M J Parker1, L D Gillespie, W J Gillespie. 1. Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA. mjparker@doctors.org.uk
Abstract
BACKGROUND: Hip fracture in the elderly is usually the result of a simple fall. Hip protectors have been advocated as a means to reduce the risk of sustaining a fracture in a fall on the hip. OBJECTIVES: To determine if external hip protectors reduce the incidence of hip fractures in elderly persons following a fall. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and reference lists of relevant articles. Identified trialists were contacted. Date of the most recent search: December 2000. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing the use of hip protectors with a control group. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS: In this second update, a further trial has been included to bring the total number of included trials to seven (3553 participants). All studies involved elderly people in nursing homes or residential care or supported living at home, four within the Scandinavian countries, one in Japan, one in the United Kingdom and one in Australia. The three largest studies involving 3210 participants randomised by care unit, nursing home or nursing home ward rather than by the individual (cluster randomisation). One study of 141 individuals was primarily a compliance study lasting only 12 weeks. Summation of results from the other six studies gave an occurrence of hip fractures of 29/1313 (2.2%) for those allocated to wear hip protectors, against 130/2099 (6.2%) to those not allocated to wear protectors. However, due to the large number of participants allocated by cluster randomisation, it was not possible to determine if this difference between groups was statistically significant. No important adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor. REVIEWER'S CONCLUSIONS: Hip protectors appear to reduce the risk of hip fracture within a selected population at high risk of sustaining a hip fracture. The generalisation of the results is unknown beyond high-risk populations. Cost effectiveness is unclear. Results from ongoing trials may clarify this situation. Acceptability by users of the protectors remains a problem, due to discomfort and practicality.
BACKGROUND:Hip fracture in the elderly is usually the result of a simple fall. Hip protectors have been advocated as a means to reduce the risk of sustaining a fracture in a fall on the hip. OBJECTIVES: To determine if external hip protectors reduce the incidence of hip fractures in elderly persons following a fall. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and reference lists of relevant articles. Identified trialists were contacted. Date of the most recent search: December 2000. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing the use of hip protectors with a control group. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS: In this second update, a further trial has been included to bring the total number of included trials to seven (3553 participants). All studies involved elderly people in nursing homes or residential care or supported living at home, four within the Scandinavian countries, one in Japan, one in the United Kingdom and one in Australia. The three largest studies involving 3210 participants randomised by care unit, nursing home or nursing home ward rather than by the individual (cluster randomisation). One study of 141 individuals was primarily a compliance study lasting only 12 weeks. Summation of results from the other six studies gave an occurrence of hip fractures of 29/1313 (2.2%) for those allocated to wear hip protectors, against 130/2099 (6.2%) to those not allocated to wear protectors. However, due to the large number of participants allocated by cluster randomisation, it was not possible to determine if this difference between groups was statistically significant. No important adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor. REVIEWER'S CONCLUSIONS: Hip protectors appear to reduce the risk of hip fracture within a selected population at high risk of sustaining a hip fracture. The generalisation of the results is unknown beyond high-risk populations. Cost effectiveness is unclear. Results from ongoing trials may clarify this situation. Acceptability by users of the protectors remains a problem, due to discomfort and practicality.