A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes

O’Halloran, Peter; Cran, G. W.; Beringer, T. R. O.; Kernohan, George; O’Neill, Ciarán; Orr, Jean; Dunlop, Louise; Murray, Liam

doi:10.1093/ageing/afh200

Cited by 64 publications

(48 citation statements)

References 15 publications

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“…Finally, we have used this approach to highlight the effectiveness of hip protectors in decreasing the risk of hip fractures in a vulnerable, often ignored population with a significant burden of disease. Process of exclusion of studies from the systematic review [26][27][28][29][30][31][32][33][34][35][36]. Table 1 Assessment of the methodologic features of included studies The unit of randomization was not clearly described in the primary publication.…”

Section: Discussionmentioning

confidence: 99%

“…In the case of the Harada et al trial, information on cluster randomization was obtained from the author, as details of randomization were not explicitly reported in the primary paper. Two trials of mixed populations (nursing home and other populations) were excluded, as they were not comprised exclusively of nursing home residents [28,35].…”

Section: Studies Included In the Systematic Reviewmentioning

confidence: 99%

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Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis

Sawka

Boulos

Beattie

et al. 2007

Journal of Clinical Epidemiology

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Objective-To design a Bayesian random effects model for pooling binary outcome data from cluster randomized trials (CRTs) with individually randomized trials (IRTs) and then use this model to determine if hip protectors decrease the risk of hip fracture in elderly nursing home residents.Study Design and Setting-Eight electronic databases were searched; abstracts and papers were reviewed in duplicate. Randomized controlled trials of hip protectors in nursing homes were included. The pooled mean odds ratio (OR) of a hip fracture in an individual allocated to hip protectors with 95% credibility interval (CRI) was calculated. CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptResults-We included four trials of 1,922 individuals (including three CRTs). The pooled OR of an elderly nursing home resident sustaining one or more hip fractures with hip protector allocation was 0.40 (95% CRI 0.25, 0.61). The model was robust in multiple sensitivity analyses assuming alternative intracluster correlation coefficient values. Conclusion-TheBayesian approach may be used in meta-analyses of IRTs and CRTs. Using this approach, we have determined that hip protectors decrease the risk of hip fracture in elderly nursing home residents. Methodologic limitations of the included trials and a possible herd effect in CRTs may have influenced these results.

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Section: Discussionmentioning

confidence: 99%

Section: Studies Included In the Systematic Reviewmentioning

confidence: 99%

Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis

Sawka

Boulos

Beattie

et al. 2007

Journal of Clinical Epidemiology

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“…To date, at least 15 randomised controlled trials (RCTs) examining the effect of external hip protectors on incidence of hip fractures have been published. Hip protectors led to a significant reduction in the incidence of hip fractures in five studies [8][9][10][11][12] while results were borderline significant in two studies [13,14] and no significant reduction in hip fracture incidence was seen in eight studies [15][16][17][18][19][20][21][22]. These discrepancies among RCTs might be attributable to differences in the methods of randomisation, biomechanical properties of the actual hip protectors used and compliance rates for use of hip protectors.…”

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confidence: 99%

External hip protectors are effective for the elderly with higher-than-average risk factors for hip fractures

et al. 2009

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“…There were also studies where the question of efficacy remained unresolved: the main reasons for failure were always low compliance and adherence, which are higher in care-dependent residential patients, thus leading to better results [48][49][50][51][52].…”

Section: Common Risk Factors For Fallsmentioning

confidence: 99%

Hip, Osteoporosis: New Paradigm

Komadina¹

2008

Eur J Trauma Emerg Surg

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Osteoporosis is the most common metabolic bone disease. Recently, the paradigm for diagnosis and treatment of osteoporosis has undergone changes due to new findings on this disease. With the arrival of densitometers that could measure BMD we started using medications that block further degradation of density and repair the densitometric results. More recent findings, however, suggest that the BMD value influences the predicted success of future fracture prevention in less than 50%. The remainder is attributed to bone quality. There are a number of risk factors for osteoporotic fractures, some of greater and some of lesser significance. A small external force is necessary to cause an osteoporotic fracture; otherwise, the osteoporotic bone still does not break. The dominant factor in a fracture is therefore the fall of the elderly patient. Falls are preventable, although most are benign and injury free. Only in the recent decade have we started paying attention to the fall phenomenon, which does not only involve accidents, but is also a consequence of the normal aging process. Incidence of falls and hip fractures in residential elderly patients can be reduced with a multifactorial interdisciplinary prevention program (MIPP):• Staff training • Adaptation of environment • Gait and mobility exercise • Technical accessories • Revision of pharmacotherapy (psychotropics) • Hip protectors • Post-fall problem-solving conferences. Mobility exercise is useful in elderly groups; however, the maintenance of mobility is not linked to a reduction of fall risk. Hip protectors are protective pads designed to cover the greater trochanter and attenuate or disperse the force of fall sufficiently to prevent a hip fracture. A number of cost-benefit studies on residential elderly patients between 2004 and 2006 proved the efficacy of MIPP and hip protectors, and some studies did so also on those patients living independently. Unfortunately, as much as 75% of women and 90% ofmen at high risk in nursing homes are not investigated, and 75% of those affected are not treated.

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A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes

Abstract: making hip protectors available to residents of nursing and residential homes did not reduce the rate of hip fracture. This research does not support the introduction of a policy of providing hip protectors to residents of nursing homes.

Cited by 64 publications

References 15 publications

Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis

Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis

External hip protectors are effective for the elderly with higher-than-average risk factors for hip fractures

Hip, Osteoporosis: New Paradigm

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