Hip protectors for preventing hip fractures in older people.
نویسندگان
چکیده
BACKGROUND Older people living in nursing care facilities or older adults living at home are at high risk of falling and a hip fracture may occur after a fall. Hip protectors have been advocated as a means to reduce the risk of hip fracture. Hip protectors are plastic shields (hard) or foam pads (soft), usually fitted in pockets in specially designed underwear.This is an update of a Cochrane review first published in 1999, and updated several times, most recently in 2010. OBJECTIVES To determine if the provision of external hip protectors (sometimes referred to as hip pads or hip protector pads) reduces the risk of fracturing the hip in older people. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12), MEDLINE (1950 to week 3 November 2012), MEDLINE In-Process (18 December 2012), EMBASE (1988 to 2012 Week 50), CINAHL (1982 to December 2012), BioMed Central (January 2010), trial registers and reference lists of relevant articles. SELECTION CRITERIA All randomised or quasi-randomised controlled trials comparing an intervention group provided with hip protectors with a control group not provided with hip protectors. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and extracted data. We sought additional information from trialists. Data were pooled using fixed-effect or random-effects models as appropriate. MAIN RESULTS This review includes 19 studies, nine of which were cluster randomised. These included approximately 17,000 people (mean age range 78 to 86 years). Most studies were overall at low risk of bias for fracture outcomes. Trials tested hard or soft hip protectors enclosed in special underwear in 18 studies.Pooling of data from 14 studies (11,808 participants) conducted in nursing or residential care settings found moderate quality evidence for a small reduction in hip fracture risk (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.67 to 1.00); the absolute effect is 11 fewer people (95% CI, from 20 fewer to 0) per 1000 having a hip fracture when provided with hip protectors.There is moderate quality evidence when pooling data from five trials in the community (5614 participants) that shows little or no effect in hip fracture risk (RR 1.15, 95% CI 0.84 to 1.58); the absolute effect is two more people (95% CI 2 fewer to 6 more) per 1000 people having a hip fracture when provided with hip protectors.There is probably little to no effect on falls (rate ratio 1.02, 95% CI 0.9 to 1.16) or fractures other than of the hip or pelvis (rate ratio 0.87, 95% CI 0.71 to 1.07). However, the risk ratio for pelvic fractures is RR 1.27 (95% CI 0.78 to 2.08); this is an absolute effect of one more person (95% CI 1 fewer to 5 more) per 1000 having a pelvic fracture when provided with hip protectors.The incidence of adverse events while wearing hip protectors, including skin irritation, ranged from 0% to 5%. Adherence, particularly in the long term, was poor. AUTHORS' CONCLUSIONS Hip protectors probably reduce the risk of hip fractures if made available to older people in nursing care or residential care settings, without increasing the frequency of falls. However, hip protectors may slightly increase the small risk of pelvic fractures. Poor acceptance and adherence by older people offered hip protectors is a barrier to their use. Better understanding is needed of the personal and design factors that may influence acceptance and adherence.
منابع مشابه
What is the role of falls ? Jacqueline
There is now firm evidence to support interventions in the prevention of falls in older people, and emerging data support prevention of falls as a method of fracture prevention. This chapter discusses the epidemiology of falls, risk factors associated with an increased risk of falling, assessment of the older faller, and evidence-based approaches to the prevention of falls in the older person. ...
متن کاملReview: evidence from individually randomised trials shows that hip protectors do not reduce hip fractures in elderly people.
Parker MJ, Gillespie LD, Gillespie WJ. Hip protectors for preventing hip fractures in the elderly. Cochrane Database Syst Rev 2004;(3):CD001255. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...
متن کاملFactors associated with the initial acceptance of hip protectors amongst older people in residential care.
Factors associated with the initial acceptance of hip protectors amongst older people in residential care SIR—Hip fractures in older people are a major public health problem. Hip protectors have been advocated as a means of preventing hip fractures in this group [1]. The impact of hip fracture and methods of prevention can be found in Appendix 1 of the supplementary data on the journal website ...
متن کاملPrevention of hip fracture with hip protectors.
The prevention of fractures amongst older people consists of (i) prevention and treatment of osteoporosis, (ii) prevention of falling and (iii) prevention of fractures using injury-site protection. As the great majority of hip fractures are caused by a sideways fall with direct impact on the greater trochanter of the proximal femur, one approach to prevention is the use of an adequately configu...
متن کاملEffectiveness of hip protectors for preventing hip fractures in elderly people: systematic review.
OBJECTIVES To present the updated results of systematic review of the current evidence for the effectiveness of hip protectors from reports of completed randomised trials, and to explore the evolution of that evidence. DESIGN Systematic review with meta-analysis. DATA SOURCES Cochrane Bone, Joint, and Muscle Trauma Group trials register (January 2005), Cochrane central register of controlle...
متن کاملHip protector compliance among older people living in residential care homes.
OBJECTIVES To estimate the compliance rates for the use of hip protectors among people living in residential care homes. Population/setting: People aged 65 years and over living in residential care homes with 20 or more beds in East Kent, south east England. METHODS Seventeen homes with the highest historical frequency of hip fractures were selected. All residents were offered SAFEHIP hip pro...
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عنوان ژورنال:
- Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention
دوره 16 6 شماره
صفحات -
تاریخ انتشار 2005