External hip protectors to prevent osteoporotic hip fractures

Ekman, Anna; Mallmin, Hans; Michaëlsson, Karl; Ljunghall, Sverker

doi:10.1016/s0140-6736(05)63140-6

Cited by 133 publications

(82 citation statements)

References 3 publications

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“…For the CRTs, the unit of randomization was reported to be a nursing home in the Ekman et al [38] and Meyer et al [40] trials. Dr. Harada informed us that the unit of randomization in his study was by room number and that rooms contained up to four residents (average cluster size unknown) [39].…”

Section: Assessment Of Methodologic Features Of the Included Studiesmentioning

confidence: 99%

“…In the four trials included in the review, a total of 1,037 participants were allocated to the treatment arms and 885 participants allocated to the control arms [37][38][39][40]. There was no gender restriction in the trials, with the exception of the Harada et al trial [39], which included only women.…”

Section: Characteristics Of the Included Trialsmentioning

confidence: 99%

“…The Safe-hip protector (Tytex) brand of hip protector was used in the Harada et al [12,39], and Meyer et al [40] trials (Table 2); three protectors were provided per participant. The JOFA AB hip protector was used in the Ekman et al trial [38] whereas a hip protector designed by the primary authors was used in the Jantti et al trial [37], with the number of hip protectors provided per participant being unclear in each of these studies. Educational cointerventions or measures to encourage adherence (such as employment of staff to educate participants or caregivers or encourage adherence) were used in the Meyer et al [40] trial.…”

Section: Characteristics Of the Included Trialsmentioning

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: Assessment Of Methodologic Features Of the Included Studiesmentioning

confidence: 99%

Section: Characteristics Of the Included Trialsmentioning

confidence: 99%

Section: Characteristics Of the Included Trialsmentioning

confidence: 99%

See 1 more Smart Citation

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%

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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Prevention of Hip Fractures by External Hip Protectors

Schoor¹,

Smit²,

Twisk³

et al. 2003

JAMA

153

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ContextSeveral randomized controlled trials have been performed to examine the effectiveness of external hip protectors in reducing the incidence of hip fractures, but the results are controversial.ObjectiveTo examine the effectiveness of hip protectors in reducing the incidence of hip fractures in an elderly high-risk population.Design, Setting, and ParticipantsRandomized controlled trial of elderly persons aged 70 years or older, who have low bone density, and are at high risk for falls. Participants lived in apartment houses for the elderly, homes for the elderly, and nursing homes in Amsterdam and surrounding areas in the Netherlands. They were enrolled in the study between March 1999 and March 2001; the mean follow-up was 69.6 weeks. Of the 830 persons who were screened, 561 persons were enrolled.InterventionExternal hip protector. Both groups received written information on bone health and risk factors for falls.Main Outcome MeasureTime to first hip fracture. Survival analysis was used to include all participants for the time they participated.ResultsIn the intervention group, 18 hip fractures occurred vs 20 in the control group. Four hip fractures in the intervention group occurred while an individual was wearing a hip protector. At least 4 hip fractures in the intervention group occurred late at night or early in the morning. Both in univariate analysis (log-rank P = .86) and in multivariate analysis (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.55-2.03), no statistically significant difference between the intervention group and control group was found with regard to time to first hip fracture. In addition, the per protocol analysis in compliant participants did not show a statistically significant difference between the groups (HR, 0.77; 95% CI, 0.25-2.38).ConclusionThe hip protector studied was not effective in preventing hip fractures.

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External hip protectors to prevent osteoporotic hip fractures

Cited by 133 publications

References 3 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

Prevention of Hip Fractures by External Hip Protectors

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