Grab Rails Research Articles

Negligible risk of surface transmission of SARS-CoV-2 in public transportation.

Exposure to pathogens in public transport systems is a common means of spreading infection, mainly by inhaling aerosol or droplets from infected individuals. Such particles also contaminate surfaces, creating a potential surface-transmission pathway. A fast acoustic biosensor with an antifouling nano-coating was introduced to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on exposed surfaces in the Prague Public Transport System. Samples were measured directly without pre-treatment. Results with the sensor gave excellent agreement with parallel quantitative reverse-transcription polymerase chain reaction (qRT-PCR) measurements on 482 surface samples taken from actively used trams, buses, metro trains and platforms between 7 and 9 April 2021, in the middle of the lineage Alpha SARS-CoV-2 epidemic wave when 1 in 240 people were COVID-19 positive in Prague. Only ten of the 482 surface swabs produced positive results and none of them contained virus particles capable of replication, indicating that positive samples contained inactive virus particles and/or fragments. Measurements of the rate of decay of SARS-CoV-2 on frequently touched surface materials showed that the virus did not remain viable longer than 1-4h. The rate of inactivation was the fastest on rubber handrails in metro escalators and the slowest on hard-plastic seats, window glasses and stainless-steel grab rails. As a result of this study, Prague Public Transport Systems revised their cleaning protocols and the lengths of parking times during the pandemic. Our findings suggest that surface transmission played no or negligible role in spreading SARS-CoV-2 in Prague. The results also demonstrate the potential of the new biosensor to serve as a complementary screening tool in epidemic monitoring and prognosis.

Accessible design features and home modifications to improve physical housing accessibility: A mixed-methods survey of occupational therapists

BackgroundDespite the number of older people and people with disabilities increasing in Australia, it is unclear which housing design features are needed to support physical housing accessibility for people with and without disabilities across the lifespan. ObjectiveThis study drew upon the experience of occupational therapists to investigate accessible housing design features and home modifications to support aging in place and discharge from hospital to home. MethodsA cross-sectional online survey exploring housing design features and home modifications was completed by 144 Australian occupational therapists over six weeks in 2021. Descriptive quantitative and qualitative data analyses were used. ResultsFor both aging in place and hospital discharge, the most important housing design features included step-free access to the dwelling, large step-free showers, and bathroom and bedroom space on the ground floor. Qualitative findings also highlighted the importance of preparing for home modifications, such as reinforcing bathroom walls to support the post-build installation of grab rails. The most frequently needed modifications were for bathroom features, while structural changes to the dwelling were the most time-intensive modifications, requiring more than six weeks to be completed. ConclusionsExternal access to the home and internal access to bedroom and bathroom facilities can support aging in place and hospital discharge and mitigate the need for costly and time-intensive home modifications. While this study was conducted in Australia, the findings have relevance outside of this context, and are important for ensuring equitable accessibility for people with and without disabilities across the lifespan.

Home modifications to prevent home fall injuries in houses with Māori occupants (MHIPI): a randomised controlled trial

As with many Indigenous populations internationally, Māori in New Zealand suffer health inequity. We aimed to assess the rate of fall injuries at home with and without home modifications in houses with Māori occupants. We did a single-blind randomised controlled trial in the Wellington and Taranaki regions of New Zealand and enrolled owner-occupied households with at least one Māori occupant. Only households who stated they intended to live at that address for the subsequent 3 years were eligible for participation. We randomly assigned (1:1) households to either the intervention group, who received home modifications (handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, repairs to window catches, high-visibility and slip-resistant edging for outside steps, fixing of lifted edges of carpets and mats, non-slip bath mats, and slip-resistant surfacing for outside areas such as decks) immediately, or the control group, who received the modifications 3 years later. Data on home injuries were obtained from the Accident Compensation Corporation and coded by study team members, who were masked to study group allocation. The primary outcome was the rate of medically treated fall injuries at home per household per year, analysed according to intention to treat. This Māori Home Injury Prevention Intervention (MHIPI) trial is now completed, and is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000148774. Between Sept 3, 2013, and Oct 1, 2014, 824 households were assessed for eligibility and 254 were enrolled, of which 126 (50%) were assigned to the intervention group and 128 (50%) were assigned to the control group. After adjustment for previous falls and geographical region, there was an estimated 31% reduction in the rate of fall injuries at home per year exposed to the intervention compared with households in the control group (adjusted relative rate 0·69 [95% CI 0·47-1·00]). Low-cost home modifications and repairs can be an effective means to reduce injury disparities. The high prevalence of modifiable safety issues in Māori homes merits considerable policy and community effort. Health Research Council of New Zealand.

