Hip Protectors Research Articles

Skilled nursing resident adherence with wearable technology to offer safer mobility and decreased fall injuries

Hip fractures are a debilitating event for thousands of older adults each year in our communities and in our care facilities. The outcomes of sustaining a hip fracture include disability, significant cost and increased mortality in a growing population of those at risk of falls and fracture. Traditional methods of injury prevention from falls for those at risk of hip fracture include the wearing of hip protector clothing with limited adherence. A smart wearable designed to overcome barriers to adherence and offer hip protection with fall-sensing technology is emerging in older adult resident facilities to capture the fall as it occurs and avoid injury. This hip protection device has been evaluated in older adult residential settings to decrease fall injuries and support a culture of mobility. Adherence to the wear of the motion sensing technology can be accomplished by embedding the program into the daily care for residents identified as at risk of hip fracture. Successful adherence and shared results are illustrated with specific insight articulated in a single user case study.

Force attenuation properties of shear-thickening polymer (STP)-based hip protector in simulated sideways fall

Shear-thickening polymer (STP) has a unique property of increasing its viscosity with an increase in shear strain to attenuate the application of force, implying that it can be used as a material for hip protectors. This study introduces a new hip protector composed of STP and compares its force attenuation capacity to that of other commercial hip protectors in simulated sideways falls. The performance of the STP-based hip protector was analyzed against eight commercial hip protectors (Pelican, Posey, SafeHip, Hornsby, FallSafe, HipSaver, Impact Wear (Hard), Impact Wear (Soft)). The simulated sideways fall conditions were created by a drop weight impact testing system using an anatomical hip model. The machine was dropped from a 20 or 30 cm height resulting in impact energy of 25.1 J (low) or 44.1 J (moderate), respectively. At low impact energy, the commercial hip protectors showed an attenuation range from 21.6 % to 53.3 %, and the STP-based hip pad was able to attenuate the force by 42.7 %. At moderate impact energy, the commercial hip protectors showed an attenuation range from 23 % to 54.3 %, and the STP-based hip pad was able to attenuate the force by 32.6 %. The low coefficient of variance showed a high precision in the execution of the experiments. Although the STP-based hip protector was thinner than the average of commercial soft shell pads and retained comfortable fit, it showed comparable force attenuation capacity to the commercial ones for the low impact energy test. This study highlights that STP, in combination with a polyurethane foam layer, provides the best features in energy-absorption and shunting, showing that it can be used in hip protectors to gain a competitive advantage over others.

Hip Protectors and their Role in Hip Fracture Prevention: A Review

Hip fractures cause severe worldwide morbidity and loss of independence, costing national healthcare systems millions of pounds each year. The incidence is increasing with the expanding elderly population common of many Western countries. Hip protectors have been progressively studied in recent years focussing upon their use in hip fracture prevention, and compliance levels. This review aims to determine the effectiveness of protectors, and also investigates compliance levels. A search for English language Randomised Controlled Trials (RCTs) testing effectiveness of hip protectors was performed on Medline and Embase. Nine articles fulfilling the search criteria were found. Each was reviewed for hip protector effectiveness and compliance rates within the study, with results and conclusions critically-appraised. Of the nine articles, six (66.6%) found hip protectors to be effective in preventing hip fractures in selective populations. However, poor compliance rates were found in all reviewed trials. Future research should therefore focus upon improving compliance rates in the studied population.

Development of hip protectors for snowboarding utilizing 3D modeling and 3D printing

The purpose of this study was to develop a highly comfortable 3D male hip protector using 3D modeling and printing technologies. The hip protector pads and patterns were devised using 3D human body shapes, and three types of pads were chosen in consideration of snowboarding motions. The three types of pads were as follows: first, the original type with no hole; second, an inner open type with an incision on the inside; and third, an outer open type, with an incision on the outside. Another variable of the protective pads was the material: 3D printed thermoplastic polyurethane (TPU) pad + ethylene–vinyl acetate (EVA) foam or only EVA foam. Six types of pad prototypes were 3D printed and evaluated for subjective wearing comfort. Subjective comfort, fit, activity comfort, and shock absorption were evaluated on an 11-point Likert scale. The study results showed that protectors printed using TPU material were not different from the results of 3D modeling. The evaluation results revealed that comfort, fit, and motion comfort were all negatively evaluated by subjects when wearing the original pad. While fit, comfort, and motion comfort were all positively evaluated by subjects when wearing the outer open-type pad, and comfort and motion comfort were positively evaluated by subjects when wearing the inner open-type pad. With respect to materials, pads made with the 3D printing (TPU) and EVA foam combination provided the best results in terms of overall comfort, buttocks comfort, and activity comfort.

