Predictors of fall protection motivation among older adults in rural communities in a middle-income country: A cross-sectional study using the Protection Motivation Theory.

AIMS: To evaluate factors associated with fall protection motivation to engage in fall preventive behaviour among rural community-dwelling older adults aged 55 and above using the protection motivation theory scale. DESIGN: A cross-sectional study. METHODS: The study was conducted in a healthcare clinic in Malaysia, using multistage random sampling from November 2021 to January 2022. Three hundred seventy-five older adults aged 55 and older were included in the final analysis. There were 31 items in the final PMT scale. The analysis was performed within the whole population and grouped into 'faller' and 'non-faller', employing IBM SPSS version 26.0 for descriptive, independent t-test, chi-square, bivariate correlation and linear regressions. RESULTS: A total of 375 older participants were included in the study. Fallers (n = 82) and non-fallers (n = 293) show statistically significant differences in the characteristics of ethnicity, assistive device users, self-rating of intention and participation in previous fall prevention programmes. The multiple linear regression model revealed fear, coping appraisal and an interaction effect of fear with coping appraisal predicting fall protection motivation among older adults in rural communities. CONCLUSION: Findings from this study demonstrated that coping appraisal and fear predict the protection motivation of older adults in rural communities. Older adults without a history of falls and attaining higher education had better responses in coping appraisal, contributing to a reduction in perceived rewards and improving protection motivation. Conversely, older adults from lower education backgrounds tend to have higher non-preventive behaviours, leading to a decline in fall protection motivation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: These results contribute important information to nurses working with older adults with inadequate health literacy in rural communities, especially when planning and designing fall prevention interventions. The findings would benefit all nurses, healthcare providers, researchers and academicians who provide care for older adults. PATIENT OR PUBLIC CONTRIBUTION: Participants were briefed about the study, and their consent was obtained. They were only required to answer the questionnaire through interviews. Older individuals aged fifty-five and above in rural communities at the healthcare clinic who could read, write or understand Malay or English were included. Those who were suffering from mental health problems and refused to participate in the study were excluded from the study. Their personal information remained classified and not recorded in the database during the data entry or analysis.

Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial.

BACKGROUND: Falls are more prevalent in stroke survivors than age-matched healthy older adults because of their functional impairment. Rapid balance recovery reaction with adequate range-of-motion and fast response and movement time are crucial to minimize fall risk and prevent serious injurious falls when postural disturbances occur. A Kinect-based Rapid Movement Training (RMT) program was developed to provide real-time feedback to promote faster and larger arm reaching and leg stepping distances toward targets in 22 different directions. OBJECTIVE: To evaluate the effectiveness of the interactive RMT and Conventional Balance Training (CBT) on chronic stroke survivors' overall balance and balance recovery reaction. METHODS: In this assessor-blinded randomized controlled trial, chronic stroke survivors were randomized to receive twenty training sessions (60-min each) of either RMT or CBT. Pre- and post-training assessments included clinical tests, as well as kinematic measurements and electromyography during simulated forward fall through a "lean-and-release" perturbation system. RESULTS: Thirty participants were recruited (RMT = 16, CBT = 14). RMT led to significant improvement in balance control (Berg Balance Scale: pre = 49.13, post = 52.75; P = .001), gait control (Timed-Up-and-Go Test: pre = 14.66 s, post = 12.62 s; P = .011), and motor functions (Fugl-Meyer Assessment of Motor Recovery: pre = 60.63, post = 65.19; P = .015), which matched the effectiveness of CBT. Both groups preferred to use their non-paretic leg to take the initial step to restore stability, and their stepping leg's rectus femoris reacted significantly faster post-training (P = .036). CONCLUSION: The RMT was as effective as conventional balance training to provide beneficial effects on chronic stroke survivors' overall balance, motor function and improving balance recovery with faster muscle response. TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov ( https://clinicaltrials.gov/ct2/show/NCT03183635 , NCT03183635) on 12 June 2017.