151 Falls in the United Kingdom: Magnitude, Risk, Disparities, and Solutions

Abstract In the UK each year there are over 250,000 emergency hospital admissions due to falls, costing £4.4 billion for falls-related fractures alone. To help reduce pressure on the NHS, the UK Fire Service are now providing home safety checks which include a review of falls hazards, provision of falls and loneliness advice and in some cases, immediate provision of aids such as grab rails. It is yet to be seen whether this will translate into a reduction in falls but it appears that the trust people place in the Fire Service is resulting in an uptake of falls prevention advice. Although we have reasonably good evidence that multifactorial falls interventions reduce the rate of falls, they are resource intensive and do not reduce the risk of falls. In contrast, exercise interventions reduce both the rate and the risk of falls and can be delivered in a group setting; however uptake and adherence is low. In an attempt to encourage local care providers to invest in falls prevention exercise, Public Health England created a Return-of-Investment tool (available online) for local commissioners to calculate the anticipated cost savings by investing in falls prevention exercise programmes. A recent, novel approach to falls prevention developed in the UK is a Massive Open Online Course (MOOC). This is a free, open-access, online course open to anyone with access to the Internet. The purpose of the ‘Ageing Well: Falls’ MOOC is to educate people about falls prevention and empower them to take action. In five years, the course has educated over 10,000 people from over 100 countries worldwide. One survey revealed that 95% of learners felt more empowered to manage their falls risk, with an increase in confidence to engage in falls prevention behaviours but also an increase in confidence to seek help for falls.

"What? That's for Old People, that." Home Adaptations, Ageing and Stigmatisation: A Qualitative Inquiry.

Older people, even those living with long-term conditions or poor mobility, can be supported to live well at home, through adapting their home to meet changing need. Installing home adaptations, from grab rails to walk in shower rooms, is cost effective, may prevent falls, reduce social isolation and improve self confidence. Despite austerity cuts to public spending, the UK government increased home adaptations’ funding. However, not much is known about older people’s experiences and understanding of acquiring and living with home adaptations and uptake of home adaptations could be improved. Using wearable camera and face to face interview data, this qualitative study explored a diverse group of older people’s retrospective experiences (n = 30). Focus group discussions were also carried out with a wide range of professionals involved in the provision of home adaptations (n = 39). Findings suggest people may delay having adaptations, because of perceived stigmatising associations with decline and vulnerability. As delaying the installation of home adaptations until crisis point is known to reduce their effectiveness, such associations need to be challenged.

The impact of an ambulance vehicle preparation service on the presence of bacteria: a service evaluation.

Introduction:Around 300,000 patients a year in England acquire a healthcare-associated infection (HAI) while being cared for by the NHS. The contribution from NHS Ambulance Services is not known, but previous studies have identified the presence of pathogenic bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus, including resistant strains in some cases, inside ambulances. To improve ambulance cleanliness, Yorkshire Ambulance Service NHS Trust (YAS) piloted an Ambulance Vehicle Preparation Service (AVPS) at two ambulance stations, where staff were tasked with ensuring every ambulance at these stations was cleaned every 24 hours.Methods:Adenosine triphosphate (ATP) bioluminescence testing was conducted on 16 ambulances at the two pilot AVPS stations and on 18 ambulances at four ‘business as usual’ (BAU) ambulance stations using a Hygiena SystemSURE luminometer. Swabs were obtained from 10 pre-selected locations inside each ambulance.Results:Between November 2016 and August 2018, a total of 690 swabs were obtained and recorded from 34 ambulances. Overall, median relative light unit (RLU) values for both groups were < 100, with only the BAU group having an upper quartile value > 100. However, when stratified by swabbing area, three areas had a median RLU of > 100 in the BAU group: suction unit handle, steering wheel and airway seat shelf. In addition, the upper quartile RLU values for the grab rail above the stretcher and the passenger seat in the BAU group were also > 100. No swab areas had a median RLU > 100 in the AVPS group.Conclusion:A dedicated AVPS results in better cleaning of ambulance vehicles than the existing cleaning system utilising operational crews. The areas most likely to be contaminated are the suction unit handle, steering wheel, airway seat shelf and grab rails. The position of equipment and the materials that equipment are constructed from should have infection prevention and control (IPC) as a consideration.

The aesthetic appeal of assistive technology and the economic value baby boomers place on it: A pilot study.