Design: A neglected factor in medicine

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스노보드 엉덩이 보호대 디자인을 위해 기술의 집을 이용한 소비자 요구도 및 제품설계요소 연구

스노보드 엉덩이 보호대 디자인을 위해 기술의 집을 이용한 소비자 요구도 및 제품설계요소 연구

Test Condition Optimization for Testing of Hip Protectors

Determining the efficacy of hip protectors designed to reduce the menace of the alarming rise in hip fracture due to fall among the elderly population is particularly challenging. Hip protector evaluation has been done using different soft tissue surrogate and at different energy level to determine the effectiveness of various hip protectors. However, some hip protectors that had been ranked effective in mechanical testing systems proof otherwise when deployed for clinical trials, this may be due to lack of optimization of the testing condition, most notably in testing when the soft tissue surrogate attenuates impacts that may be unduly attributed to the effectiveness of the hip protector. In this study, the performance of a surrogate soft tissue, fabricated from polyethylene, was evaluated at different energy levels (3.68 J – 37.9 J) to ascertain the optimal position for evaluating the efficacy of a hip protector to simulate a representative condition of an actual fall to the sideways by a person. A drop-weight impact testing machine was used to evaluate the impact force response of an employed femoral geometry with and without the soft tissue at various residual impact energy. The result showed that the soft tissue might be responsible for up to about 95.17 % of peak impact force attenuation if not adequately modelled. Therefore various conditions were examined to get representative sideways impact condition where the soft tissue employed do not attenuate beyond 11 - 28 % of the peak impact force. This finding demonstrates that the impact condition is as critical as all other parameters in determining the performance of a hip protector.

The Effect of Fall Biomechanics on Risk for Hip Fracture in Older Adults: A Cohort Study of Video-Captured Falls in Long-Term Care.

ABSTRACTOver 95% of hip fractures in older adults are caused by falls, yet only 1% to 2% of falls result in hip fracture. Our current understanding of the types of falls that lead to hip fracture is based on reports by the faller or witness. We analyzed videos of real‐life falls in long‐term care to provide objective evidence on the factors that separate falls that result in hip fracture from falls that do not. Between 2007 and 2018, we video‐captured 2377 falls by 646 residents in two long‐term care facilities. Hip fracture was documented in 30 falls. We analyzed each video with a structured questionnaire, and used generalized estimating equations (GEEs) to determine relative risk ratios (RRs) for hip fracture associated with various fall characteristics. All hip fractures involved falls from standing height, and pelvis impact with the ground. After excluding falls from lower than standing height, risk for hip fracture was higher for sideways landing configurations (RR = 5.50; 95% CI, 2.36–12.78) than forward or backward, and for falls causing hip impact (3.38; 95% CI, 1.49–7.67). However, hip fracture risk was just as high in falls initially directed sideways as forward (1.14; 95% CI, 0.49–2.67), due to the tendency for rotation during descent. Falling while using a mobility aid was associated with lower fracture risk (0.30; 95% CI, 0.09–1.00). Seventy percent of hip fractures involved impact to the posterolateral aspect of the pelvis. Hip protectors were worn in 73% of falls, and hip fracture risk was lower in falls where hip protectors were worn (0.45; 95% CI, 0.21–0.99). Age and sex were not associated with fracture risk. There was no evidence of spontaneous fractures. In this first study of video‐captured falls causing hip fracture, we show that the biomechanics of falls involving hip fracture were different than nonfracture falls for fall height, fall direction, impact locations, and use of hip protectors. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

Hip fracture risk functions for elderly men and women in sideways falls

Falls among the elderly cause a huge number of hip fractures world-wide. The objective is to generate hip fracture force risk functions for elderly women and men in sideways falls which can be used for determining effectiveness of fall prevention measures as well as for individual assessment of fracture risk at the clinics. A literature survey was performed and ten publications were identified who contained several hundred individual femoral neck fracture forces in sideways fall for both elderly women and men. Theoretical distributions were tested for goodness of fit against the pooled dataset with the Anderson-Darling test (AD-test) and root mean square errors (RMSE) were extracted. According to the AD-test, a Weibull distribution is a plausible model for the distribution of hip fracture forces. A simple, exponential two-parameter Weibull function was therefore proposed, having a RMSE below 2.2% compared to the experimental distribution for both men and women. It was demonstrated that elderly women only can endure nearly half the proximal femur force for 5 and 10% fracture risk as elderly men. It should be noted though, that women were found to have significantly lesser body height and body weight which would produce less impact force during falls from standing height. The proposed sex-specific hip fracture risk functions can be used for biomechanically optimizing hip protectors and safety floors and for determining their effectiveness as a fall prevention measure.

