validity of data collected by NHSN, and increasing speed and efficiency of public health surveillance.
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Infecções por Clostridium , Segurança do Paciente , Humanos , Estados Unidos , Qualidade da Assistência à Saúde , Coleta de Dados , Centers for Disease Control and Prevention, U.S.RESUMO
Towards developing more effective interventions for fall-related injuries, this study analysed a novel database from six retirement home facilities over a 4-year period comprising 1,877 fallers and 12,445 falls. Falls were characterized based on location, activity, injury site, and type, and the database was stratified across four levels of care: Independent Living, Retirement Care, Assisted Care, and Memory care. Falls most occurred within the bedroom (62.8%), and during unknown (38.1%), walking (20.2%), and transfer tasks (14.6%). Approximately one in three (37%) of all falls resulted in an injury, most commonly involving the upper limb (31.8%), head (26.3%), and lower limb (22.2%), resulting in skin tears (35.3%), aches/pains (29.1%), or bruises (28.0%). While fall location, activity, and injury site were different across levels of care, injury type was not. The data from this study can assist in targeting fall-related injury prevention strategies across levels of care within retirement facilities.
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BACKGROUND: Reducing fall-related injuries is difficult due to the multi-factorial nature of falls, and challenges in implementing injury-preventative strategies. While safety floors are effective at absorbing energy and reducing fall-related impact forces, the low stiffness component of these floors may impair an individual's balance and mobility, thereby increasing fall risk. RESEARCH QUESTION: Therefore, the objective of this study was to investigate the influence of compliant flooring (i.e., safety flooring) on balance and mobility in young and older adults. METHODS: Kinematics were measured with inertial measurement units from 20 young and 10 older adults. Static balance was evaluated during quiet stance on three flooring surfaces (traditional, safety, foam) with three stance positions (regular, tandem, one-legged). Mobility was evaluated using the 3 m timed-up-and-go test on two flooring surfaces (traditional, safety). RESULTS: All participants were able to complete quiet standing trials on normal and safety flooring surfaces; however, most older adults could not complete one-legged stance trials or standing on foam. Significant age-related effects were observed for several balance and mobility tasks, particularly during the more challenging tandem stance condition, and the dynamic timed-up-and-go mobility test. In contrast, the introduction of safety flooring (compared to traditional flooring) had limited effects on balance/mobility (1 of 16 outcome variables showed negative effects). SIGNIFICANCE: Overall, the findings demonstrate minimal effects of a novel safety floor compared to the age-related differences, and provide insights to assist researchers, consumers, and industry stakeholders in the development of environments that support safe movement and maintained independence for older adults.
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Pisos e Cobertura de Pisos , Equilíbrio Postural , Humanos , Idoso , Estudos de Tempo e Movimento , MovimentoRESUMO
OBJECTIVES: The presence of a mechanical aortic valve has been a contraindication to the use of an arch branch aortic endograft due to the risk of damaging the valve, resulting in acute aortic regurgitation, or a trapped endograft. METHODS: We present a 67-year-old woman, with a background of Marfan's syndrome and a previous Bentall's procedure, who presented with a symptomatic enlarging aortic arch and descending thoracic aortic aneurysm, with a type 1A endoleak. RESULTS: Using an inner branch arch endograft (Cook Medical, Bloomington, Indiana), the nose cone of the delivery system was passed laterally through the semi-circular aperture of the mechanical aortic valve to facilitate deployment just distal to the coronary buttons. CONCLUSIONS: With advancement of endovascular technology, techniques and experience, endovascular aortic arch repair in the presence of a mechanical aortic valve is feasible.
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PURPOSE OF REVIEW: This review surveys recent literature related to cortical bone fracture mechanics and its application towards understanding bone fragility and hip fractures. RECENT FINDINGS: Current clinical tools for hip fracture risk assessment have been shown to be insensitive in some cases of elevated fracture risk leading to the question of what other factors account for fracture risk. The emergence of cortical bone fracture mechanics has thrown light on other factors at the tissue level that are important to bone fracture resistance and therefore assessment of fracture risk. Recent cortical bone fracture toughness studies have shown contributions from the microstructure and composition towards cortical bone fracture resistance. A key component currently overlooked in the clinical evaluation of fracture risk is the importance of the organic phase and water to irreversible deformation mechanisms that enhance the fracture resistance of cortical bone. Despite recent findings, there is an incomplete understanding of which mechanisms lead to the diminished contribution of the organic phase and water to the fracture toughness in aging and bone-degrading diseases. Notably, studies of the fracture resistance of cortical bone from the hip (specifically the femoral neck) are few, and those that exist are mostly consistent with studies of bone tissue from the femoral diaphysis. Cortical bone fracture mechanics highlights that there are multiple determinants of bone quality and therefore fracture risk and its assessment. There is still much more to learn concerning the tissue-level mechanisms of bone fragility. An improved understanding of these mechanisms will allow for the development of better diagnostic tools and therapeutic measures for bone fragility and fracture.
