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Are non-slip socks really 'non-slip'? An analysis of slip resistance

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  • Metro North Hospitals and Health Service

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Non-slip socks have been suggested as a means of preventing accidental falls due to slips. This study compared the relative slip resistance of commercially available non-slip socks with other foot conditions, namely bare feet, compression stockings and conventional socks, in order to determine any traction benefit. Phase one involved slip resistance testing of two commercially available non-slip socks and one compression-stocking sample through an independent blinded materials testing laboratory using a Wet Pendulum Test.Phase two of the study involved in-situ testing among healthy adult subjects (n = 3). Subjects stood unsupported on a variable angle, inclined platform topped with hospital grade vinyl, in a range of foot conditions (bare feet, non-slip socks, conventional socks and compression stockings). Inclination was increased incrementally for each condition until slippage of any magnitude was detected. The platform angle was monitored using a spatial orientation tracking sensor and slippage point was recorded on video. Phase one results generated through Wet Pendulum Test suggested that non-slip socks did not offer better traction than compression stockings. However, in phase two, slippage in compression stockings was detected at the lowest angles across all participants. Amongst the foot conditions tested, barefoot conditions produced the highest slip angles for all participants indicating that this foot condition provided the highest slip resistance. It is evident that bare feet provide better slip resistance than non-slip socks and therefore might represent a safer foot condition. This study did not explore whether traction provided by bare feet was comparable to 'optimal' footwear such as shoes. However, previous studies have associated barefoot mobilisation with increased falls. Therefore, it is suggested that all patients continue to be encouraged to mobilise in appropriate, well-fitting shoes whilst in hospital. Limitations of this study in relation to the testing method, participant group and sample size are discussed.
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BioMed Central
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BMC Geriatrics
Open Access
Research article
Are non-slip socks really 'non-slip'? An analysis of slip resistance
Satyan Chari*†1,2, Terrence Haines†3,4,5, Paul Varghese6 and
Alyssia Economidis7
Address: 1Safety and Quality Unit, Royal Brisbane and Women's Hospital, Queensland Health, Queensland 4029, Australia, 2Faculty of Medicine,
Nursing and Health Sciences, Monash University, Victoria 3800, Australia, 3Clinical Research, Southern Physiotherapy School, Monash University,
Victoria 3168, Australia, 4School of Health and Rehabilitation Sciences, The University of Queensland, Queensland 4072, Australia, 5Allied Health
Research Unit, Kingston Centre, Southern Health, Victoria 3192, Australia, 6Geriatric Medicine, Geriatric and Rehabilitation Unit (GARU), Princess
Alexandra Hospital, Queensland Health, Queensland 4102, Australia and 7Early Assessment and Medical Unit, Internal Medicine Services, The
Prince Charles Hospital, Queensland Health, Queensland 4032, Australia
Email: Satyan Chari* - srcha5@student.monash.edu.au; Terrence Haines - terrence.haines@med.monash.edu.au;
Paul Varghese - paul_varghese@health.qld.gov.au; Alyssia Economidis - alyssia_economidis@health.qld.gov.au
* Corresponding author †Equal contributors
Abstract
Background: Non-slip socks have been suggested as a means of preventing accidental falls due to slips.
This study compared the relative slip resistance of commercially available non-slip socks with other foot
conditions, namely bare feet, compression stockings and conventional socks, in order to determine any
traction benefit.
Methods: Phase one involved slip resistance testing of two commercially available non-slip socks and one
compression-stocking sample through an independent blinded materials testing laboratory using a Wet
Pendulum Test.
Phase two of the study involved in-situ testing among healthy adult subjects (n = 3). Subjects stood
unsupported on a variable angle, inclined platform topped with hospital grade vinyl, in a range of foot
conditions (bare feet, non-slip socks, conventional socks and compression stockings). Inclination was
increased incrementally for each condition until slippage of any magnitude was detected. The platform
angle was monitored using a spatial orientation tracking sensor and slippage point was recorded on video.
Results: Phase one results generated through Wet Pendulum Test suggested that non-slip socks did not
offer better traction than compression stockings. However, in phase two, slippage in compression
stockings was detected at the lowest angles across all participants. Amongst the foot conditions tested,
barefoot conditions produced the highest slip angles for all participants indicating that this foot condition
provided the highest slip resistance.
Conclusion: It is evident that bare feet provide better slip resistance than non-slip socks and therefore
might represent a safer foot condition. This study did not explore whether traction provided by bare feet
was comparable to 'optimal' footwear such as shoes. However, previous studies have associated barefoot
mobilisation with increased falls. Therefore, it is suggested that all patients continue to be encouraged to
mobilise in appropriate, well-fitting shoes whilst in hospital. Limitations of this study in relation to the
testing method, participant group and sample size are discussed.
Published: 25 August 2009
BMC Geriatrics 2009, 9:39 doi:10.1186/1471-2318-9-39
Received: 19 February 2009
Accepted: 25 August 2009
This article is available from: http://www.biomedcentral.com/1471-2318/9/39
© 2009 Chari et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
BMC Geriatrics 2009, 9:39 http://www.biomedcentral.com/1471-2318/9/39
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Background
Falls continue to remain among the highest reported
causes of unintended harm to elderly patients in hospital
[1]. Several multifactorial interventions to prevent falls in
hospitals have been investigated, and some have demon-
strated effectiveness [2-5]. However, few have focussed on
the role of footwear in the prevention of in-hospital falls.
The 2005 Australian Falls Prevention Guidelines (Prevent-
ing Falls and Harm from Falls among Older People) rec-
ommend that patients wear well fitting, closed shoes with
a flat heel while in hospital [6]. However, ensuring com-
pliance with this recommendation is sometimes difficult
due to patient cognitive impairment (confusion, delir-
ium, dementia), lack of access to appropriate footwear,
intentional non-compliance and other factors.
