Hip protectors: recommendations for conducting clinical trials—an international consensus statement (part II)

IntroductionWhile hip protectors are effective in some clinical trials, many, including all in community settings, have been unable to demonstrate effectiveness. This is due partly to differences in the design and analysis. The aim of this report is to develop recommendations for subsequent clinical research.MethodsIn November of 2007, the International Hip Protector Research Group met to address barriers to the clinical effectiveness of hip protectors. This paper represents a consensus statement from the group on recommended methods for conducting future clinical trials of hip protectors.Results and conclusionsConsensus recommendations include the following: the use of a hip protector that has undergone adequate biomechanical testing, the use of sham hip protectors, the conduct of clinical trials in populations with annual hip fracture incidence of at least 3%, a run-in period with demonstration of adequate adherence, surveillance of falls and adherence, and the inclusion of economic analyses. Larger and more costly clinical trials are required to definitively investigate effectiveness of hip protectors.

[1]  S. Lord,et al.  Risk Factors for Fracture Following a Fall Among Older People in Residential Care Facilities in Australia , 2008, Journal of the American Geriatrics Society.

[2]  A. Anis,et al.  Cost-effectiveness of hip protectors in the prevention of osteoporosis related hip fractures in elderly nursing home residents. , 2004, The Journal of rheumatology.

[3]  R. Norton,et al.  Circumstances of Falls Resulting in Hip Fractures Among Older People , 1997, Journal of the American Geriatrics Society.

[4]  D. Kiel,et al.  An Epidemiologic Study of Fall‐Related Fractures Among Institutionalized Older People , 1995, Journal of the American Geriatrics Society.

[5]  S. Lord,et al.  Differing Risk Factors for Falls in Nursing Home and Intermediate‐Care Residents Who Can and Cannot Stand Unaided , 2003, Journal of the American Geriatrics Society.

[6]  D. Kiel,et al.  The Hip Impact Protection Project: design and methods , 2008, Clinical trials.

[7]  K. Michaëlsson,et al.  External hip protectors to prevent osteoporotic hip fractures , 1997, The Lancet.

[8]  Ari Heinonen,et al.  Shifting the focus in fracture prevention from osteoporosis to falls , 2008, BMJ : British Medical Journal.

[9]  M. M. Petersen,et al.  Effect of external hip protectors on hip fractures , 1993, The Lancet.

[10]  Jacek A Kopec,et al.  A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. , 2005, Social science & medicine.

[11]  J. Howland,et al.  Hip protectors efficacy and barriers to adoption to prevent fall-related injuries in older adults: findings and recommendations from an international workgroup. , 2006, Journal of safety research.

[12]  M. Seguí-Gómez,et al.  COST AND EFFECTIVENESS OF HIP PROTECTORS AMONG THE ELDERLY , 2002, International Journal of Technology Assessment in Health Care.

[13]  D. Altman,et al.  CONSORT statement: extension to cluster randomised trials , 2004, BMJ : British Medical Journal.

[14]  Y. Hirota,et al.  External hip protectors are effective for the elderly with higher-than-average risk factors for hip fractures , 2009, Osteoporosis International.

[15]  R. Cumming,et al.  Adherence with hip protectors: a proposal for standardised definitions , 2004, Osteoporosis International.

[16]  A. Gafni,et al.  Do hip protectors decrease the risk of hip fracture in institutional and community-dwelling elderly? A systematic review and meta-analysis of randomized controlled trials , 2005, Osteoporosis International.

[17]  A. Wettstein,et al.  Acceptance of Hip Protectors for Hip Fracture Prevention in Nursing Homes , 2001, Osteoporosis International.

[18]  M. Järvinen,et al.  Majority of Hip Fractures Occur as a Result of a Fall and Impact on the Greater Trochanter of the Femur: A Prospective Controlled Hip Fracture Study with 206 Consecutive Patients , 1999, Calcified Tissue International.

[19]  R. Francis,et al.  Randomized controlled trial of hip protectors among women living in the community , 2004, Osteoporosis International.

[20]  H Inskip,et al.  Will elderly rest home residents wear hip protectors? , 1998, Age and ageing.

[21]  E. Barrett-Connor,et al.  Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. , 2001, JAMA.

[22]  Kim Delbaere,et al.  Development and validation of fall risk screening tools for use in residential aged care facilities , 2008, The Medical journal of Australia.

[23]  A. C. Laing,et al.  Hip protectors: recommendations for biomechanical testing—an international consensus statement (part I) , 2009, Osteoporosis International.

[24]  H. Orimo [FRAX--Fracture Risk Assessment Tool by WHO]. , 2009, Clinical calcium.

[25]  D Moher,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. , 2001, Annals of internal medicine.

[26]  O. Johnell,et al.  World-wide Projections for Hip Fracture , 1997, Osteoporosis International.

[27]  C. Becker,et al.  Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus , 2005, Journal of the American Geriatrics Society.

[28]  R. Cumming,et al.  Hip protectors in aged-care facilities: a randomized trial of use by individual higher-risk residents. , 2001, Age and ageing.

[29]  W. Hung,et al.  Effectiveness and acceptability of a newly designed hip protector: a pilot study. , 2000, Archives of gerontology and geriatrics.

[30]  G. Kernohan,et al.  A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes. , 2004, Age and ageing.

[31]  A. Bergland,et al.  Uptake and adherence with soft- and hard-shelled hip protectors in Norwegian nursing homes: a cluster randomised trial , 2007, Osteoporosis International.

[32]  L. Gillespie,et al.  Hip protectors for preventing hip fractures in older people. , 2010, The Cochrane database of systematic reviews.

[33]  D. Kiel,et al.  Efficacy of a Hip Protector to Prevent Hip Fracture in Nursing Home Residents The HIP PRO Randomized Controlled Trial , 2007 .

[34]  D. Moher,et al.  Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. , 2008, Annals of internal medicine.

[35]  C. Becker,et al.  Hip Fractures in Institutionalized Elderly People: Incidence Rates and Excess Mortality , 2008, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[36]  P. Lips,et al.  Biomechanical comparison of hard and soft hip protectors, and the influence of soft tissue. , 2006, Bone.

[37]  R. Cumming,et al.  A randomised trial of hip protector use by frail older women living in their own homes , 2003, Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention.

[38]  O. Johnell,et al.  An Assessment Tool for Predicting Fracture Risk in Postmenopausal Women , 2001, Osteoporosis International.

[39]  Stirling Bryan,et al.  EQ-5D in Patients With Dementia An Investigation of Inter-Rater Agreement , 2001, Medical care.

[40]  S. Datta,et al.  An economic analysis of external hip protector use in ambulatory nursing facility residents. , 2003, Age and ageing.

[41]  Lex M Bouter,et al.  Prevention of hip fractures by external hip protectors: a randomized controlled trial. , 2003, JAMA.

[42]  K. Michaëlsson,et al.  Simply ask them about their balance--future fracture risk in a nationwide cohort study of twins. , 2008, American journal of epidemiology.

[43]  N. Niino,et al.  Hip Fracture Prevention Trial Using Hip Protectors in Japanese Nursing Homes , 2001, Osteoporosis International.

[44]  Gabriele Meyer,et al.  Effect on hip fractures of increased use of hip protectors in nursing homes: cluster randomised controlled trial , 2003, BMJ : British Medical Journal.

[45]  P Kannus,et al.  Prevention of hip fracture in elderly people with use of a hip protector. , 2000, The New England journal of medicine.

[46]  D. Moher,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials , 2001, The Lancet.