Conclusion: No indications for effectiveness
Eligible interventions are those which focus on reducing physical hazards in children; including the building fabris or 'fixtures and fittings' (that is, removable items within a property that are fastened or attached to the building fabric) in the domestic environment, and where modifications such as the installation of grab rails, stair gates, fire-guards, cupboard locks, hot-water tap adaptions and lighting adjustment, have been included.
The review of Lyons et al (2006) describes 5 randomised controlled trials focusing on children under the age of 5 or caregivers of children under the age of 5. None of the studied RCT's focusing on children (under five) demonstrated a reduction in injuries that might have been due to environmental adaption in the home; one study reported a reduction in injuries and in hazards but the two could not be linked.
There is little high level scientific evidence for modification of the built home environment as an effective method of reducing childhood injury. However, most studies that were included in the review of Lyons et al (2006) which is the basis for this evidence statement, were based on small sample sizes and so could not be expected to detect differences. Therefore, this review has not shown that these interventions do not work but the quality and size of the studies were not sufficiently good or large enough to reach a definitive conclusion in most cases.
Recommendations (for research & practice)
Future studies on the effectiveness of modifications of the home environment should use larger samples in order to be able to detect significant effects.
Review Date: 18/08/2011
Articles (reviews) and reports were included that were published between 2000 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.
Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).
The outcomes of the study were reviewed by an expert in the field of child safety in the summer of 2010.
Modification of the home environment for the reduction of injuries (version 1)
R.A. Lyons, L.V. Sander, A.L. Weightman ... [et al.] (2006)