Concurrently, there has been a growing recognition of
hospital morbidity and mortality due to venous-throm-
boembolism (VTE) [7]. The Australian and New Zealand
Working Party on the Management and Prevention of
Venous Thromboembolism suggest consideration of grad-
uated compression stockings as an adjunct to pharmaco-
logical prophylaxis, in the management of patients at risk
of VTE [8].
As patients can tend to mobilise without footwear while
in hospital, there has been concern among clinicians that
patients might be at an increased risk of falling due to the
'slippery' texture of most compression stocking products.
As a result, the use of 'non-slip' socks over compression
stockings has gained popularity as a strategy to improve
under-foot traction. Non-slip socks (also referred to as
anti-skid or treaded socks) are socks with a tread pattern
provided on the sole, or ventral surface, for the purpose of
improving traction. These socks appear to be a logical
solution, however there is limited evidence regarding their
effectiveness in improving traction and more importantly,
their impact on patient safety.
One retrospective study evaluated falls rates for a 102 day
period before and after implementation of a non-slip sock
(treaded sock) intervention in a Special Care Unit at a
nursing home [9]. In total, twenty one falls were recorded
in 102 days prior to intervention and eighteen falls were
recorded in the 102 days after intervention; a modest
change that was not statistically significant. An eight-fold
reduction in falls due to slips on urine was reported by the
authors, who attributed this positive finding to the
treaded sock intervention. However, there was a concur-
rent five-fold increase in falls where patients were 'found
on the floor', which suggests that the intervention had lit-
tle positive effect overall and that modified reporting
might have been a factor as staff were not blinded to the
intervention period.
This study aimed to establish the slip-resistance of non-
slip socks relative to other foot conditions commonly
encountered in hospital, in order to determine any trac-
tion benefit. Additionally, the data generated through this
study would help inform decisions on further clinical
research on non-slip socks as a falls prevention strategy.
Methods
Design
Ethics approval was sought and gained from the Princess
Alexandra Hospital Human Research Ethics Committee. A
two-phase study was designed. In phase one, two com-
mercially available non-slip socks and one brand of com-
pression stockings were tested for slip resistance through
a blinded, independent materials testing laboratory
(Commonwealth Scientific and Industrial Research
Organisation's Manufacturing and Materials Technology
Laboratory in Victoria). The samples were tested using a
Pendulum Friction Test, also referred to as the Wet Pendu-
lum Test [10,11]. The Wet Pendulum Test was selected
instead of the alternative Inclined Ramp Test described in
AS/NZS 4586:2004 [10], as it provides a continuous
(rather than ordinal) measure, and is therefore more sen-
sitive to small differences in slip resistance. Phase two
involved in-situ testing of slip resistance of non-slip socks
and other foot conditions among healthy adults. Phase
two testing was analogous to the Inclined Ramp Test pre-
scribed by the Australian Standard [10]. However, the
method of testing followed in phase two, arguably pro-
vides a better approximation of standard hospital flooring
in a dry state whilst also allowing for a continuous meas-
ure of slip resistance.
Phase One
The Wet Pendulum Test was carried out at the Common-
wealth Scientific and Industrial Research Organisation's
(CSIRO) Materials, Surfaces and Finishes laboratory at
Highett, Victoria. The testers were blinded to brand and
manufacturer details of samples provided (all tags and
identifiers removed), but not to product function. Sam-
ples were labelled A (compression stocking), B and C
(non-slip socks) respectively.
Apparatus and Procedure
The Wet Pendulum Test was completed in accordance
with AS/NZS 4586:2004 [10] using a calibrated Munro-
Stanley Pendulum Friction Tester. The Wet Pendulum Test
is a test designed to simulate the mechanics of a person
slipping on a wet surface. The terminal end of the pendu-
lum arm has a mechanical foot with a spring-loaded rub-
ber slider attached, to simulate the heel of the foot (Figure
1). The floor surface is saturated with deionised water
prior to testing to simulate the presence of a fluid contam-
inant. The test is set up with the apparatus level to the
floor and the length of the pendulum arm adjusted such
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that the rubber slider 'kicks' through when released, con-
tacting the floor surface momentarily. On 'kicking'
through, a loss of momentum occurs due to the friction
generated at the point of contact. The amount of friction
is dependant on the slip resistance characteristics of the
floor and 'heel' surfaces. This loss in momentum causes a
proportionate reduction in the arc described by the pen-
dulum which is measured on an inverse scale affixed to
the tester. The scale provides a British Pendulum Number
(BPN) which is the unit of measurement for this test. A
higher BPN indicates higher slip resistance. A detailed
description of the Pendulum Friction Testing protocol is
available as an appendix to the AS/NZS 4586:2004 [10].
The Wet Pendulum Test is normally used to test different
floor surfaces for slip resistance while the rubber slider is
conditioned before testing to provide a constant slip
resistance. However, for the purpose of this study the con-
ditions were reversed, by keeping the floor surface con-
stant (2.0 mm thickness hospital graded vinyl) and
varying 'foot' conditions by draping the test samples over
the slider. Samples were adhered to the rubber slider using
double-sided adhesive tape to eliminate bunching of the
material on contact. Five different specimens cut from the
ventral surface of the samples were tested three times
each, producing fifteen readings per sample. Testing was
performed at an ambient temperature of 23°C (prescribed
testing temperature range).
Phase Two
Phase two of the study was conducted at the Princess Alex-
andra Hospital's Physiotherapy Gait Laboratory. A con-
venience sample of three brands of non-slip socks were
tested (Figure 2). All of the non-slip sock products tested
are commercially available in Australia and marketed for
use with hospital patients. The non-slip socks brands
tested in phase one (samples B and C) were included in
phase two. An additional non-slip sock product was
included in phase two as the investigators only became
aware of the existence of this product following the com-
pletion of phase one.
