Systematic review on the efficacy of hip protectors in preventing hip fracture

Abstract

Objective: To review and investigate the efficacy of hip protectors in preventing hip fractures in elderly. Methods: Literatures search was performed in 2 electronic databases, PubMed and Medline (OvidSP), with the application of inclusion and exclusion criteria. Keywords applied in the search included ‘hip protector AND fracture hip’. Systematic review of selected trials has been conductedto examine the reduction in geriatric hip fracture by applying hip protector. CONSORT was applied to test the quality of trials. Results: 11 randomized controlled trials were selected from PubMed and Medline (OvidSP) respectively. The average study period is 19.4 months. 6 trials are reported to have a reduction in hip fracture and fall. The compliance rate to hip protectors varies from 31% to 79.7% and a decreasing trend is noted in compliance with increasing study period. It was identified the design of randomization method is associated with the efficacy of hip protectors. The relative risk (RR) of hip fracture reduced in cluster randomization varies from 0.4 to 0.74. There is only 1 RCT in individual randomization reported a significant reduction in hip fracture (RR: 0.23; 95% CI: 0.08-0.67). 4 out of 5 individual randomization trails reported an insignificant effect in fracture reduction (RR: 0.77 to 3.49). Elderly in cluster randomization controlled trials enjoy a lower rate of hip fracture. Moreover, the efficacy of hip protector is positively related to the compliance rate. The methodological quality of include trials is valued by CONSORT with a three-point grading scale. The mean CONSORT grading score is 22.9, which implies the selected studies are well designed and interpreted. Discussion: The efficacy of hip protectors in preventing hip fractures is secured given that participants are located in nursing homes with adequate motivation given. The accountability of applying hip protectors in Hong Kong nursing homes is evaluated. It shares the same conclusion that hip fracture reduction can be achieved in Hong Kong institutions. Moreover, cultural and geographical differences are not obstacles for the reduction of hip fracture in Hong Kong elderly. As a result, a pilot program is suggested to further examine the effect of hip protectors with the application of the same type of hip protectors as this systematic review.The potential applicability in Hong Kong is subjected to the cost of hip protectors and resources allocated to implement the pilot study.