Quantifying the uncertainty in tribometer measurements on walkway surfaces.

Properly estimating and reporting the uncertainty of walkway surface friction is key to ensuring pedestrian safety. Here we quantified the amount and sources of uncertainty in friction measurements by having four users of four units of each of two walkway tribometer models (Slip-Test Mark IIIB, English XL) perform 12 measurements on four samples of four different surfaces that ranged from slippery to slip-resistant. We found that 51-82% of the total variance in the measurements was explained by the user, unit, sample and a user-unit interaction, which means that the variance a single user calculates from their own data does not capture most of the uncertainty in their measurements. Based on these data, the minimum uncertainty associated with the mean of a user's measurements is ±0.064 (Mark IIIB) and ±0.072 (XL) to be 95% confident that their mean captures a surface's available friction. Practitioner Summary: Walkway surface friction measurements are less accurate than they appear. Based on an experiment quantifying the amount and sources of uncertainty in surface friction measurements using two common tribometers, we quantified and report the minimum uncertainty that users can assign to their walkway surface friction measurements. Abbreviations: ANOVA: analysis of variance; ANSI: American National Standards Institute; CI: confidence interval; E: east; ILS: interlaboratory study; ISO: International Standards Organization; JCGM: joint committee for guides in metrology; N: north; S: south; SBR: styrene-butadiene rubber; SD: standard deviation; TR: test result; W: west.

Contaminant film thickness affects walkway friction measurements.

Walkway tribometers are used to measure available friction for evaluating walkway safety and pedestrian slip risk. Numerous variables can affect tribometer measurements, including the type and distribution of contaminants on the surface. Here, we quantified the effect of application method on contaminant film thickness, and the effect of film thickness on tribometer measurements on the four reference walkway surfaces used in ASTM F2508-16e. Distilled water, 0.05% sodium lauryl sulfate (SLS) solution, and 0.04% Triton X-100 solution were poured, squirted, and sprayed onto the surfaces to quantify their naturally occurring film thicknesses. These application methods had a significant effect on the resulting film thickness (p < 0.038), with the pour method consistently generating the thickest films and the spray method generating the thinnest films. We then quantified the effect of film thickness for the three contaminants (thickness range 0.3-3.3 mm) on the friction measurements of three common tribometers (Mark IIIB, English XL, and BOT 3000E) on each reference surface. A separate ANOVA was used for each of the 3 × 4 × 3 = 36 combinations of tribometer, surface, and contaminant. Friction measured with the Mark IIIB decreased with increasing film thickness on one surface across all three contaminants and on a second surface with the SLS contaminant. Friction measured with the BOT 3000E was sensitive to film thickness on two surfaces with water and one surface with Triton. The XL was unaffected by contaminant film thickness. Overall, despite significant differences in film thickness with contaminant application method, friction measurements were either insensitive to film thickness or varied only a small amount in all cases except for the Mark IIIB on the roughest surface. Film thickness did not alter the relative slip resistance of the four ASTM F2508 reference surfaces.

Shoe Tread Wear Occurs Primarily during Early Stance and Precedes the Peak Required Coefficient of Friction.

Worn shoes contribute to injuries caused by slip-and-fall accidents. The peak required coefficient of friction (RCOF) has been associated with tread wear rate. However, the temporal relationship between RCOF and shoe wear is unknown. The purpose of this study was to determine whether the contact region at the time of peak RCOF is consistent with the region of shoe wear. The shoe contact region at peak RCOF was imaged by frustrated total internal reflection. Images of worn tread after months of use were captured. The worn tread region was more posterior than the contact region at RCOF and did not correlate with the contact region at the time of RCOF. The contact regions observed during earlier stance (within 83 ms of heel contact) were more consistent with the worn region, suggesting that RCOF may not directly cause tread wear. These results serve to motivate future studies to identify early-stance gait parameters associated with tread wear development.