Additional foot conditions tested in phase two were con-
ventional socks (worn by the participants on the day of
testing), bare feet and a compression stocking product
currently used by facilities in Queensland Health (also
tested in phase one).
Two male (Participant B and C) and one female partici-
pant (Participant A) were included in phase two of this
study. Written informed consent was secured from partic-
ipants prior to commencement. Participant A was 173 cm
in height, weighed 65 kg and wore Australian size 8
women's footwear. Participant B was 182 cm in height,
weighed 105 kg and wore Australian size 11.5 men's foot-
wear. Participant C was 186 cm in height, weighed 85 kg
and wore Australian size 12 men's footwear. All partici-
pants were aged between 29 and 31 years on the day of
testing.
Apparatus and Procedure
The surface of the ramp was constructed by mounting a
900 mm × 600 mm panel of 2.0 mm thickness hospital
grade vinyl (AS/NZS 2055.1:1985) [12], on to a rigid
wooden board as per manufacturer's instructions. The
ramp was bracketed on one end and the angle of inclina-
tion was adjusted by shifting support blocks forwards or
backwards. The ramp was positioned in between a set of
Phase one testing apparatus: Wet Pendulum TestFigure 1
Phase one testing apparatus: Wet Pendulum Test.
pendulum arm
rubber slider (wit h
specimen sample
att ached)
mechanical
‘foot
scale
Point of contact
(with w nant)ater contami
Non-slip sock samplesFigure 2
Non-slip sock samples.
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mobile parallel bars (Figure 3). An Intersense Interi-
aCube® inertial orientation reference system was used to
accurately measure the inclination of the ramp. The sen-
sor was taped to the surface of the ramp such that the
'pitch' reading provided the angle of inclination. Data was
monitored on a laptop in real time. The testing procedure
was recorded on video to enable verification of manually
collected data prior to transcription to a spreadsheet for
analysis.
Once the angle of inclination was set (with an error toler-
ance of 0.2°), participants were asked to stand on the
ramp and attempt to maintain an erect posture unsup-
ported for a minimum of three seconds. If successful, the
angle of the ramp was increased in one degree increments
and the test was repeated until a slippage point was noted.
Once slippage occurred, testing of that particular foot con-
dition for the participant was complete. This procedure
was repeated for every foot condition with each partici-
pant (non-slip socks, compression stockings, bare feet,
and standard socks). Where multiple sizes of a non-slip
sock product were available, these were also tested. The
ramp surface was wiped down periodically to reduce con-
taminant build-up during testing.
Results
Phase one
The compression stocking sample achieved the highest
mean British Pendulum Number (55) followed by the
two non slip sock samples B (40) and C (26), indicating
that the compression stocking demonstrated the highest
slip resistance in this testing condition (Figure 4). There
was little variation in results from the five different areas
of sole tested.
Phase two
Results of phase two testing demonstrated a relatively
consistent slippage pattern across all three participants
(Figure 5). However, in contrast to the Wet Pendulum Test
in phase one, all participants slipped at the lowest angles
while wearing compression stockings (12°,11° and11°
respectively). Performance in conventional socks was rel-
atively better, with slippage at 18°, 17° and 16° respec-
tively. Performance in non-slip socks was variable, with
slippage occurring in some products at angles comparable
to conventional socks. Other non-slip socks performed
better with traction maintained up to 30° in the case of
one participant for a specific size of a non-slip sock brand.
Different sizes within the same product also varied in per-
formance (slippage at 19° for the 'small' sized sock and
30° for the 'medium' sized sock of the same brand in one
participant). Barefoot conditions consistently resulted in
the highest levels of traction across all participants with
slippage at 38°, 27° and 30° respectively.
Discussion
Previous studies have associated mobilisation in foot con-
ditions other than shoes (such as slippers, sandals, socks,
bare-feet and other 'non-ideal' foot conditions) with an
increased risk of falling [13-15]. The poorer relative per-
formance of non-slip socks compared to barefoot condi-
Phase one testing apparatus: Inclined Ramp TestFigure 3
Phase one testing apparatus: Inclined Ramp Test.






Phase one wet pendulum test resultsFigure 4
Phase one wet pendulum test results.
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
Specimen 1 Specimen 2 Specimen 3 Specimen 4 Specimen 5
Bri tish P endulum Number (BPN)
Sample A – Com pression Stocking
Sam
p
le B
Traction Socks
Sam
p
le C
Gri
p
sox
Phase two test results: slippage pointsFigure 5
Phase two test results: slippage points.
11
18 17 17
21 22
19
30
38
12
17 18
21
17
19 18
25
27
11
15
18 19 18 19 18
26
30
0
10
20
30
40
50
Compression
Stockings
Conventional
Socks
Traction
Socks®
Green
Traction
Socks® Blue
Jobst Socks®
S-M
Jobst Socks®
M-L
Gripsox®
Small
Gripsox®
Medium
Barefoot
Angle in Degrees
Participant A
Participant B
Participant C
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tions (a 'non-ideal' foot condition) in our study suggest
that non-slip socks do not represent an adequate alterna-
tive to well-fitting rubber soled footwear or even to mobi-
lisation in bare feet.
Additionally, ensuring that non-slip socks are being worn
appropriately (with tread pattern aligned with the sole of
the foot) would most likely require periodic checks by
clinical staff, especially if provided to patients with cogni-
tive impairment. Aside from the resource implications,
poorly fitted socks or socks that are mis-aligned could
constitute a trip or slip hazard for patients. It is suggested
that these risks might outweigh the clinical benefits of
marginally improved underfoot traction over compres-
sion stockings.
All non-slip sock products tested in this study had a tread
pattern on the ventral surface (sole) of the sock (Figure 2).
