Prevention of Hip Fracture in Elderly People with Use of a Hip Protector

Kannus, Pekka; Parkkari, Jari; Niemi, Seppo; Pasanen, Matti; Palvanen, Mika; Järvinen, Markku; Vuori, Ilkka

doi:10.1056/nejm200011233432101

Cited by 470 publications

(245 citation statements)

References 32 publications

Supporting

Mentioning

206

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…The acceptance and compliance results of the other randomized clinical trials are presented in Table 3. Primary acceptance could be determined in only two randomized clinical trials, because in these studies the willingness to participate was assessed after randomization: 69% and 72% of the persons assigned to the hip protector group were willing to participate, respectively [25,28]. Compliance varied from 24% to 92%, with a median compliance of 57% (interquartile range 44-70%).…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…Primary acceptance was low to moderate: it ranged from 37% to 72% in the studies in which hip protectors were actually given to participants [17,[22][23][24][25]28,47]. Compliance varied between 20% and 92% [3,11,[16][17][18][19][20][21][22][23][24][25][26][27]29,30,32,47].…”

Section: Discussionmentioning

confidence: 99%

“…Compliance varied between 20% and 92% [3,11,[16][17][18][19][20][21][22][23][24][25][26][27]29,30,32,47]. The median acceptance and compliance were 68% (interquartile range 57-70%) and 56% (interquartile range 41-73%), respectively.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Schoor

Devillé

Bouter

et al. 2002

Osteoporosis International

128

View full text Add to dashboard Cite

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.

show abstract

Suggested Guidelines for Evaluation and Treatment of Glucocorticoid-Induced Osteoporosis for the Department of Veterans Affairs

Adler¹,

Hochberg²

2003

Arch Intern Med

View full text Add to dashboard Cite

show abstract

Prevention of Hip Fracture in Elderly People with Use of a Hip Protector

Cited by 470 publications

References 32 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

Suggested Guidelines for Evaluation and Treatment of Glucocorticoid-Induced Osteoporosis for the Department of Veterans Affairs

Contact Info

Product

Resources

About