Playground Equipment-related Genital Injuries in Children: An Analysis of United States Emergency Departments Visits, 2010-2019.

OBJECTIVE: To evaluate the demographics, epidemiology, and common mechanisms associated with playground equipment-related genital injuries in children. METHODS: We examined the National Electronic Injury Surveillance System database to obtain playground-related genital injuries sustained in children ≤17 years from 2010 to 2019. Demographics of the patients and injury characteristics were analyzed using sample weights to produce national estimates. RESULTS: During the study period, an estimated 27,738 (95% confidence interval 18,602-36,874) emergency department visits with an average annual incidence of 3.8 (95% confidence interval 2.5-5) per 100,000 United States population ≤17 years were reported. The mean age was 6.6 (standard error 0.152) years with most injuries occurring in pre-school children (48.1%) and females (81.1%). Over ½ of genital injuries (55.2%) were associated with climbing apparatus. This was followed by slides (10.7%), swings (9%), and seesaws (4.8%). Most genital injuries occurred at public (41.4%) and school settings (36.3%). Straddling and/or falling was the most common mechanism leading to genital injuries (84.4%). The incidence of injuries remained constant during the 10-year study period (change = + 2.6%; r2 = 0.121, P = .326). Monthly variations in the number of injuries existed with peak injuries in April-May, and September-October. CONCLUSION: Despite current safety standards, genital injuries arising from playground equipment have remained stable since 2010. By defining common devices, mechanisms, and conditions associated with genital injuries, this study may help guide efforts aimed at the prevention of such injuries in various locations.

Differences in Friction Performance between New and Worn Shoes.

Occupational ApplicationsSlips and falls are among the most common reason for non-fatal work accidents. Preventing slips in the workplace can be achieved by ensuring sufficient friction between the shoe and floor. As shoes are worn down, there is a decrease in the coefficient of friction, which increases the risk of injury from a slip and fall for the wearer. We found that shoes worn in the workplace commonly had friction performance that is about 25% lower than their new condition and that this effect was largest for shoes with the highest initial friction performance. These results inform the magnitude of improvement in friction performance that can be achieved through footwear replacement programs.

TECHNICAL ABSTRACTBackground As slip-resistant shoes are naturally worn, the coefficient of friction (COF) decreases. Proper and timely shoe replacement is an important factor for preventing injuries related to slips. Knowledge of the change in COF for naturally worn shoes in the workplace, relative to the COF of their new counterparts, is needed for a better understanding in this area. Methods: Slip-resistant shoes worn in the workplace and their new counterparts were mechanically tested to assess their COF. Eighteen pairs of shoes (new and worn) were tested on a whole-shoe slip testing device that simulates under-shoe slipping conditions. The COF was calculated for each pair of shoes at a shoe-floor angle of 17 ± 1° relative to the ground surface, a speed of 0.5 m/s, and a mean normal force of 250 ± 10 N. Results: A mean decrease in COF of 0.055 (25%) was observed when comparing the naturally worn shoes with the new shoes. New shoes with an initial higher COF showed a larger loss in COF due to wear. Conclusions: Naturally worn, slip-resistant shoes have substantively reduced COF compared to their new counterparts. These findings demonstrate the potential for programs that monitor and replace slip-resistant shoes as a means to prevent slips.

Slip and Fall Incidents at Work: A Visual Analytics Analysis of the Research Domain.

