Compliance study of hip protector users for prevention of fragility fracture: A pilot randomized trial

Abstract

Background:Hip protectors have been widely used for hip fracture prevention in the elderly, but its efficacy remains controversial. Users' compliance to hip protector is an important factor for its efficacy. However, the assessment of users' compliance tended to be subjective and unreliable in the past.Objectives:To quantify the elderly's compliance to hip protectors and investigate the effect of different underpant designs on the elderly's compliance.Study Design:A pilot randomized trial.Methods:Thirty-one participants were recruited and provided with hip protectors in which compliance monitors were installed and delivered with three pairs of either the conventional underpants or the purpose-design underpants randomly. Participants were encouraged to use the hip protectors with the assigned underpants for whole day. After 4 weeks, compliance data were downloaded from the compliance monitors. Participants were also asked to fill a survey form for acceptance analysis. The Spearman correlation coefficient and the Wilcoxon signed-rank test/2 independent samples t test/Mann-Whitney U test were used for the corresponding statistical analyses.Results:Thirty-one participants were recruited initially. Eighteen participants were excluded from instrumented compliance analysis because of limited or no data collection. The data of the resting 13 participants (six in the conventional underpants group and seven in purpose-design underpants group) were analyzed and showed an average instrumented compliance of 77.5% which was lower than the average self-reporting compliance (83.3%) of all the available 23 participants (eight of 31 became wheelchair-bounded). Participants' compliance was positively correlated with their acceptance to the hip protectors and significantly higher in the purpose-design underpants group than in the conventional underpants group (P < 0.05).Conclusions:This pilot study demonstrated a feasible protocol for compliance quantification of the elderly to the hip protectors, the importance to have an objective compliance measure to assess users' actual compliance, and purpose-design underpants could improve the users' compliance. Future studies with long-term observation and large sample size deserve further proof of the current findings.

Objective Methods of Monitoring Usage of Orthotic Devices for the Extremities: A Systematic Review

“…The 23 studies that were included in the review included three randomised controlled trials [31][32][33] and 20 observational studies [21,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] (Table 1). Seven studies collected data from healthy participants [34,35,38,39,[42][43][44][45], fifteen studies recruited patients [21,[31][32][33]36,37,41,[46][47][48][49][50][51][52], and one study included data from both healthy and patient participants [40]. The sample size of the included studies ranged from two to 124.…”

“…The sample size of the included studies ranged from two to 124. Five studies used upper limb orthoses [21,34,39,45,46], two used hip orthoses [33,47], and sixteen used lower limb orthoses [31,32,[35][36][37][38][40][41][42][43][44][48][49][50][51][52]. The included studies were conducted in a variety of geographical regions.…”

“…The majority were conducted in Europe-five in the United Kingdom [32,36,37,42,44], three in the Netherlands [34,40,41], three in Germany [35,38,48], two in Switzerland [21,46], and one in Portugal [39]. Out of the remaining nine studies, seven were conducted in the United States of America [31,45,47,[49][50][51][52], one in China [33], and one in Australia [43]. Studies employed orthoses used for a wide range of medical conditions, including diabetes [32,[40][41][42]48,52], clubfoot [31,37,49,50], postoperative care after shoulder surgery [21,45,46], carpel tunnel syndrome [39], hip fracture prevention [33], hip dysplasia [47], lower limb fracture recovery [35,51], foot drop [44], and spinal cord injury [36].…”

“…Out of the remaining nine studies, seven were conducted in the United States of America [31,45,47,[49][50][51][52], one in China [33], and one in Australia [43]. Studies employed orthoses used for a wide range of medical conditions, including diabetes [32,[40][41][42]48,52], clubfoot [31,37,49,50], postoperative care after shoulder surgery [21,45,46], carpel tunnel syndrome [39], hip fracture prevention [33], hip dysplasia [47], lower limb fracture recovery [35,51], foot drop [44], and spinal cord injury [36]. Three studies did not mention a specific condition but investigated upper limb orthoses for the impairment of the shoulder, arm or hands [34], foot and lower limb disorders [43], and calf muscle unloading [38].…”

“…Out of the twenty-three studies that were included in the review, fourteen studies utilised temperature sensors to monitor compliance [21,33,34,[39][40][41][42][43][45][46][47][48][49][50], six studies used pressure sensors [31,32,35,39,51,52], four studies used step counters [36,40,41,44], and six studies used accelerometers [33,37,38,[42][43][44]. Sixteen studies used one type of sensor in their methodology to monitor compliance [21,31,32,[34][35][36][37][38][45][46][47][48][49][50][51][52], while seven used a combination of sensors: three studies used temperature sensors alongside accelerome-ters [33,42,…”