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This review found that the evidence around safety of flooring was generally of low quality, thus much uncertainty remains.

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Amy Drahota 1,*, Lambert M Felix 1, James Raftery 2, Bethany E Keenan 3, Chantelle C Lachance 1, Dawn C Mackey 4, Chris Markham 1, Andrew C Laing 5, Kirsten Farrell-Savage 1, Olanrewaju Okunribido 6

1 School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
2 Wessex Institute, University of Southampton, Southampton, UK
3 School of Engineering, Cardiff University, Cardiff, UK
4 Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
5 Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
6 Health and Safety Executive Science and Research Centre, Buxton, UK
* Corresponding author Email: amy.drahota@port.ac.uk

Declared competing interests of authors: Amy Drahota and Bethany E Keenan collaborated with the Health and Safety Laboratory (2018–20) on some unfunded academic research using a new testing procedure to assess the shock absorbency of various floor coverings. Five flooring manufacturers delivered free samples for use in the project; Amy Drahota and Bethany E Keenan have no stake in any of these companies. In 2015, Amy Drahota was involved in a collaborative funding application with Polyflor Ltd (Manchester, UK) for some SBRI Healthcare innovation funding. The application was shortlisted, but was unsuccessful. Amy Drahota has no stake in Polyflor Ltd. Andrew C Laing reports grants from SofSURFACES Inc. (Petrolia, ON, Canada), and grants and personal fees from SorbaShock LLC (Fort Wayne, IN, USA) and Viconic Sporting (Dearborn, MI, USA) outside the submitted work. Andrew C Laing was a member of an ASTM International Work Group (WK38804), whose technical contact is the president of Seamless Attenuating Technologies (SATECH), Inc. (Chehalis, WA, USA). SATECH, Viconic Sporting and Mannington Mills (Salem, NJ, USA) have donated flooring materials to Andrew C Laing’s laboratory that have formed the basis of several studies examining the biomechanical effectiveness of compliant flooring (i.e. safety flooring). Andrew C Laing has never had (nor does he currently have) any financial links to these companies. Chantelle C Lachance is employed at the Canadian Agency for Drugs and Technologies in Health (CADTH) outside the submitted work. Amy Drahota, Dawn C Mackey, Chantelle C Lachance and Andrew C Laing authored original research papers that were included in this review. James Raftery is a member of the National Institute for Health Research Health (NIHR) Technology Assessment and Efficacy and Mechanism Evaluation Editorial Board (2012–present). He was also director of the Wessex Institute, University of Southampton (2005–12), and was concurrently director of the NIHR Evaluation, Trials and Studies Coordinating Centre, part of the Wessex Institute, which was funded by NIHR.

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