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Doenças Ósseas , Fraturas do Quadril , Humanos , Densidade Óssea , Fraturas do Quadril/epidemiologia , Colo do Fêmur , Água , Medição de RiscoRESUMO
Soft tissues overlying the hip play a critical role in protecting against fractures during fall-related hip impacts. Consequently, the development of an efficient and cost-effective method for estimating hip soft tissue thicknesses in living people may prove to be valuable for assessing an individual's injury risk and need to adopt preventative measures. The present study used multiple linear stepwise regression to generate prediction equations from participant characteristics (i.e., height, sex) and anthropometric measurements of the pelvis, trunk, and thigh to estimate soft tissue thickness at the iliac crests (IC) and greater trochanters (GT) in younger (16-35 years of age: 37 males, 37 females) and older (36-65 years of age: 38 males, 38 females) adults. Equations were validated against soft tissue thicknesses measured from full body Dual-energy X-ray Absorptiometry scans of independent samples (younger: 13 males, 13 females; older: 13 males, 12 females). Younger adult prediction equations exhibited adjusted R2 values ranging from 0.704 to 0.791, with more explained variance for soft tissue thicknesses at the GT than the IC; corresponding values for the older adult equations were higher overall and ranged from 0.819 to 0.852. Predicted and actual soft tissue thicknesses were significantly correlated for both the younger (R2 = 0.466 to 0.738) and older (R2 = 0.842 to 0.848) adults, averaging ≤ 0.75cm of error. This research demonstrates that soft tissue thicknesses overlying the GT and IC can be accurately predicted from equations using anthropometric measurements. These equations can be used by clinicians to identify individuals at higher risk of hip fractures who may benefit from the use of preventative measures.
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Fêmur , Ílio , Masculino , Feminino , Humanos , Idoso , Adulto , Antropometria/métodos , Absorciometria de Fóton/métodos , Coxa da Perna , Composição CorporalRESUMO
OBJECTIVE: Pseudoaneurysm formation post type A aortic dissection repair is rare. Revision surgical repair is challenging, with a risk of death from haemorrhage. METHODS: We present a 56-year-old man who presented with a rapidly enlarging distal ascending aortic anastomotic pseudoaneurysm following a recent ascending and hemiarch replacement for acute type A aortic dissection. RESULTS: A tight kink in the ascending aortic graft precluded an endovascular repair utilizing two antegrade branches, and so a novel custom-made 3 inner branched aortic endograft was designed, with an antegrade brachiocephalic inner branch and retrograde left common carotid and subclavian artery inner branches. The patient required an angioplasty to dilate the kinked/coarcted surgical graft, but made an uneventful recovery. CONCLUSION: An aortic arch inner branch design with an antegrade brachiocephalic branch but retrograde left common carotid and left subclavian branches was feasible and may prove particularly useful when there is limited space in the ascending aorta.
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Occupations or activities where donning head-supported mass (HSM) is commonplace put operators at an elevated risk of chronic neck pain. Yet, there is no consensus about what features of HSM influence the relative contributions to neck loads. Therefore, we tested four hypotheses that could increase neck loads: (i) HSM increases gravitational moments; (ii) more muscle activation is required to stabilize the head with HSM; (iii) the position of the HSM centre of mass (COM) induces gravitational moments; and (iv) the added moment of inertia (MOI) from HSM increases neck loads during head repositioning tasks. We performed a sensitivity analysis on the C5-C6 compression evaluated from a 24-degree freedom cervical spine model in OpenSim for static and dynamic movement trials. For static trials, we varied the magnitude of HSM, the position of its COM, and developed a novel stability constraint for static optimization. In dynamic trials, we varied HSM and the three principle MOIs. HSM magnitude and compression were linearly related to one another for both static and dynamic trials, with amplification factors varying between 1.9 and 3.9. Similar relationships were found for the COM position, although the relationship between C5-C6 peak compression and MOI in dynamic trials was generally nonlinear. This sensitivity analysis uncovered evidence in favour of hypotheses (i), (ii) and (iii). However, the model's prediction of C5-C6 compression was not overly sensitive to the magnitude of MOI. Therefore, the HSM mass properties may be more influential on neck compression than MOI properties, even during dynamic tasks.
