Hip protectors for preventing hip fractures in the elderly.

backgroundHip fracture in the elderly is usually the result of a simple fall and hip protectors have been advocated as a means to reduce impact and consequences of such falls.

objectivesTo determine if external hip protectors reduce the incidence of hip fractures in elderly persons following a fall. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, MEDLINE, and reference lists of relevant articles were searched, and identified trialists contacted. Date of the most recent search: August 1998. 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

resultsFive randomised trials involving 1681 participants were included within the review. All studies involved elderly people in nursing homes or residential care, three within the Scandinavian countries, one in Japan and one in the United Kingdom. The two largest studies involving 1409 participants randomised by nursing home or nursing home ward rather than by the individual (cluster randomisation). One study of 141 individuals was primarily a compliance study. Summation of results from four of these studies gave an occurrence of hip fractures of 13/620 (2.1%) for those allocated to wear hip protectors, against 57/920 (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 demonstrate conclusively that this difference between groups was statistically significant. Only one of the 13 hip fractures that occurred in the individuals allocated to wear hip protectors occurred whilst the protector was worn. No significant adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor. REVIEWER'S

conclusionsHip protectors appear to reduce the risk of hip fracture within a selected population at high risk of sustaining a hip fracture. However, this conclusion is based on four trials of low to moderate quality. As two used cluster randomisation, pooling of data was not possible. The generalisability of the results is unknown beyond high-risk populations. Results from six ongoing trials may clarify this situation. Acceptability by users of the protectors remains a problem, due to discomfort and practicality.