This pilot study aimed to understand the importance of assistive technology (AT) aesthetics on the intention to purchase, using grab rails as the example. Furthermore, the study explored the economic value consumers placed on aesthetic appeal. Structured interviews were conducted with 25 participants, nine female, mean age 59; where seven grab rails were presented and feedback obtained on the level of appeal and 'willingness to pay'. Responses to open-ended and fixed response questions were transcribed by the interviewer during the interview and a qualitative content analysis conducted. Positive and negative terms in relation to aesthetics were used to describe appealing and unappealing grab rails; however, all grab rails were felt to have negative aesthetic aspects by at least five participants. Physical design and finish emerged as the two main themes regarding the appeal of the grab rail designs. Participants' 'willingness-to-pay' for appealing options was mixed, with both over and under valuations. The most likely grab rails to be purchased were considered both appealing and cost effective by participants. Aesthetic appeal plays an important role in acceptance and uptake of AT. Designers and manufacturers should be encouraged to provide appealing options as the study has shown consumers prefer aesthetically appealing grab rails. However, the challenge is creating more appealing designs, without increasing cost as consumers seem to not want to pay more for them. Furthermore, clinicians need to acknowledge the importance of aesthetics when recommending interventions and be familiar with a range of options to provide clients with more choice.

Cost–benefit analysis of fall injuries prevented by a programme of home modifications: a cluster randomised controlled trial

BackgroundInjuries due to falls in the home impose a huge social and economic cost on society. We have previously found important safety benefits of home modifications such as handrails for...

Home modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: a cluster-randomised controlled trial

Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. We tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. We did a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. We randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which we derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, we analysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085-1263), the crude rate of fall injuries per person per year was 0.061 in the treatment group and 0.072 in the control group (relative rate 0.86, 95% CI 0.66-1.12). The crude rate of injuries specific to the intervention per person per year was 0.018 in the treatment group and 0.028 in the control group (0.66, 0.43-1.00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0.74, 95% CI 0.58-0.94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0.61, 0.41-0.91). Our findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested. Health Research Council of New Zealand.

Comparative analysis of speed's impact on muscle demands during partial body weight support motor-assisted elliptical training

Individuals with walking limitations often experience challenges engaging in functionally relevant exercise. An adapted elliptical trainer (motor to assist pedal movement, integrated body weight harness, ramps/stairs, and grab rails) has been developed to help individuals with physical disabilities and chronic conditions regain/retain walking capacity and fitness. However, limited published studies are available to guide therapeutic interventions. This repeated measures study examined the influence of motor-assisted elliptical training speed on lower extremity muscle demands at four body weight support (BWS) levels commonly used therapeutically for walking. Electromyography (EMG) and pedal trajectory data were recorded as ten individuals without known disability used the motor-assisted elliptical trainer at three speeds [20,40, 60revolutions per minute (RPM)] during each BWS level (0%, 20%, 40%, 60%). Overall, the EMG activity (peak, mean, duration) in key stabilizer muscles (i.e., gluteus medius, gluteus maximus, vastus lateralis, medial gastrocnemius and soleus) recorded at 60RPM exceeded those at 40RPM, which were higher than values at 20RPM in all but three situations (gluteus medius mean at 0% BWS, vastus lateralis mean at 20% BWS, soleus duration at 40% BWS); however, these differences did not always achieve statistical significance. Slower motor-assisted speeds can be used to accommodate weakness of gluteus medius, gluteus maximus, vastus lateralis, medial gastrocnemius and soleus. As strength improves, training at faster motor-assisted speeds may provide a means to progressively challenge key lower extremity stabilizers.

The Antimicrobial Efficacy of Copper Alloy Furnishing in the Clinical Environment: A Crossover Study

To determine whether copper incorporated into hospital ward furnishings and equipment can reduce their surface microbial load. A crossover study. Acute care medical ward with 19 beds at a large university hospital. Fourteen types of frequent-touch items made of copper alloy were installed in various locations on an acute care medical ward. These included door handles and push plates, toilet seats and flush handles, grab rails, light switches and pull cord toggles, sockets, overbed tables, dressing trolleys, commodes, taps, and sink fittings. Their surfaces and those of equivalent standard items on the same ward were sampled once weekly for 24 weeks. The copper and standard items were switched over after 12 weeks of sampling to reduce bias in usage patterns. The total aerobic microbial counts and the presence of indicator microorganisms were determined. Eight of the 14 copper item types had microbial counts on their surfaces that were significantly lower than counts on standard materials. The other 6 copper item types had reduced microbial numbers on their surfaces, compared with microbial counts on standard items, but the reduction did not reach statistical significance. Indicator microorganisms were recovered from both types of surfaces; however, significantly fewer copper surfaces were contaminated with vancomycin-resistant enterococci, methicillin-susceptible Staphylococcus aureus, and coliforms, compared with standard surfaces. Copper alloys (greater than or equal to 58% copper), when incorporated into various hospital furnishings and fittings, reduce the surface microorganisms. The use of copper in combination with optimal infection-prevention strategies may therefore further reduce the risk that patients will acquire infection in healthcare environments.