This tread pattern is three-dimensional in nature resulting
in a series of peaks (1–2 mm high) and troughs. In phase
one, specimens cut from the three samples were adhered
to the rubber slider using double sided tape. As the Wet
Pendulum Test generates limited downward force during
the 'kick' phase of the test, force at the point of contact is
predominantly along the horizontal plane. As a result, the
rubber slider does not press down on the troughs. Conse-
quently, only the raised portion of the sock specimen
would make contact with the floor, reducing what could
be termed as the 'effective contact area' and therefore
reducing slip resistance. This phenomenon is avoided in
the compression stocking sample due to the absence of a
tread pattern resulting in a level surface. In this case, the
effective contact area would be equal to the size of the
specimen adhered to the rubber slider.
When tested in-situ during phase two, the combined effect
of participant weight and pliant characteristics of soft tis-
sue of the foot are likely to force contact between the
troughs of the non-slip sock and the floor thereby ensur-
ing contact is made between the whole foot and floor
across all testing conditions. This difference is proposed a
plausible explanation for the apparent lack of congruence
between phase one and phase two results.
Nagata, Watanabe, Inoue and Kim (2008) studied the
validity of five different friction testing methods as an
index of the risk of slipping with seventy subjects and con-
cluded that of the five methods tested, the ramp test was
the most reliable, and the pendulum tester the least relia-
ble [16]. These results appear to validate the incongruence
between results of two phases of our study.
There is also a possibility that the relative performance of
non-slip socks and compression stocking is altered in the
presence of a fluid contaminant. This hypothesis would
require further investigation and if verifiable, has poten-
tial clinical implications when using non-slip socks with
older persons having issues with bladder continence.
Given previous findings that slips associated with stand-
ing in urine were reduced amongst nursing home resi-
dents wearing non-slip socks, one would have expected
these socks to display greater slip resistance in the Wet
Pendulum Test condition. However, this was not the case.
Limitations
This study tested a convenience sample of non-slip socks,
however it is recognised that there may be alternative
products which perform differently.
This study tested non-slip sock performance on hospital
grade vinyl which is the preferred floor covering as per AS
2055.1 [12]. However, it is possible that relative results
might vary over other surfaces such as tile, polished con-
crete or carpet. Foot anatomy, biomechanics and skin
characteristics of the relatively young and healthy partici-
pants in this study are also likely to be different to hospital
patients who are older and frail. Some variation in per-
formance across foot conditions could be expected with a
sample of older hospital patients.
The testing protocol employed in phase two, although not
standardised or previously validated, is very similar in
method to the ramp test recommended in the Australian
Standard [10]. However, the testing protocol still provides
a reliable method to compare performance of various foot
conditions within the same participant.
It needs to be acknowledged that the phase two ramp test
collected slippage data with participants in a static stand-
ing position. It is conceivable that slippage characteristics,
and therefore performance, of these foot conditions might
vary during dynamic walking on a level surface.
The small number of participants can be considered a lim-
itation of this study. However, we would like to highlight
that the unit of analysis is not the individual participant
but rather the results of the test in each foot condition,
which is a product of the unique characteristics of the con-
tact material (compression stocking, non-slip sock, con-
ventional sock or skin), the fit of the particular sock (or
compression stocking sample) to the participant's feet,
and the weight of the participant. Additionally, we tested
subjects with both large and small feet, as well as signifi-
cant difference in weight, and found the results to follow
a consistent pattern across all participants.
Conclusion
Non-slip socks demonstrated poorer slip resistance than
bare feet. It is therefore suggested that patients would be
more likely to slip whilst mobilising in non-slip socks
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BMC Geriatrics 2009, 9:39 http://www.biomedcentral.com/1471-2318/9/39
Page 6 of 6
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compared to bare feet. Non-slip socks offer marginal ben-
efit in slip-resistance over compression stockings in dry
conditions, however slip resistance of such products in the
presence of fluid contaminants needs to be explored fur-
ther. This study did not explore whether traction provided
by bare feet was comparable to 'optimal' footwear such as
shoes. However, previous studies have associated barefoot
mobilisation with increased falls. It is therefore suggested
that all patients continue to be encouraged to mobilise in
appropriate, well-fitting shoes whilst in hospital.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
SC, TH, PV contributed to the development, conceptuali-
zation and design of the study. TH, SC and AE were
responsible data collection and the conduct of Phase 2
testing. SC was responsible for data transcription, analy-
sis, and preparation of the manuscript. TH supervised the
data collection and provided assistance with data analyses
and editing the final manuscript. All authors contributed
to interpretation of results and read and approved the
final draft of the manuscript.
Acknowledgements
The authors would like to thank the Queensland Falls Injury Prevention
Collaborative for approving this study and the Queensland Health Patient
Safety Centre for funding phase 1 testing through an external research lab-
oratory. The authors would also like to thank the Princess Alexandra Hos-
pital Geriatric Assessment and Rehabilitation Unit (GARU) for allowing the
use of the physiotherapy gait laboratory facilities. The authors acknowledge
the invaluable support received from Princess Alexandra Hospital physio-
therapy research and clinical staff towards setting up the testing environ-
ment.
SC would like to specifically thank the Royal Brisbane and Women's Hos-
pital Safety and Quality Unit for the support, resources and off-line time
which enabled completion of this study.
None of the investigators received any financial support related to the
research in this paper. The research was investigator initiated and not spon-
sored by any company.
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... Deux autres études expérimentales viennent étayer les conclusions de cette revue, en analysant le degré de résistance au glissement des chaussettes antidérapantes en position statique puis lors de la marche (33,34). Cependant, l'étude de Chari et al., en 2009, analyse une population différente de la population gériatrique ciblée par la problématique de notre travail. ...
... En effet, les participants sont âgés de 29 à 31 ans et sont en bonne santé. De plus, l'échantillon composé de trois personnes est trop faible pour extrapoler les résultats et apporter de réelles affirmations (34). La seconde étude, menée par Hatton et al., en 2013, montre une amélioration significative des critères de marche (temps de réalisation, nombre de pas, degré de résistance perçu) lors de la réalisation du Timed Up and Go avec les chaussettes antidérapantes comparée aux essais en chaussettes standards. ...
