Introduction
Hip protectors represent a promising strategy for preventing fall-related hip fractures. However, clinical trials have yielded conflicting results due, in part, to lack of agreement on techniques for measuring and optimizing the biomechanical performance of hip protectors as a prerequisite to clinical trials.
Methods
In November 2007, the International Hip Protector Research Group met in Copenhagen to address barriers to the clinical effectiveness of hip protectors. This paper represents an evidence-based consensus statement from the group on recommended methods for evaluating the biomechanical performance of hip protectors.
Results and conclusions
The primary outcome of testing should be the percent reduction (compared with the unpadded condition) in peak value of the axial compressive force applied to the femoral neck during a simulated fall on the greater trochanter. To provide reasonable results, the test system should accurately simulate the pelvic anatomy, and the impact velocity (3.4 m/s), pelvic stiffness (acceptable range: 39–55 kN/m), and effective mass of the body (acceptable range: 22–33 kg) during impact. Given the current lack of clear evidence regarding the clinical efficacy of specific hip protectors, the primary value of biomechanical testing at present is to compare the protective value of different products, as opposed to rejecting or accepting specific devices for market use.
Introduction
While hip protectors are effective in some clinical trials, many, including all in community settings, have been unable to demonstrate effectiveness. This is due partly to differences in the design and analysis. The aim of this report is to develop recommendations for subsequent clinical research.
Methods
In November of 2007, the International Hip Protector Research Group met to address barriers to the clinical effectiveness of hip protectors. This paper represents a consensus statement from the group on recommended methods for conducting future clinical trials of hip protectors.
Results and conclusions
Consensus recommendations include the following: the use of a hip protector that has undergone adequate biomechanical testing, the use of sham hip protectors, the conduct of clinical trials in populations with annual hip fracture incidence of at least 3%, a run-in period with demonstration of adequate adherence, surveillance of falls and adherence, and the inclusion of economic analyses. Larger and more costly clinical trials are required to definitively investigate effectiveness of hip protectors.
Hip protectors are used in the preventive management of older people who are at risk of fracturing their hip after a fall. However, nurses have little guidance about which type is the most appropriate for particular patients. This article highlights the different designs available and their mechanical performance was assessed by the authors using a purpose-built impact rig. Problems with compliance and issues about tissue viability are discussed and the article also contains a risk assessment tool to help nurses decide on which is the most suitable type of hip protector to use.
Introduction: A new shock-absorbing flooring has been developed for use in Institutions that provide care for the older person. This flooring aims to prevent or reduce injuries that occur on impact with the floor following a fall. There was a concern, however, that the forces required to push wheelchairs and similar heavy equipment over the shock-absorbing flooring may be much larger than over conventional vinyl flooring and could have risk implications for safe moving and handling, This study was designed to assess the push-to-start force (termed 'stiction' force) and the constant speed force (Vc) for the new flooring and to compare these results with those over regular vinyl flooring. Method: An instrumented standard wheelchair was used in the study, with different weights that would cover a range of normal usage. Results: The force to overcome the initial resistance and to push at a constant speed was greater over the shock-absorbing flooring than over the 2 mm vinyl. The forces increased with subject weight, the maximum stiction force being 63 N (14.2 lbf) and 39 N (8.8 lbf) pushing at a constant speed of 3 km/hr, for a total weight of 125 kg. Conclusion: This is a significant increase in force required to push a weighted 8L wheelchair over the shock-absorbing flooring. There would be similar increases in the pushing forces for other wheeled equipment, such as beds.
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