Hospital Fall-Prevention Plans Don't Stand Up

Hospital Fall-Prevention Plans Don't Stand Up

Hand-Handhold Coupling: Effect of Handle Shape, Orientation, and Friction on Breakaway Strength

The aim was to determine the maximum force that can be exerted on an object before it is pulled or slips from the grasp of the hand ("breakaway strength") for fixed overhead handholds of varying orientation, shape, and friction. Many studies have quantified hand strength by having participants squeeze, pull on, or create torque on an object or handle, but few studies have measured breakaway strength directly. In two experiments, hand strength was measured as both overhead breakaway strength for handholds typical of fixed industrial ladders and as maximum isometric grip strength measured using a common Jamar grip dynamometer. Breakaway strength was greatest for a fixed horizontal cylinder ("high friction"; 668 +/- 40 N and 691 +/- 132 N for Experiments 1 and 2, respectively), then for a horizontal cylinder that simulated low surface friction ("low friction"; 552 +/- 104 N), then for a vertical cylinder (435 +/- 27 N), and finally, for a vertical rectangular-shaped rail (337 +/- 24 N). Participants are capable of supporting only their own body weight with one hand when grasping the fixed horizontal cylinder. Breakaway strength for both the high- and low-friction horizontal cylinders was significantly greater than isometric grip strength (1.58 +/- 0.25 and 1.26 +/- 0.19 times, respectively). Results support the hypothesis that hand-handhold coupling is composed of active (isometric or eccentric finger flexion) and passive (frictional) components. Traditional isometric grip strength alone does not predict the strength of a couple between a hand and a handhold well. This research shows that handhold shape, orientation, and friction are important in the safe design of grab rails or ladders.

The effects of unilateral grab rail assistance on the sit-to-stand performance of older aged adults

This study investigated the effects of unilateral grab rail assistance during the sit-to-stand transfer to develop an understanding of lower limb joint mechanics and whole body movement patterns. External reaction forces at the grab rail and floor interfaces were also investigated to understand the nature of the assistance provided by the introduction of unilateral upper body assistance. While 12 older aged adults performed the sit-to-stand, three-dimensional body segment kinematics were recorded to determine lower body joint motion and whole body centre of mass motion. Grab rail reaction forces and bilateral ground reaction forces were recorded to determine external reaction forces and lower body joint kinetics. Grab rail assisted conditions were compared with unassisted transfers. During grab rail assistance, a systematic asymmetry was introduced to lower limb joint kinetics, without noticeable alterations to peak lower body joint motion and whole body movement patterns. Ipsilateral net joint moments and powers decreased in the ankle and hip and increased in the knee, while the contralateral net joint moments and powers increased in the hip and decreased in the knee. Joint kinetic and kinematic responses suggest a motor control strategy that maintains symmetric sit-to-stand movement patterns by adjusting bilateral muscle control when a unilateral external reaction force is provided. Understanding the mechanical assistance that is generated during the sit-to-stand will facilitate optimal design of grab rails for older aged adults and may contribute to design for specific pathologies. Such design implementation will influence the ability of older aged adults to remain independent in the community.

Assistive devices and community-based services among 85-year-old community-dwelling elderly in The Netherlands: Ownership, use,and need for intervention

Objective. To assess the home-situation of the oldest old regarding the ownership, use, and need for intervention of assistive devices and community-based services.Methods. A research nurse and an occupational therapist, who evaluated the current situation regarding ownership and use of assistive devices, visited a representative group of 147 Dutch community-dwelling 85-year-olds in their own homes. Furthermore, the occupational therapist assessed whether an intervention was indicated. Assistance in purchasing devices, information, and instruction were provided when necessary.Results. 94% of the subjects owned one or more assistive devices, with a mean of 4.5 (SD 2.7) assistive devices. Most frequently owned were grab rails. Of the total number of 591 assistive devices, 74 (13%) were not in use. In 66 of the 147 (45%) subjects at least one intervention was indicated. A total number of 23 subjects received information and instruction on mobility-related issues, while 17 subjects received information and instruction on personal care-related issues. Moreover, for 19 subjects an application procedure was started for a total of 25 assistive devices and five community-based services in the mobility category while for 19 subjects an application procedure was started for a total of 31 devices and four services in the personal care category.Conclusions. Based on detailed information from occupational therapists, the home situation of community-dwelling elderly regarding the presence and use of assistive devices and community-based services is not optimal.

