Hip Fracture Prevention Trial Using Hip Protectors in Japanese Nursing Homes

Abstract

A method to protect the hips during falls could effectively reduce the incidence of hip fractures. We report the results of the first hip protector trial in Japan, performed between July 1996, and September 1999. One hundred and sixty-four elderly female residents of nursing homes, with Activities of Daily Living above the wheelchair level, agreed to participate in this study. Among them, 88 were randomly selected to wear a hip protector and 76 controls did not. All falls and resulting injuries were recorded daily. In anthropometric measurements and ultrasonic bone evaluation, no significant differences were found between the two groups, except in height. During an average of 377 days, the wearers and the non-wearers fell a total of 131 and 90 times, respectively. Among the wearers, there were two non-hip fractures and one hip fracture, so the annual hip fracture rate was calculated at 1.2%, against 8 hip fractures among the non-wearers, or 9.7% per year. The hip fracture rate was significantly lower among the wearers than non-wearers, while the annual number of falls per subject and the distribution of fallers remained the same. According to Cox's proportional hazard regression analysis, the effect of the hip protector on hip fracture prevention was independent of anthropometric data, ultrasonic bone assessment values or number of falls. Moreover, even after limiting the subjects to fallers only, the annual hip fracture rate in non-wearers was higher than in wearers (19.8% vs 2.0%) and the annual hip fracture rate per fall in wearers was lower than that in non-wearers (0.8% vs 8.2%). It was thus concluded that the hip protector is a beneficial device for the prevention of hip fractures.

Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis

“…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]. The ICC or VIF was not reported in the primary publication of any of the CRTs.…”

“…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.…”

“…There was no gender restriction in the trials, with the exception of the Harada et al trial [39], which included only women. For the three CRTs, we estimated the respective mean cluster sizes to be 19 in the Meyer et al trial, 186 in the Ekman et al trial, and 3 in the Harada et al trial (minimum plus maximum divided by two for the latter trial).…”

“…The duration of trials ranged from 11 to 15 months ( Table 1). 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.…”

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

“…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].…”