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Vértebras Cervicais , Pescoço , Pescoço/fisiologia , Músculos , Simulação por Computador , Fenômenos BiomecânicosRESUMO
The quest for better predictive tools as well as new preventative and therapeutic measures for bone fragility and fracture has highlighted the need for greater mechanistic understanding of the bone fracture process. Cortical bone, the major load bearing part of the bone, employs different toughening mechanisms to either inhibit or slow down crack growth which leads to fracture. Among these toughening mechanisms, is the formation of a micro-damage process zone (MDPZ) around the region of the propagating crack. Investigations into the MDPZ to date have primarily been based on quasi-static or cyclic loading rate experiments which do not necessarily replicate physiological fracture rates. Consequently, the impact of fall-related loading rates on the formation of the micro-damage process zone was investigated comparing these to quasi-static loading rate equivalents. The size of MDPZ was found to be 42% smaller in the high-rate group compared to the quasi-static rate group. The smaller MDPZ size was associated with a brittle, unstable fracture behaviour and an overall smaller fracture resistance measure (Jmax). This result points to the possibility of a strain rate hardening mechanism at the heart of micro-damage formation, which is hampered under high loading rates, resulting in lower overall fracture resistance.
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Acidentes por Quedas , Fraturas Ósseas , Osso e Ossos , Osso Cortical , Humanos , Estresse Mecânico , Suporte de CargaRESUMO
Metrics of femur geometry and body composition have been linked to clinical hip fracture risk. Mechanistic explanations for these relationships have generally focused on femur strength; however, impact loading also modulates fracture risk. We evaluated the potential effects of femur geometry and body composition on femoral neck stresses during lateral impacts. Fifteen female volunteers completed low-energy sideways falls on to the hip. Additionally, participants completed ultrasound and dual-energy x-ray absorptiometry imaging to characterize trochanteric soft tissue thickness (TSTT) over the hip and six metrics of femur geometry, respectively. Subject-specific beam models were developed and utilized to calculate peak femoral neck stress (σNeck), utilizing experimental impact dynamics. Except for femoral neck axis length, all metrics of femur geometry were positively correlated with σNeck (all p < 0.05). Larger/more prominent proximal femurs were associated with increased force over the proximal femur, whereas a wider neck-shaft angle was associated with greater stress generation independent of force (all p < 0.05). Body mass index (BMI) and TSTT were negatively correlated with σNeck (both p < 0.05). Despite strong correlations, these metrics of body composition appear to influence femoral neck stresses through different mechanisms. Increased TSTT was associated with reduced force over the proximal femur, whereas increased BMI was associated with greater resistance to stress generation (both p < 0.05). This study provided novel insights into the mechanistic pathways through which femur geometry and body composition may modulate hip fracture risk. Our findings complement clinical findings and provide one possible explanation for incongruities in the clinical fracture risk and femur strength literature.
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Colo do Fêmur , Fraturas do Quadril , Absorciometria de Fóton/métodos , Composição Corporal , Densidade Óssea , Feminino , Fêmur , Colo do Fêmur/diagnóstico por imagem , HumanosRESUMO
INTRODUCTION: Between 43 and 97% of helicopter pilots in the Canadian Armed Forces report neck pain. Potential contributing factors include the weight of their helmet, night vision goggles (NVG), and counterweight (CW) combined with deviated neck postures. Therefore, the purpose of this investigation was to quantify changes in neck loads associated with posture, helmet, NVG, and CW.METHODS: Eight male subjects volunteered. They undertook one of five deviated neck postures (flexion, extension, lateral bending, axial rotation) times four configurations (no helmet, helmet only, helmet and NVG, and helmet, NVG, and CW). 3D kinematics and EMG from 10 muscles (5 bilaterally) drove a 3D inverse dynamics, EMG-driven model of the cervical spine which calculated joint compression and shear at C5-C6.RESULTS: The compression in the neutral posture was 116.5 (5.7) N, which increased to 143.7 (11.4) N due to a 12.7 N helmet. NVGs, weighing 7.9 N, also generated this disproportionate increase, where the compression was 164.2 (3.7) N. In flexion or extension, the compression increased with increasing head-supported mass, with a maximum of 315.8 (67.5) N with the CW in flexion. Anteroposterior shear was highest in the lateral bending [34.0 (6.2) N] condition, but was generally low (< 30 N). Mediolateral shear was less than 5 N for all conditions.DISCUSSION: Repositioning the center of gravity of the helmet with either NVGs or CW resulted in posture-specific changes to loading. Posture demonstrated a greater potential to reposition the head segment's center of gravity compared to the helmet design. Therefore, helmet designs which consider repositioning the center of gravity may reduce loads in one posture, but likely exacerbate loading in other postures.Barrett JM, McKinnon CD, Dickerson CR, Laing AC, Callaghan JP. Posture and helmet configuration effects on joint reaction loads in the middle cervical spine. Aerosp Med Hum Perform. 2022; 93(5):458-466.