... Trois articles concluent que les chaussettes antidérapantes influencent positivement la marche (augmentation de la vitesse, diminution du nombre de pas, réduction du temps de décélération), si on les compare avec des chaussons ou des chaussettes classiques fréquemment retrouvés en milieu gériatrique (30,31). Il est à noter que ces trois études n'ont montré aucune différence significative entre ces dispositifs antidérapants et la condition pieds nus (33,34,46). z Biais et limites Les sept études incluses dans cet article sont menées en secteur hospitalier et appartiennent de ce fait à la recherche clinique. ...
Article
Introduction : les chutes chez les personnes âgées fragiles hospitalisées sont un phénomène majeur et préoccupant au quotidien. Contexte : les chaussages inadéquats, fréquemment observés au sein de cette population, constituent l’un des principaux facteurs de risques. Plusieurs hôpitaux utilisent des chaussettes antidérapantes comme moyen préventif. Dans le contexte de la médecine basée sur les preuves, il semble nécessaire de vérifier l’existence de données probantes concernant leur efficacité. Objectif : cet article vise à statuer sur l’efficacité préventive des chaussettes antidérapantes. Méthode : cinq bases de données ont été investiguées (PubMed, PEDro, Cochrane, ScienceDirect et Google Scholar). Les critères d’éligibilité (PICO) incluent les patients âgés hospitalisés. Résultats : sept études ont été incluses. Les chaussettes antidérapantes montrent un effet préventif pour diminuer les récidives de chutes (p = 0.009) ou la prévalence des chutes en lien avec l’incontinence urinaire. Discussion : plusieurs études concluent sur la plus-value des chaussettes antidérapantes comparativement aux chaussettes classiques ou aux pantoufles. Les limites inhérentes aux études sélectionnées sont considérées dans l’élaboration des conclusions. Conclusion : un chaussage considéré comme sécuritaire par les thérapeutes et sécurisant par le patient constitue l’option la plus recommandée actuellement. Des études cliniques complémentaires sont nécessaires pour étayer notre conclusion.
... Non-slip socks are sometimes provided to hospitalized patients, in an attempt to reduce falls [3][4][5]. Non-slip socks are also known as 'traction socks' and 'grip socks' and have a rubber or synthetic tread that provides friction with the aim of increasing stability [6,7]. They are footwear options that are sometimes provided alongside other fall prevention strategies such as patient education [8,9], clinician education [10,11], bed alarms [12], assistive devices, exercise and rehabilitation [13,14], medication reviews, fall policies and systems and environmental adaptations [1,15]. ...
... Some have claimed benefits [19,20]. Others reported that walking barefooted offers similar slip resistance [7], even though walking without footwear might not be advisable in a hospital setting. A concerning issue is the risk of spreading infection when walking around the hospital in socks [21]. ...
... Nine studies used non-slip socks as an intervention in hospitals [3,[35][36][37][38][39][40][41][42]. Three assessed the safety and efficacy of traction socks in a laboratory setting [7,19,20]. Two investigated bacterial transfer between the floor, socks or bed linen [21,43]. There were no randomized controlled trials identified in the search. ...
Article
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Background Non-slip socks are sometimes used in an attempt to prevent falls in hospitals despite limited evidence of benefit. We critique the current literature on their risks, benefits and effects. Methods A rapid review was conducted following the Cochrane Rapid Review Methods Group Guidelines. To be included, studies needed to have data on single or multifactorial interventions that used non-slip socks in hospitals or their safety, risks or effects in a laboratory setting. Six electronic databases were searched: Medline, Embase, Cinahl, Cochrane, AMED and Proquest Central. Results Fourteen articles met the inclusion criteria. Nine used non-slip socks as an intervention in hospitals. Three assessed their effects in laboratory settings. Two reported risks in relation to bacterial transfer. Most studies that used non-slip socks to prevent hospital falls had negative or equivocal results and were of comparatively low method quality, with a high risk of bias. Two of the laboratory tests reported traction socks to be no safer than walking barefoot and to have similar slip resistance. The laboratory studies had a low risk of bias and showed that bacteria can sometimes be acquired from socks. Conclusion Non-slip socks carry an infection control risk that requires careful management. There was no strong or conclusive evidence that they prevent hospital falls.
... The use of non-slip socks for the prevention of falls in healthcare facilities has become protocol, despite the lack of evidence to support the use of this footwear. A literature review revealed four studies that investigated the correlation between footwear and risk of falls [1,6,11,12]. Only two of those studies looked specifically at the use of non-slip socks to prevent falls [11,12]. ...
... A literature review revealed four studies that investigated the correlation between footwear and risk of falls [1,6,11,12]. Only two of those studies looked specifically at the use of non-slip socks to prevent falls [11,12]. Chari concluded that an individual has more slip-resistance while being barefoot on an inclined ramp compared to while wearing non-slip socks. ...
... Chari concluded that an individual has more slip-resistance while being barefoot on an inclined ramp compared to while wearing non-slip socks. This was determined by a sensor that detected the angle at which slippage occurs [11]. In contrast, Hubscher found that wearing non-slip socks was comparable to being barefoot and was better than conventional socks when looking at heel deceleration time using a 1-directional accelerometer to detect slip distance [12]. ...
