Interstep Variations of Stairways and Associations of High-Contrast Striping and Fall-Related Events: Observational Study
Authors: Harper Sara A , Brown Chayston , Poulsen Shandon L , Barrett Tyson S , Dakin Christopher J 
Published: January 2025

Background
Interstep variations in step riser height and tread depth within a stairway could negatively impact safe stair negotiation by decreasing step riser height predictability and, consequently, increasing stair users’ fall risk. Unfortunately, interstep variations in riser height and depth are common, particularly in older stairways, but its impact may be lessened by highlighting steps’ edges using a high-contrast stripe on the top front edge of each step.

Objective
This study aimed to determine (1) if fall-related events are associated with greater interstep riser height and depth variations and (2) if such fall-related events are reduced in the presence of contrast-enhanced step edges compared with a control stairway.

Methods
Stair users were video recorded on 2 public stairways in a university building. One stairway had black vinyl stripes applied to the step’s edges and black-and-white vertical stripes on the last and top steps’ faces. The stairway with striping was counterbalanced, with the striped stairway than a control, and the control with stripes. Each stair user recorded was coded for whether they experienced a fall-related event. A total of 10,000 samples (observations) of 20 fall-related events were drawn with 0.25 probability from each condition to determine the probability of observing a distribution with the constraints outlined by the hypotheses by a computerized Monte Carlo simulation.

Results
In total, 11,137 individual stair user observations had 20 fall-related events. The flights that had 14 mm in interstep riser height variation and 38 mm in interstep depth variation were associated with 80% (16/20) of the fall-related events observed. Furthermore, 2 fall-related events were observed for low interstep variation with no striping, and 2 fall-related events were observed during low interstep variation with striping. A total of 20 fall-related events were observed, with 4 occurring on flights of stairs with low interstep variation. For stairs with high variability in step dimensions, 13 of 16 (81%) fall-related events occurred on the control stairway (no striping) compared with 3 of 16 (19%) on the high-contrast striping stairway. The distribution of fall-related events we observed between conditions likely did not occur by chance, with a probability of 0.04.

Conclusions
These data support the premise that a vision-based strategy (ie, striping) may counteract fall risk associated with interstep riser height and tread depth variation. Possibly, perception and action elicited through the horizontal-vertical illusion (striping) may have a positive impact on the incidence of fall-related events in the presence of high interstep riser height and depth variation. The findings of this study suggest that contrast enhancement (ie, striping) may be a simple and effective way to reduce the risk of falls associated with interstep variation, highlighting the potential for this approach to make a significant impact on fall prevention efforts.