Slip and fall incidents at work remain an important class of injury and fatality causing mechanisms. An extensive body of safety research has accumulated on this topic. This article presents an analysis of this research domain. Two bibliometric visualization tools are applied: VOSviewer and HistCite. Samples of 618 slip and fall related articles are obtained from the Web of Science database. Networks of institutions, authors, terms, and chronological citation relationships are established. Collaboration and research activities of the slip and fall research community show that most contributors are from the United States, with the (now closed) Liberty Mutual Research Institute for Safety the most influential research organization. The results of a term clustering analysis show that the slip and fall research can be grouped into three sub-domains: epidemiology, gait/biomechanics, and tribology. Of these, early research focused mainly on tribology, whereas research on gait/biomechanics and epidemiological studies are relatively more recent. Psychological aspects of slip and fall incident occurrence represent a relatively under-investigated research topic, in which future contributions may provide new insights and safety improvements. Better linking of this research domain with other principles and methods in safety science, such as safety management and resilience, may also present valuable future development paths.

Subjective assessments of floor slipperiness before and after walk under two lighting conditions.

A gait experiment was performed. The participants were tested under shoes, floors, surface and lighting conditions. They gave floor slipperiness ratings before and after a gait trial. The perceived sense of slip (PSOS) was collected. It was found that the perceived floor slipperiness (PFS) before walking was affected significantly by the lighting, floor and surface conditions. Relative low PFS values were recorded under wet and detergent-contaminated conditions in the normal daylight condition as compared with those in the dimmed condition. The PFS after the gait was significantly affected by the floor and surface conditions. The PSOS was highly correlated with the PFS after trial. The regression analyses results indicated that both the coefficient of friction (COF) of the floor and lighting were primary predictors of the PFS before a gait. The COF and walking speed were the primary predictors of the PFS after a gait.

Coefficient of friction testing parameters influence the prediction of human slips.

Measuring the available coefficient of friction (ACOF) of a shoe-floor interface is influenced by the choice of normal force, shoe-floor angle and sliding speed. The purpose of this study was to quantify the quality of slip prediction models based on ACOF values measured across different testing conditions. A dynamic ACOF measurement device that tests entire footwear specimens (Portable Slip Simulator) was used. The ACOF was measured for nine different footwear-contaminant combinations with two levels of normal force, sliding speed and shoe-floor angle. These footwear-contaminant combinations were also used in human gait studies to quantify the required coefficient of friction (RCOF) and slip outcomes. The results showed that test conditions significantly influenced ACOF. The condition that best predicted slip risk during the gait studies was 250 N normal force, 17° shoe-floor angle, 0.5 m/s sliding speed. These findings can inform footwear slip-resistance measurement methods to improve design and prevent slips.

Performance testing of work shoes labeled as slip resistant.

The variability in friction and slip propensity across slip resistant (SR) shoes is poorly understood. This study aimed to quantify the impact of shoe design features on the available coefficient of friction (ACOF) across shoes labeled as SR. Differences in ACOF and the slipping rate across SR shoes were also quantified. Twelve shoes were tested across five types of flooring and three contaminant conditions using a whole shoe mechanical slip tester. Geometric and hardness parameters were measured to determine the effect of heel outsole design on ACOF. The rate of slipping was evaluated for three of the shoes on vinyl tile with canola oil using human subjects. Differences in ACOF were significant across shoe outsole designs (p < .001). ACOF was correlated with geometrical and hardness parameters. Rate of slipping was lower for the highest ACOF shoe (p < .001). This information can be used to guide SR shoe selection and design.

Required coefficient of friction during level walking is predictive of slipping.

The required coefficient of friction (RCOF) is frequently reported in the literature as an indicator of slip propensity. This study aimed to further develop slip prediction models based on RCOF by examining slips under moderately slippery conditions where the RCOF was approximately equal to the available coefficient of friction. Baseline RCOFs were found for normal walking trials and then an unexpected slip was introduced with a moderately slippery boot-floor contaminant combination for thirty-one subjects. Slip outcomes (i.e., whether a subject experienced a slip) were assessed based on the displacement of a marker placed on the heel. A logistic regression analysis was used to model the impact of RCOF on slipping. Results showed that subjects who walked with a greater RCOF were found to have a higher probability of slipping. The predicted probability of a slip across the RCOF ranged from 3% to 95% and an increase of 0.01 in RCOF was associated with a slipping odds ratio of 1.7. Thus, modest differences in RCOF can have a dramatic impact on slip propensity. This study shows that RCOF can be a sensitive and valid predictor of slipping in realistic frictional environments.