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Dispositivos de Proteção da Cabeça , Músculos do Pescoço , Fenômenos Biomecânicos , Canadá , Vértebras Cervicais , Eletromiografia , Humanos , Masculino , Músculos do Pescoço/fisiologia , Postura/fisiologiaRESUMO
BACKGROUND: Muscle capacity utilization reflects the percentage of maximal knee extensor strength required to complete physical activities. RESEARCH QUESTION: Is pain associated with muscle capacity utilization during walking in older adults with knee osteoarthritis? Secondarily, is muscle capacity utilization in older adults with knee osteoarthritis sex-specific? METHODS: Twenty-three participants (15 females) with symptomatic knee OA completed this study [age 67 ( ± 8) years, body mass index 29.7 ( ± 3.9) kg/m2, gait speed during the Six Minute Walk test 1.25 ( ± 0.25) m/s]. Pain was measured using the Knee injury and Osteoarthritis Outcome Score. Muscle capacity utilization was quantified as the peak external knee flexor moment during level walking normalized to knee extensor maximum voluntary isometric contraction. The knee flexor moment was calculated from kinematic and kinetic data during barefoot level walking at a self-selected speed and at 1.1 m/s. Knee extensor maximum voluntary isometric contraction was measured on a dynamometer. Multiple linear regressions were used to determine the relationship between pain and muscle capacity utilization after adjusting for age, sex, body mass index, and gait speed. Independent sample t-tests examined sex differences. RESULTS: Pain was not associated with muscle capacity utilization during self-selected and standardized walking speeds (p = 0.38 and p = 0.36, respectively). Females did not require a greater muscle capacity utilization than males to complete gait at self-selected and standardized speeds (p = 0.28, and p = 0.40, respectively). SIGNIFICANCE: Muscle capacity utilization was not associated with pain during walking in people with knee osteoarthritis. Future work should explore more challenging activities of daily living in knee OA.
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Osteoartrite do Joelho , Atividades Cotidianas , Idoso , Feminino , Marcha/fisiologia , Humanos , Articulação do Joelho , Masculino , Força Muscular , Músculos , Osteoartrite do Joelho/complicações , Dor/etiologia , Caminhada/fisiologiaRESUMO
Hip fractures in older adults, which often lead to lasting impairments and an increased risk of mortality, are a major public health concern. Hip fracture risk is multi-factorial, affected by the risk of falling, the load acting on the femur, and the load the femur can withstand. This study investigates the influence of impact direction on hip fracture risk and hip protector efficacy. We simulated falls for 4 subjects, in 7 different impact directions (15° and 30° anterior, lateral, and 15°, 30°, 60°, and 90° posterior) at two different impact velocities (2.1 and 3.1 m/s), all with and without hip protector, using previously validated biofidelic finite element models. We found the highest number of fractures and highest fragility ratios in lateral and 15° posterior impacts. The hip protector attenuated femur forces by 23-49 % for slim subjects under impact directions that resulted in fractures (30° anterior to 30° posterior). The hip protector prevented all fractures (6/6) for 2.1 m/s impacts, but only 10% of fractures for 3.1 m/s impacts. Our results provide evidence that, regarding hip fracture risk, posterior-lateral impacts are as dangerous as lateral impacts, and they support the efficacy of soft-shell hip protectors for anterior- and posterior-lateral impacts.
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Acidentes por Quedas/prevenção & controle , Fraturas do Quadril/prevenção & controle , Equipamentos de Proteção/normas , Fenômenos Biomecânicos , Simulação por Computador , Análise de Elementos Finitos , Humanos , Pressão , Estresse MecânicoRESUMO
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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Acidentes por Quedas , Fraturas Ósseas , Acidentes por Quedas/prevenção & controle , Idoso , Pisos e Cobertura de Pisos , Fraturas Ósseas/prevenção & controle , Hospitais , HumanosRESUMO
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.