Article
Full-text available
Background and Purpose: Non-slip socks are frequently used in health care settings in an attempt to reduce falls. Increased velocity of postural sway has been shown to relate to increased risk of falling. The influence of footwear on velocity of postural sway has yet to be determined. The purpose of this study was to compare the velocity of postural sway of community-dwelling older adults during a simulated fall while barefoot, wearing athletic type shoes, or wearing non-slip socks. Methods: Postural sway was measured during a simulated fall on 27 ambulatory adults with an average age of 58.07 years using computerized posturography. Subjects underwent three simulated falls in each footwear condition (barefoot, shoes, non-slip socks). Thirteen of the 27 subjects completed a post-study survey to subjectively rank the stability of each footwear condition. Hierarchical linear modeling statistics determined the difference in velocity of sway wearing different types of randomly applied footwear with P≤.05. Results and Discussion: In static standing, the mean velocity of postural sway for barefoot and non-slip socks was 0.26 m/s, athletic shoes was 0.31 m/s; barefoot and non-slip socks demonstrated lower velocity of sway at p-value of P<0.05 when compared to athletic shoes. In dynamic standing during the simulated fall, the mean velocity of postural sway for barefoot was 2.57m/s, athletic shoes was 2.66m/s and non-slip socks was 2.38m/s. Non-slip socks demonstrated lowest velocity of sway at p-value of P<0.001 when compared to athletic shoes. Post-study survey analysis revealed a p-value of 1.000. The p-value of 1.000 for the post study surveys concludes that the subjective rank of the most stable footwear condition did not match objective data. This indicates subjects could were unable to subjectively determine which footwear most reduced postural sway. Conclusions: Non-slip socks may be effective at reducing the velocity of postural sway in community-dwelling older adults and may be effective at reducing fall risk. Key Words: Fall prevention, Footwear, Postural Sway
... A literature review revealed four studies that investigated the correlation between footwear and risk of falls. 1,5,10,11 Only two of those studies looked specifically at the use of non-slip socks to prevent falls. 10,11 Chari concluded that an individual has more slip-resistance while being barefoot on an inclined ramp compared to while wearing non-slip socks. ...
... 1,5,10,11 Only two of those studies looked specifically at the use of non-slip socks to prevent falls. 10,11 Chari concluded that an individual has more slip-resistance while being barefoot on an inclined ramp compared to while wearing non-slip socks. This was determined by a sensor that detected the angle at which slippage occurs. ...
... This was determined by a sensor that detected the angle at which slippage occurs. 10 In contrast, Hubscher found that wearing non-slip socks was comparable to being barefoot and was better than conventional socks when looking at heel deceleration time using a 1-directional accelerometer to detect slip distance. 11 A double-blind study by Fernie looked at the relationship between postural sway and incidence of falls in an institutionalized geriatric population. ...
Article
Full-text available
Aims: This pilot study provides a methodology to measure differences in velocity of postural sway of older adults while barefoot, with non-slip socks, and in athletic shoes during a simulated fall. Methods: Postural sway was measured during a simulated fall on 14 ambulatory adults over 50 years of age using computerized posturography. Hierarchical linear modeling statistics determined the difference in velocity of sway wearing different types of randomly applied footwear with p ≤ .05. Results: Velocity of sway while wearing socks was significantly lower compared to barefoot (p = 0.0132). Velocity of sway while being barefoot compared to wearing shoes did not significantly differ (p = 0.1460). Velocity of sway while wearing socks is significantly lower compared to wearing shoes (p = 0.0001). Conclusions: This pilot study indicates postural sway is lowest during a simulated fall while wearing non-slip socks.
... The data was extracted and synthesized into a summery table (Table 1). Two themes emerged: (1) the non-slip properties of non-slip socks, 14,15,17 and (2) use of non-slip socks as an intervention for falls prevention. 8,16,18 ...
... Three studies examined the non-slip properties of non-slip socks. 14,15,17 One quazi-experimental study tested the slip resistance of non-slip socks and concluded that compression stockings offered better slip resistance than non-slip socks. 14 They also concluded that bare feet provided better slip resistance than non-slip socks and compression stockings. ...
... 14,15,17 One quazi-experimental study tested the slip resistance of non-slip socks and concluded that compression stockings offered better slip resistance than non-slip socks. 14 They also concluded that bare feet provided better slip resistance than non-slip socks and compression stockings. 14 Another study concluded that bare feet provided better slip resistance than non-slip socks, followed by standard socks, as well as determined that the walking patterns were similar for those participants wearing non-slip socks and bare feet. ...
Article
Falls among hospitalized older adults are a growing concern. Hospitals are using non-slip socks as an alternative footwear to help prevent falls, however there is limited evidence to support their use. The aim of this article is to review the literature on the effectiveness of non-slip socks to determine if there is sufficient evidence to support their use in the prevention of falls among hospitalized older adults. A comprehensive literature search was conducted using Medline, CINAHL, Scopus, PubMed and the Cochrane Library. Six studies were included in this review. The results suggested that there is inconclusive evident to support the use of non-slip socks to prevent falls among hospitalized older adults. Non-slip socks do not possess the properties of adequate footwear and have the potential to spread infection. The patient's personal footwear from home is the safest footwear option while admitted into hospital.
... The footwear that should be characterized by a low slip risk, yet ensure the ability of forced slip are gymnastic shoes used in ballet dancing. Such footwear is classified in the P4 category, and the average SRV equals to 39 ± 4. Similar requirements are imposed on anti-slip socks used during amateur acrobatics in jump arenas, the SRV of which ranges from 27 to 55, depending on the sock type [92]. Footwear with felt soles (b) is the least safe, with its average SRV of 28 ± 3, putting the product in the P2 category. ...