The effectiveness of showers fitted via a grant for people with physical impairments

Many people with physical impairments have a shower fitted, with the aim of restoring independence. Studies conducted in small geographical areas have indicated that this aim is usually achieved, but the only published national study has encompassed a range of adaptations with little detail concerning showers. Additionally, shower tray design has advanced considerably recently. The aim of this study was to gather national data, through 18 local authorities, from 700 people who had had a shower fitted within the past 2 years, to ascertain its effectiveness and impact. The study was funded by the Medical Devices Agency. The majority of respondents felt the shower had improved their life and found it easy to use. Grab rails were important to many respondents, to make them feel safe. For a few respondents, the shower had impacted negatively on their life. Brief guidelines drawn from the survey data are presented to help practitioners when assessing for and choosing a shower installation. Most installations meet the needs of people with physical impairments and appropriate recommendations by professionals and good product design combine to provide this result.

Equipment: Is it the Answer? An Audit of Equipment Provision

The provision of equipment and adaptations is a major part of the social services occupational therapist's role and is, therefore, an area that needs investigation to ensure that assessed needs are...

What is the prevalence of environmental hazards in the homes of dementia sufferers and are they associated with falls

Objectives To examine the frequency of environmental hazards in the homes and care environments of patients with dementia and their associations with falls. Method Falls were prospectively assessed in 65 dementia patients using carer diaries, and the safety of the environment assessed by an occupational therapist using a home hazard checklist. Results Hazards were found in 20 (95%) of patients' own homes and 31 (74%) of residential or nursing home environments (care environments). Patients' homes had a mean of 5.4 hazards compared to a mean of 1.8 hazards in care environments, with two or more hazards in 90% of patients' homes and 52% of care environments. Common hazards included low chairs, an absence of grab rails (toilet area), toilets too low and a missing second banister on the stairs. There was no significant association between the number of hazards and the number of falls, although 13 (10%) falls could be attributed to a specific hazard. Conclusion Rigorous assessment of the patient's environment revealed multiple rectifiable risks that were contributory to a significant minority of falls. Copyright © 2000 John Wiley & Sons, Ltd.

What is the prevalence of environmental hazards in the homes of dementia sufferers and are they associated with falls.

To examine the frequency of environmental hazards in the homes and care environments of patients with dementia and their associations with falls. Falls were prospectively assessed in 65 dementia patients using carer diaries, and the safety of the environment assessed by an occupational therapist using a home hazard checklist. Hazards were found in 20 (95%) of patients' own homes and 31 (74%) of residential or nursing home environments (care environments). Patients' homes had a mean of 5.4 hazards compared to a mean of 1.8 hazards in care environments, with two or more hazards in 90% of patients' homes and 52% of care environments. Common hazards included low chairs, an absence of grab rails (toilet area), toilets too low and a missing second banister on the stairs. There was no significant association between the number of hazards and the number of falls, although 13 (10%) falls could be attributed to a specific hazard. Rigorous assessment of the patient's environment revealed multiple rectifiable risks that were contributory to a significant minority of falls.

Ambulant disabled persons using buses: experiments with entrances and seats

This paper describes research work carried out in Sweden to adapt buses to the requirements of ambulant disabled people. It contains an experimental study where subjects tried different entrances and seats. For the experiments a bus was rebuilt and equipped with new entrance and seating arrangements. Three categories of subjects participated: seriously ambulant disabled, representing people having severe ambulatory difficulties in their daily life; less seriously ambulant disabled, representing people that normally travel with the special transportation service; and slightly ambulant disabled, representing ordinary elderly people. The evaluation was based on observations, photographs, interviews and in some cases timing with a stopwatch. The results show that low similar steps and well-designed handrails in the bus entrance made boarding and alighting easier. The seat trials showed the importance of having suitable grab rails to allow people to pull or heave themselves up. Design requirements are presented in the paper. The Swedish Board of Transport have used the results when working out regulations to adapt public transport vehicles for use by disabled people.