Efficacy of a rubber outsole with a hybrid surface pattern for preventing slips on icy surfaces.

Conventional winter-safety footwear devices, such as crampons, can be effective in preventing slips on icy surfaces but the protruding studs can lead to other problems such as trips. A new hybrid (rough and smooth) rubber outsole was designed to provide high slip resistance without use of protruding studs or asperities. In the present study, we examined the slip resistance of the hybrid rubber outsole on both dry (-10 °C) and wet (0 °C) icy surfaces, in comparison to three conventional strap-on winter anti-slip devices: 1) metal coils ("Yaktrax Walker"), 2) gritted (sandpaper-like) straps ("Rough Grip"), and 3) crampons ("Altagrips-Lite"). Drag tests were performed to measure static (SCOF) and dynamic (DCOF) coefficients of friction, and gait trials were conducted on both level and sloped ice surfaces (16 participants). The drag-test results showed relatively high SCOF (≧0.37) and DCOF (≧0.31) values for the hybrid rubber sole, at both temperatures. The other three footwear types exhibited lower DCOF values (0.06-0.20) when compared with the hybrid rubber sole at 0 °C (p < 0.01). Slips were more frequent when wearing the metal coils, in comparison to the other footwear types, when descending a slope at -10 °C (6% of trials vs 0%; p < 0.05). There were no other significant footwear-related differences in slip frequency, distance or velocity. These results indicate that the slip-resistance of the hybrid rubber sole on icy surfaces was comparable to conventional anti-slip footwear devices. Given the likely advantages of the hybrid rubber sole (less susceptibility to tripping, better slip resistance on non-icy surfaces), this type of sole should contribute to a decrease in fall accidents; however, further research is needed to confirm its effectiveness under a wider range of test conditions.

A Method for Measuring Fluid Pressures in the Shoe-Floor-Fluid Interface: Application to Shoe Tread Evaluation.

BACKGROUND: Fluid contaminants cause slipping accidents by reducing shoe-floor friction. Fluid pressures in the shoe-floor interface reduce contact between the surfaces and, thus, reduce friction between the surfaces. A technological gap for measuring fluid pressures, however, has impeded improved understanding of what factors influence these pressures. PURPOSE: This study aimed to introduce a technique for measuring fluid pressures under the shoe and to demonstrate the utility of the technique by quantifying the effects of tread depth and fluid viscosity on fluid pressures for two different shoes. METHODS: A fluid pressure sensor embedded in the floor surface was used to measure fluid pressures, while a robotic slip-tester traversed the shoe over the floor surface. Multiple scans were collected to develop 2D fluid pressure maps across the shoe surface. Two shoe tread types (an athletic shoe and a work shoe), two fluids (high-viscosity diluted glycerol and a low-viscosity detergent solution), and three tread depths (full tread, half tread, and no tread) were tested, while fluid pressures were measured. RESULTS: Untreaded shoes combined with a high-viscosity fluid resulted in high fluid pressures, while treaded shoes or low-viscosity fluids resulted in low fluid pressures. The increased fluid pressures that were observed for the untreaded shoes are consistent with tribology theory and evidence from human slipping studies. CONCLUSIONS: The methods described here successfully measured fluid pressures and yielded results consistent with tribological theory and human slipping experiments. This approach offers significant potential in evaluating the slip-resistance of tread designs and determining wear limits for replacing shoes.

Fluid pressures at the shoe-floor-contaminant interface during slips: effects of tread and implications on slip severity.