Article
Full-text available
The aim of the research was to show that changes occur in floor surface parameters resulting from increased use in public utility buildings. The study included corridors and staircases that differ in terms of covering material in a public utility building in Poznań. Measurements were carried out with the use of the British Pendulum Test Value (PTV) in three stages. The first stage included a research methodology recreating the movement of people wearing footwear with rubber soles and people using assistive devices with rubber endings. It indicated that surface wear is the greatest at staircase edges and lift entrances, and the possibility of slipping is increased from ca. 17% do 41%, depending on surface type. The second stage consisted of research taking into account the interaction of various surfaces used for floors in homes, shops, and industrial premises, with a rubber sample representing the ending of assistive devices. It demonstrated that the least dangerous surface material among the tested ones in terms of slip risk is roofing with an SVR of 73 ± 8, and the most dangerous are laminated surfaces of wood-based materials with an SVR of 29 ± 12. The last stage consisted of recreating the movement of people in various footwear on the selected research surface. It demonstrated that a bare foot (corresponding to a measurement with a rubber solitaire 55 or footwear with a rubber sole - Slip Resistance Value (SVR) of 55 ± 5) is characterized by the lowest possibility of slipping, while footwear with a felt sole (SVR of 29 ± 3) used, e.g., when visiting historic palaces and castles is characterized by the highest slip risk. The conducted tests made it possible to identify locations in the public utility building with an increased risk of slipping. The total number of surfaces examined during the three stages was sixteen. The test results were then referenced to the criteria for assessing surface slip resistance specified in applicable standards. The conducted research may support the processes of designing assistive devices (e.g., orthopaedic crutches, walking sticks, tripods, etc.) for persons with disabilities moving in buildings, and may also constitute a criterion for the scope of safety and a determinant of planned renovation works.
Chapter
This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
Chapter
This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
Article
Full-text available
A 3D printer in FDM technology allows printing with two nozzles, which creates an opportunity to produce multi-material elements. Printing from two materials requires special consideration of the interface zone generated between their geometrical boundaries. This article aims to present the possibility of printing with PLA and TPU using commercially available filaments and software to obtain the best possible bond strength between two different polymers with respect to printing parameters, surface pattern (due to the material contact surface’s roughness), and the order of layer application. The interaction at the interface of two surfaces of two different filaments (PLA-TPU and TPU-PLA) and six combinations of patterns were tested by printing seven replicas for each. A total of 12 combinations were obtained. By analyzing pairs of samples (the same patterns, different order of materials), the results for the TPU/PLA samples were better or very close to the results for PLA/TPU. The best variants of pattern combinations were distinguished. Well-chosen printing parameters can prevent a drop in parts efficiency compared to component materials (depending on the materials combination).
Article
Falls in hospitalized patients are a pressing patient safety concern, but there is a limited body of evidence demonstrating the effectiveness of commonly used fall prevention interventions in hospitals. This article reviews common study designs and the evidence for various hospital fall prevention interventions. There is a need for more rigorous research on fall prevention in the hospital setting.
Article
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a range of footwear features have been shown to influence balance in older people, however, little is known about the relationships between inappropriate footwear, falls and hip fracture. to describe the characteristics of footwear worn at the time of fall-related hip fracture and establish whether the features of the shoe influenced the type of fall associated with the fracture. 95 older people (average age 78.3 years, SD 7.9) who had suffered a fall-related hip fracture were asked to identify the footwear they were wearing when they fell. Footwear characteristics were then evaluated using a standardised assessment form. Information was also collected on the type and location of fall. the most common type of footwear worn at the time of the fall was slippers (22%), followed by walking shoes (17%) and sandals (8%). Few subjects were wearing high heels when they fell (2%). The majority of subjects (75%) wore shoes with at least one theoretically sub-optimal feature, such as absent fixation (63%), excessively flexible heel counters (43%) and excessively flexible soles (43%). Subjects who tripped were more likely to be wearing shoes with no fixation compared to those who reported other types of falls [chi(2)=4.21, df=1, P=0.033; OR=2.93 (95%CI 1.03-8.38)]. many older people who have had a fall-related hip fracture were wearing potentially hazardous footwear when they fell. The wearing of slippers or shoes without fixation may be associated with increased risk of tripping. Prospective studies into this proposed association appear warranted.
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To assess the effectiveness of a targeted, multiple intervention falls prevention programme in reducing falls and injuries related to falls in a subacute hospital. Randomised controlled trial of a targeted multiple intervention programme implemented in addition to usual care compared with usual care alone. Three subacute wards in a metropolitan hospital specialising in rehabilitation and care of elderly patients. 626 men and women aged 38 to 99 years (average 80 years) were recruited from consecutive admissions to subacute hospital wards. Falls risk alert card with information brochure, exercise programme, education programme, and hip protectors. Incidence rate of falls, injuries related to falls, and proportion of participants who experienced one or more falls during their stay in hospital. Participants in the intervention group (n = 310) experienced 30% fewer falls than participants in the control group (n = 316). This difference was significant (Peto log rank test P = 0.045) and was most obvious after 45 days of observation. In the intervention group there was a trend for a reduction in the proportion of participants who experienced falls (relative risk 0.78, 95% confidence interval 0.56 to 1.06) and 28% fewer falls resulted in injury (log rank test P = 0.20). A targeted multiple intervention falls prevention programme reduces the incidence of falls in the subacute hospital setting.
Article
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falls and related injuries are known to be a significant problem for older people. There is evidence that identifying and addressing individual risk factors can reduce the incidence of falls in the community but no evidence of the effectiveness of targeted risk factor reduction methods applied to hospital in-patients. to test the efficacy of a targeted risk factor reduction core care plan in reducing risk of falling while in hospital. a group (ward) randomised trial. elderly care wards and associated community units of a district general hospital in the North of England. all elderly patients who received care in eight wards and community units during a 12-month study period. matched pairs of wards were randomly allocated to intervention or control groups. In the intervention wards, staff used a pre-printed care plan for patients identified as at risk of falling and introduced appropriate remedial measures. Numbers of falls in each group were then compared. after introduction of the care plan there was a significant reduction in the relative risk of recorded falls on intervention wards (relative risk 0.79, 95% CI 0.65-0.95) but not on control wards (RR 1.12, 95% CI 0.96-1.31). The difference in change between the intervention wards and control wards was highly significant (RR 0.71, 95% CI 0.55-0.90, P = 0.006). There was no significant reduction in the incidence of falls-related injuries. the use of a core care plan targeting risk factor reduction in older hospital in-patients was associated with a reduction in the relative risk of recorded falls.
