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Prevention of Slip and Fall Accidents: Risk Factors, Methods and Suggestions for Prevention
Abstract
Slips and falls are major causes of accidents and injuries at work, in public areas and at home. Studies have shown that the more risk factors an individual is exposed to, the higher risk for slips and falls. The aim of this paper is to describe risk factors for slips and falls, methods that can be used in prevention, and ideas on how physiotherapists can work with prevention of slip and fall accidents. A review of the literature has been done, searching for relevant literature published in English between 1985 and 2000, from the Medline catalogue. The result showed many different risk factors for slip and fall accidents: (a) transfer situations; (b) reduced postural control, i.e. disturbed balance together with reduced muscle strength in the lower extremity; (c) reduced mobility in the hips and feet; (d) dizziness and vestibular asymmetries; and (e) medication. The following diseases may increase the risk for slip and fall accidents: stroke, cardiovascular diseases, musculoskeletal disorders, depression, Parkinson's disease, diabetes and dementia. Preventive interventions have been described but more are needed. A standardized fall anamnesis has been described including patients' earlier fall accidents and relevant risk factors present. Walking ability, balance, medicine consumption can be registered. Preventive programmes concerning risk factors for slips and falls, physical activities for daily use, and preventive aids have been developed and can be recommended for use by patients visiting primary health care and occupational health care. Studies have shown that physical training can increase the number of activities in daily life, reduce the use of technical aids, increase balance and walking ability, which all reduce the risk for slip and fall accidents.
Pedestrians slipping and falling is a major safety problem around the world, not least in countries with long winters such as Sweden. About 25000-30000 people need medical care every year for treatment of fall injuries in Sweden. Use of appropriate shoes and anti-slip devices are examples of individual measures that have been suggested to prevent slipping and falling. An intervention study was performed during the period February to April 2008. The study, which focused on healthy adults in northern Sweden, examined the effect of using anti-slip devices on daily walking journeys and prevention of slip and falls. The respondents were divided into three groups: an Intervention Group, a Control Group, with similar distribution of gender and age, and a Comparison Group. Four questionnaires were distributed: (1) background, (2) daily diary of distance walked and occurrence of incidents or accidents reported weekly, (3) detailed incident or fall report and (4) experiences of using anti-slip devices for those who used these devices during the trial period. Half of the respondents stated that they had previous experience of using anti-slip devices. In this study, 52% of the respondents used anti-slip devices. Anti-slip devices improve the walking capability during wintertime. Among those using appropriate anti-slip devices, the average daily walking distance was found to be statistically significantly longer compared to people not using anti-slip devices. This study indicates that an increase in daily walking distance can be made without increasing the risk of slips/falls when using anti-slip devices. The study also indicates that by using appropriate anti-slip devices and having information about when and where to use them, based on their design, people avoid having slips and falls. The respondents experienced in using anti-slip devices in this study will continue to use them and will also recommend others to use anti-slip devises.
The interest for effective preventive strategies for slips and falls is growing. Much remains to be done, however, to prevent slips and falls in the traffic environment. Using an appropriate anti-slip device may reduce the risk of slips and falls on different surfaces outdoors during winter. The aim of this study was to evaluate the best anti-slip devices of different designs in the Swedish market on a larger group of healthy individuals in different ages on five different slippery surfaces as a way to develop a standard method to test anti-slip devices. Three different designs of anti-slip devices: heel device, foot-blade device and whole-foot device were evaluated on ice surfaces uncovered or covered with gravel, sand, salt or snow. The evaluations were done according to subject's perceived walking safety and balance, videorecordings of walking postures and movements, time to take on and off each anti-slip device, advantages/disadvantages with each anti-slip device and a list of priorities for own use according to three criteria: safety, balance and appearance. The heel device was perceived to be the most safe on all five surfaces, followed by the toe device and the whole-foot device. The heel device was also perceived to be the one with the best walking balance on uncovered ice and on snow covered ice. There were some significant differences due to gender and age. Most subjects walked with a normal muscle function in the hip and knee when walking with or without an anti-slip device on all surfaces. The heel device was perceived as the most rapid one to take on and the toe device as the most rapid one to take off. All three devices were perceived as having a good foothold. The heel device was perceived to fit the shoe and to be stable at heel-strike. The toe device was easily portable and stable on uncovered ice. The whole-foot device was comfortable to walk with and safe on snow covered ice. The heel device had the highest priority according to walking safety, walking balance and choice for own use.
Functional reach (FR, maximal safe standing forward reach) is a precise, reliable, clinically accessible, age-sensitive measure of balance that approximates center of pressure excursion and validly estimates physical frailty. We now test its ability to detect improvement in balance over time. Twenty-eight inpatient male veterans (age 40 to 105, mean, 67.3) undergoing physical rehabilitation and 13 nonrehabilitation controls were evaluated at baseline and every 4 weeks using FR (yardstick method), 10-foot walking time (WT), the Duke hierarchical mobility skills protocol (HMS) and a portion of the Functional Independence Measure (FIM). Their sensitivity to change was determined using the responsiveness index (RI). FR as well as the other physical performance instruments tested were found to be sensitive to change (RI for FR = 0.97, WT = 11.26, HMS = 4.63, FIM = 4.93) and therefore, appropriate measures for use in prospective clinical trials.