Previous research on slip and fall accidents has suggested that pressurized fluid between the shoe and floor is responsible for initiating slips yet this effect has not been verified experimentally. This study aimed to (1) measure hydrodynamic pressures during slipping for treaded and untreaded conditions; (2) determine the effects of fluid pressure on slip severity; and (3) quantify how fluid pressures vary with instantaneous resultant slipping speed, position on the shoe surface, and throughout the progression of the slip. Eighteen subjects walked on known dry and unexpected slippery floors, while wearing treaded and untreaded shoes. Fluid pressure sensors, embedded in the floor, recorded hydrodynamic pressures during slipping. The maximum fluid pressures (mean+/-standard deviation) were significantly higher for the untreaded conditions (124+/-75 kPa) than the treaded conditions (1.1+/-0.29 kPa). Maximum fluid pressures were positively correlated with peak slipping speed (r=0.87), suggesting that higher fluid pressures, which are associated with untreaded conditions, resulted in more severe slips. Instantaneous resultant slipping speed and position of sensor relative to the shoe sole and walking direction explained 41% of the fluid pressure variability. Fluid pressures were primarily observed for untreaded conditions. This study confirms that fluid pressures are relevant to slipping events, consistent with fluid dynamics theory (i.e. the Reynolds equation), and can be modified with shoe tread design. The results suggest that the occurrence and severity of unexpected slips can be reduced by designing shoes/floors that reduce underfoot fluid pressures.

A família no cuidado ao idoso após o acidente por quedas / La familia en el cuidado a personas mayores tras accidente por caídas / The family in the care process of an elderly after a fall accident

It aims at knowing elderly family care after fall accidents. Method: qualitative approach and ecologic insertion method, based on Ecologic Theory of Systems. Results: it has been identified that the family plays an important role in the recovery of impaired elderly, once it offers affective support, necessary for the development of this group. The vicissitudes suffered by the elderly - in this case fall accidents - bring the families together, promoting a restructuration of family bounds and of the activities developed by each member of this core. Conclusion: getting to know family care devoted to elderly after fall accidents elucidates tools helping health professionals to orientate their attention beyond these individuals, trying to understand family functioning as an essential component for service planning towards therapeutic success...

Conhecer o cuidado familiar dedicado ao idoso após o acidente por quedas. Método: abordagem qualitativa e o método utilizado foi inserção ecológica, fundamentada na Teoria dos Sistemas Ecológicos. Resultados: identificou-se que a família executa um importante papel para recuperação do idoso fragilizado, sendo que ela oferece suporte afetivo necessário para o desenvolvimento desse grupo. As intercorrências que acometem os idosos - nesse caso o acidente por quedas - fazem com que as famílias se aproximem, promovendo, assim, uma reestruturação do vínculo familiar e das atividades desenvolvidas por cada membro constituinte desse núcleo. Conclusão: conclui-se que conhecer o cuidado familiar dedicado ao idoso após acidente por queda instrumentaliza e auxilia os profissionais de saúde a direcionarem seu olhar para além dos indivíduos, buscando compreender a funcionalidade familiar como um componente essencial do planejamento assistencial para o alcance do sucesso terapêutico...

Conocer el cuidado familiar dedicado al mayor tras el accidente por caídas. Método: enfoque cualitativo y el método de la inserción ecológica fundamentada en la teoría de los sistemas ecológicos. Resultados: se identificó que la familia ejecuta un importante rol para la recuperación del mayor debilitado, por lo que ofrece soporte afectivo necesario para el desarrollo de ese grupo. Las complicaciones que acometen al mayor, enese caso, el accidente por caídas, hacen con que las familias se aproximen, promoviendo una reestructuración del vínculo familiar. Conclusión: se concluye que conocer el cuidado familiar dedicado al mayor, tras accidente por caída instrumentaliza y auxilia a los profesionales de la salud a direccionar su mirada más allá de los individuos, en la búsqueda por entender la funcionalidad familiar como componente esencial del planeamiento asistencial para el alcance del suceso terapéutico...