Key result
Although pooled data showed hip protectors reduced hip fractures in institutional settings (RR 0.77), suboptimal implementation in primary trials questions conclusions about their ineffectiveness.
Why the study?
Do hip protectors prevent hip fractures in high-risk elderly populations?
Do hip protectors prevent hip fractures in high-risk elderly populations?
The apparent ineffectiveness of hip protectors in recent trials may be driven by suboptimal implementation and low adherence rather than a true lack of efficacy.
Hip protectors seemed to be the only non-pharmacological intervention to effectively prevent hip fractures in high-risk populations. In contrast, recently published trials did not find hip fracture reduction through hip protector interventions. An updated Cochrane review concluded that the device is ineffective for community-dwelling elderly and of uncertain effectiveness for institutionalised elderly. However, some primary studies used suboptimal implementation of hip protectors, which has led to low adherence and ineffectiveness of the intervention. Shortcomings in implementation techniques have not been assessed by the Cochrane review. Therefore, reviewers should explicitly assess whether the intervention was well planned and competently administered. As a checklist cannot adequately assess individual, study-specific implementation flaws, we suggest narrative expert review and feedback to the authors of the primary study.
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Meyer et al. (2006) conducted a review in Hip fractures. Hip protectors vs. No hip protectors was evaluated on Incidence of hip fractures in institutional settings (RR 0.77, 95% CI 0.62 to 0.97). Although pooled data showed hip protectors reduced hip fractures in institutional settings (RR 0.77), suboptimal implementation in primary trials questions conclusions about their ineffectiveness.
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