Effect of external hip protectors on hip fractures

Lauritzen, Jes Bruun; Petersen, Michael Mørk; Lund, B.

doi:10.1016/0140-6736(93)92480-h

Cited by 552 publications

(215 citation statements)

References 11 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%

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%

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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“…The following factors may influence the compliance negatively: musculoskeletal or cerebral disorders [11]; adverse effects, such as skin irritation or abrasion, swelling of the legs, bowel irritation [25,26,30]; hip protector experienced as too hot [29,33], uncomfortable in bed [26,29,33] and necessitating assistance in toileting [29,33]; being bedridden [30]. Other factors may influence the compliance positively: the good understanding and sufficient motivation of the institution staff [27] or staff commitment [26]; dementia [27]; hip protectors feeling warm, increasing the feeling of safety and decreasing the fear of falling [29,33]; positive attitude of the staff because the patients could be left to walk around more freely [29,33].…”

Section: Resultsmentioning

confidence: 99%

“…When pooling the results of five studies [3,11,29,30,48], only 251 of 694 trial participants (36%) were wearing the hip protectors in the long term. Finally, hip protectors can improve self-confidence and diminish self-restraint of physical activity, which is often caused by fear of falling [38].…”

Section: Resultsmentioning

confidence: 99%

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Acceptance and Compliance with External Hip Protectors: A Systematic Review of the Literature

Schoor

Devillé

Bouter

et al. 2002

Osteoporosis International

129

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Abstract. Hip fractures may be prevented by the use of external hip protectors, but compliance is often poor. Therefore, the objective of this study was to assess the determinants of compliance with hip protectors by systematically reviewing the literature. A literature search was performed in PubMed, Embase and the Cochrane Library. Primary acceptance with hip protectors ranged from 37% to 72% (median 68%); compliance varied between 20% and 92% (median 56%). However, in most studies it was not very clear how compliance was defined (e.g., average wearing time on active days and during waking hours, number of user-days per all available follow-up days, percentage falls with hip protector) and how it was measured. To provide more insight in the compliance percentages, the different methods of defining and measuring compliance were presented for the selected studies, when provided. Because of the heterogeneity in study design of the selected studies and the lack of quantitative data in most studies, results regarding the determinants of compliance could not be statistically pooled. Instead a qualitative summary of the determinants of compliance was given. The reasons most frequently mentioned for not wearing hip protectors, were: not being comfortable (too tight/ poor fit); the extra effort (and time) needed to wear the device; urinary incontinence; and physical difficulties/ illnesses. In conclusion, compliance is a very complex, but important issue in hip protector research and implementation. Based on the experiences of elderly people who wear the hip protectors, adjustments should be made to the protector and the underwear, while maintaining the force attenuation capacity. Furthermore, methods to improve the compliance should be developed, and their effectiveness tested.

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“…Effective treatments are now available to reduce hip fractures in these high-risk patients, including the newer bisphosphonates (alendronate and risedronate) (7,8), calcium and vitamin D (9), and hip protectors for patients at increased risk of falling (10). This information has been presented widely to physicians through the medical literature and continuing education programs, yet recent reports suggest that hip fracture patients are not receiving adequate evaluation and treatment for osteoporosis (11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Hip fracture patients are not treated for osteoporosis: A call to action

Harrington

Broy

Derosa

et al. 2002

Arthritis & Rheumatism

146

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Objective. To determine whether hip fracture patients, a group at very high risk for additional fragility fractures, are being evaluated and treated effectively for osteoporosis. Methods. Clinical and bone densitometry (dual x-ray absorptiometry [DXA]) records were reviewed in hip fracture patients at 4 Midwestern US health systems to determine the frequency of DXA use, calcium and vitamin D supplementation, and antiresorptive drug treatment. Results. DXA was performed at the 4 study sites in only 12%, 12%, 13%, and 24% of patients, respectively. Calcium and vitamin D supplements were prescribed in 27%, 1%, 3%, and 25% of the patients at the 4 study sites. Antiresorptive drugs were prescribed in 26%, 12%, 7%, and 37% of the patients with only 2-10% receiving a bisphosphonate. Conclusion. Reducing osteoporotic fractures will require more effective approaches to managing hip fracture patients and other high-risk populations.

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Effect of external hip protectors on hip fractures

Cited by 552 publications

References 11 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

Acceptance and Compliance with External Hip Protectors: A Systematic Review of the Literature

Hip fracture patients are not treated for osteoporosis: A call to action

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