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A comparison of floor surfaces for injury prevention in care settings: impact forces and horizontal pulling force required to move wheeled equipment

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Summary: Shock-absorbing flooring is one potential solution to prevent fall-related injuries. No standards exist to characterize shock-absorbing healthcare flooring. This study explores two mechanical tests for impact force reduction and horizontal force required to move wheeled objects. An appropriately designed rubber underlay can reduce peak impact by 25% compared with 1% with standard vinyl.

Introduction: Severe falls often occur in hospitals and care homes. Shock-absorbing flooring is one potential solution to prevent fall-related injuries; however, no standards exist for characterizing flooring as an injury prevention measure. Shock-absorbing flooring use in high-risk settings may influence both patients (injury-saving potential) and staff (manoeuvring equipment). We aimed to explore two tests to characterize floors, to determine shock absorbency and horizontal pulling force required to move wheeled objects.

Methods: Mechanical testing was performed according to the Canadian Standards Association Z325 Hip Protectors document. This test was developed for hip protectors but is applicable to compliant surfaces that form part of the floor. Tests were performed on commercially available floor materials (suitable for care settings) to assess the force required to initiate movement of a wheeled object across the floor. We explored the relationships between horizontal force required to pull wheeled objects, impact force, floor thickness, and core material.

Results: Considerable differences were identified between floor samples in their ability to reduce the peak impact force (range 0.7–25%). A peak force reduction of up to 25% can be achieved with a specially designed rubber underlay. Horizontal pulling force increased with floor thickness but was lower for rubber floors. There was no direct relationship between impact attenuation and horizontal pulling force. Whilst thickness and core material explain some variations (66.5% for wheel movement; 82.3% for impact), other unmeasured factors clearly influence floor performance.

Conclusions: These results can inform the development of flooring and the establishment of standards needed to underpin practice, research, and development in this field.
Original languageEnglish
JournalOsteoporosis International
Early online date9 Jul 2020
Publication statusEarly online - 9 Jul 2020


  • A comparison of floor surfaces

    Rights statement: This is a post-peer-review, pre-copyedit version of an article published in Osteoporosis International. The final authenticated version is available online at:

    Accepted author manuscript (Post-print), 995 KB, PDF document

    Due to publisher’s copyright restrictions, this document is not freely available to download from this website until: 9/07/21

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