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Falls are one of the most frequent episodes on the hospital wards. Objective: To identify orthopaedic injuries sustained by in-patients falling on the hospital wards and to find out what treatment these required along with the additional time and cost that this incurred. A retrospective analysis of 900 incident forms and case records was undertaken for a 3-year period. Fractures and other soft-tissue injuries sustained and time, place, and mode of injury were noted. Type of fractures sustained and specific treatment required including operative procedure needed were studied. The cost of each treatment and the total cost in terms of time and money were calculated. We identified 42 patients with orthopaedic injuries; 53% of the falls were recorded on medical wards. A poor pre-fall mobility was an important factor in over 80% of the cases, and a variety of medical conditions pre-existed in the elderly ill patients. Eighteen patients (42%) sustained hip fractures, of whom 15 patients (36%) required surgical treatment. There were 9 deaths in total, 5 of them occurred in patients with hip fractures. The cost of treating the injuries amounted to about GBP 70,000. An additional hospital stay of 56 weeks in total was needed, most patients requiring between 1 and 5 weeks of additional stay. Falls in elderly in-patients can result in a variety of skeletal injuries. These may require major operative procedures and result in significant morbidity and can prove fatal. The treatment of these injuries is a substantial added expenditure to the trust.
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This study evaluates whether a postoperative multidisciplinary, intervention program, including systematic assessment and treatment of fall risk factors, active prevention, detection, and treatment of postoperative complications, could reduce inpatient falls and fall-related injuries after a femoral neck fracture. A randomized, controlled trial at the orthopedic and geriatric departments at Umeå University Hospital, Sweden, included 199 patients with femoral neck fracture, aged >or=70 years. Twelve patients fell 18 times in the intervention group compared with 26 patients suffering 60 falls in the control group. Only one patient with dementia fell in the intervention group compared with 11 in the control group. The crude postoperative fall incidence rate was 6.29/1,000 days in the intervention group vs 16.28/1,000 days in the control group. The incidence rate ratio was 0.38 [95% confidence interval (CI): 0.20 - 0.76, p=0.006] for the total sample and 0.07 (95% CI: 0.01-0.57, p=0.013) among patients with dementia. There were no new fractures in the intervention group but four in the control group. A team applying comprehensive geriatric assessment and rehabilitation, including prevention, detection, and treatment of fall risk factors, can successfully prevent inpatient falls and injuries, even in patients with dementia.
Article
To determine how the risk of a fall in an older adult varies in relation to style of footwear worn. Nested case-control study. Group Health Cooperative, a large health maintenance organization in Washington state. A total of 1,371 adults aged 65 and older were monitored for falls over a 2-year period; 327 qualifying fall cases were compared with 327 controls matched on age and sex. Standardized in-person examinations before fall occurrence, interviews about fall risk factors after the fall occurred, and direct examination of footwear were conducted. Questions for controls referred to the last time they engaged in an activity broadly similar to what the case was doing at the time of the fall. Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2, 95% confidence interval (CI)=2.4-51.8). Relative to athletic/canvas shoes, other footwear was associated with a 1.3-fold increase in the risk of a fall (95% CI=0.9-1.9), varying somewhat by style. Contrary to findings from gait-laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes.
Article
To determine whether the rate of falls and associated serious injuries in a hospital aged care setting can be reduced using a multistrategy prevention approach. DESIGN, setting and participants: Three-year quality improvement project comparing data at baseline (2001) and at 2-year follow-up (2003) after interventions to reduce falls. All patients admitted to the Aged Care Services wards at Caulfield General Medical Centre, Melbourne, between January 2001 and December 2003 were included. Multistrategy approach phased in over 3 months from September 2001 and involving data gathering, risk screening with appropriate interventions, work practice changes, environmental and equipment changes, and staff education. Total number of falls; number of falls resulting in serious injuries (fractures, head injuries, death); staff compliance with the risk assessment. Over a 2-year period, there was a 19% reduction in the number of falls per 1000 occupied bed-days (OBDs) (12.5 v 10.1; P = 0.001) and a 77% reduction in the number of falls resulting in serious injuries per 1000 OBDs (0.73 v 0.17; P < 0.001). Staff compliance with completing the falls risk assessment tool increased from 42% to 70%, and 60% of staff indicated they had changed their work practices to prevent falls. A multistrategy falls prevention program in an aged care hospital setting produced a significant reduction in the number of falls and a marked reduction in serious fall-related injuries. Incorporating a falls prevention program into all levels of an organisation, as part of daily care, is crucial to the success and sustainability of falls prevention.
Article
Footwear characteristics have been shown to influence balance in older people; however, the relationship between footwear and falls is unclear. To determine the relationships between footwear characteristics and the risk of indoor and outdoor falls in older people. Footwear characteristics (shoe type, heel height, heel counter height, heel width, critical tipping angle, method of fixation, heel counter stiffness, sole rigidity and flexion point, tread pattern and sole hardness) were assessed in 176 people (56 men and 120 women) aged 62-96 (mean age 80.1, SD 6.4) residing in a retirement village. Falls were recorded over a 12-month follow-up period and comparisons made between fallers and non-fallers. 50 participants (29%) fell indoors and 36 (21%) fell outdoors. After controlling for age, gender, demographic characteristics, medication use, physiological falls risk factors and foot problems, those who fell indoors were more likely to go barefoot or wear socks inside the home (OR = 13.74; 95% CI 3.88-48.61, p < 0.01). However, there were no significant differences in indoor or outdoor footwear characteristics between fallers and non-fallers. Five indoor fallers (10%) and three outdoor fallers (8%) stated that their shoes contributed to their fall. Footwear characteristics were not significantly associated with falls either inside or outside the home. Risk of falling indoors was associated with going barefoot or wearing socks. Older people at risk of falling should therefore be advised to wear shoes indoors where possible.