AIM: The aim of this study was to summarise what is known about shock-absorbing flooring for reducing injurious falls in hospitals and care homes. BACKGROUND: Falls and fall-related injuries are a major problem for older adults in both hospitals and care homes. Shock-absorbing flooring (such as carpet, sports floors or specially designed floors) provides a more cushioned surface and is one potential solution to help reduce the impact forces from a fall. METHODS: From literature searches, we identified relevant studies on shock-absorbing flooring use in hospitals and care homes. We gathered data on the quality of the studies' methods, what and who the studies involved, and the study findings. Members of the public were involved throughout the project. They helped improve the clarity of the reporting and collaborated in meetings to help guide the study team. FINDINGS: One high-quality study in a care home found that vinyl overlay with novel shock-absorbing underlay was no better at reducing injuries than vinyl overlay with plywood underlay on concrete subfloors. We found very low-quality evidence that shock-absorbing flooring may reduce injuries in hospitals and care homes, without increasing falls; if this were true, then economic evidence suggested that shock-absorbing flooring would be the best-value option for patients (lower cost and improved outcomes). There was insufficient evidence to determine the effects of shock-absorbing flooring on fractures or head injuries, although wooden subfloors resulted in fewer hip fractures than concrete subfloors. Shock-absorbing flooring made it harder for staff to move equipment such as beds and trolleys, and led to staff changing how they work. IMPLICATIONS: The evidence suggests that one type of shock-absorbing floor may not work in care homes, compared with rigid flooring; however, gaps still exist in the knowledge. The evidence in favour of shock-absorbing flooring was of very low quality, meaning it is uncertain. There is a lack of robust evidence in hospitals, which often have concrete subfloors and different population characteristics. If planning to install shock-absorbing flooring, it is important to consider the wider impacts on the workplace and how best to manage these.
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Pisos e Cobertura de Pisos , Fraturas Ósseas , Idoso , Hospitais , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Low back pain (LBP) is frequently reported following rear impact collisions. Knowledge of how the facet joint capsule (FJC) mechanically behaves before and after rear impact collisions may help explain LBP development despite negative radiographic evidence of gross tissue failure. This study quantified the Green strain tensor in the facet joint capsule during rotation and translation range-of-motion tests completed before and following an in vitro simulation of a rear impact collision. Eight FSUs (4 C3-C4, 4 C5-C6) were tested. Following a preload test, FSUs were flexed and extended at 0.5 deg/s until an ±8 N·m moment was achieved. Anterior and posterior joint translation was then applied at 0.2 mm/s until a target ±400 N shear load was imposed. Markers were drawn on the facet capsule surface and their coordinates were tracked during pre- and postimpact range-of-motion tests. Strain was defined as the change in point configuration relative to the determined neutral joint posture. There were no significant differences (p > 0.05) observed in all calculated FJC strain components in rotation and translation before and after the simulated impact. Our results suggest that LBP development resulting from the initiation of strain-induced mechanoreceptors and nociceptors with the facet joint capsule is unlikely following a severe rear impact collision within the boundaries of physiological joint motion.
Assuntos
Articulação Zigapofisária , Animais , Fenômenos Biomecânicos , Vértebras Cervicais , Cápsula Articular , Movimento , Amplitude de Movimento Articular , Suínos , Articulação Zigapofisária/fisiologiaRESUMO
BACKGROUND: We describe the first-in-human experience using the Route 92 Medical Aspiration System to perform thrombectomy in the initial 45 consecutive stroke patients enrolled in the SUMMIT NZ trial. This aspiration system includes a specifically designed delivery catheter which enables delivery of 0.070 inch and 0.088 inch aspiration catheters. METHODS: The SUMMIT NZ trial is a prospective, multicenter, single-arm study with core lab imaging adjudication. Patients presenting with acute ischemic stroke from large vessel occlusion are eligible to enrol. The study has had three phases which transitioned from use of the 0.070 inch to the 0.088 inch catheter. RESULTS: Vessel occlusions were located in the internal carotid artery (27%), M1 (60%) and M2 (13%). Median baseline National Institutes of Health Stroke Scale (NIHSS) was 16 (IQR 10). Across the three phases, the first-pass reperfusion rate of modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b was 62% using the Route 92 Medical system; this rate was 29% in phase 1, 56% in phase 2, and 80% in phase 3. The first-pass reperfusion rate of mTICI ≥2c was 42% overall, 29% in phase 1, 33% in phase 2, and 55% in phase 3. A final reperfusion rate of mTICI ≥2b was achieved in 96% of cases, with 36% of cases using adjunctive devices. Patients had an average improvement of 6.7 points in NIHSS from baseline at 24 hours, and at 90 days 48% were functionally independent (modified Rankin Scale 0-2). CONCLUSIONS: In this early experience, the Route 92 Medical Aspiration System has been effective and safe. The system has design features that improve catheter deliverability and have the potential to increase first-pass reperfusion rates in aspiration thrombectomy.