Effect of Femur Geometry on Hip Protectors Testing System

There have been different types of simplified femoral geometry incorporated into test systems for testing the biomechanical effectiveness of hip protectors. However, the effect of the simplification of femoral geometry in simulated sideways impact experiment has not been reported. In this study, an actual femoral geometry was fabricated and examined along with a simplified femoral geometry in a surrogate hip arrangement to mimic the fracture-causing situation in a sideways fall. A pendulum impact testing machine was used to evaluate the impact force response of both the femoral geometries at various velocity and constant residual impact energy for both geometries. The result showed that the peak impact force varied only 9% between actual and simplified geometries after normalizing the weight for both femurs in testing without a hip protector. However, a higher distinction of the impact force responses of both femurs was observed when testing with a hip protector. This findings at this moment suggest that the femur geometry affects the performance of a testing system. Therefore, the simplified femur geometry may not accurately substitute for the actual femur geometry in comparison of the impact attenuation of a hip protector in a simulated sideways fall.

Hip protectors are cost-effective in the prevention of hip fractures in patients with high fracture risk.

Cost-effective preventive interventions are necessary for tackling the increasing number of hip fractures, which are frequently occuring as a serious consequence of osteoporosis. Several interventions have been available for preventing and treating osteoporosis. The aim of this study wasto systematically review and critically appraise studies that assessed cost-effectiveness of hip protectors for the prevention of hip fractures and to investigate the effects of age, gender and residence situation on cost-effectiveness. A systematic review was conductedin order to identify economic evaluation studies examining the hip protector solely or compared tono treatment according to the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Synthesis of results was performed to observe trends between the studies. Methodological quality of the studies was assessed by the use of the Quality of Health Economic Studies (QHES) instrument. A total of 15 economic evaluation studies were included for analysis. The methodological quality was high in most studies (13/15). The hip protector was solely evaluated in three studies and within 12 other studies compared with no intervention. All studies that investigated the cost-effectiveness in long-term care facilities revealed that hip protector use is a cost-effective strategy for the prevention of hip fractures inelderly. Cost-effectiveness was also observed in two studies that provided hip protectors in a geriatric hospital ward. Four studies included both community-dwelling residents and residents living in a long-term care facility in their study. These studies showed more variability regarding cost-effectiveness. One study did not report information regarding the residence situation of their cohort, but also observed cost-effectiveness. In conclusion, this review suggests that hip protectors are a cost-effective approach in the prevention of hip fractures in populations with high risk of hip fractures especially in long-term care facilities and a geriatric ward in a hospital.

EVALUATION OF SMART BELT HIP PROTECTION IN A SKILLED NURSING FACILITY

Hip fractures impact > 300,000 US older adults yearly resulting in 70,000 deaths and are expected to gain in numbers with the rising population. Residents of skilled nursing facilities are among the highest at risk of sustaining hip fractures due to increased risk of falls and frailty. These most vulnerable stand to experience the most serious results of hip fracture with > 50% resulting in total dependency and/or death. Care providers are focused on providing an environment of safety with implementation of traditionally utilized fall prevention measures. Unfortunately, the maintenance of safety in this high-risk population often comes at the price of limiting independent mobility. The utilization of passive hip protector padding for those recognized as being at high risk of hip fracture can decrease the risk of hip fracture by 82%; however, challenges to adherence of hip protectors limit the effectiveness of this widely utilized measure. Emerging technology in the form of a smart belt was evaluated in a skilled nursing setting to offer insight into efficacy and user adherence. The smart belt is capable of sensing when the wearer is experiencing a motion that would likely result in a fall onto the hip, deploy an anatomically conforming airbag and alert caregivers that a fall has occurred. The embedding of the hip protection technology into care planning led to daily patient utilization totaling over 3000 hours. Specific findings of the user derived motion and experience will be articulated through case studies and illustration of the technology captured motion data.

Musculoskeletal Rehabilitation after Hip Fracture: A Review

AbstractWith increasing longevity, hip fractures become more and more a serious burden not only for societies in developed civilization, but also for emerging countries. According to world-wide projections 1.5 million people are affected each year. Although a lot of research has been performed over the last decade, there is still a lack of standardized and evidence-based approaches for prevention, treatment, and rehabilitation of this worst complication of osteoporosis.Therefore, the evidence base for this article was synthesized in accordance with SIGN methodology. Databases searched include Medline, Embase, Cinahl and the Cochrane Library between March 1999 and March 2019. The following terms are used: osteoporosis, hip fracture, rehabilitation, falls, muscle strength, nutrition, exercise, balance, sway, and hip protectors. Moreover, reference lists from included studies were checked and author`s names were searched for additional studies.Possibly, the best approach to rehabilitation after hip fracture is a multi-disciplinary team co-ordinating medical, social, educational and vocational measure for training or retraining the individual to the highest possible level of function. In order to prevent thromboembolism low-dose anti-coagulation therapy (e. g. fondaparinux, rivaroxaban) may be used for approximately two weeks after surgery. This should be accompanied by a daily nutritional intake of at least 20 g protein, 1200 mg of elemental calcium and 800 I. U. of vitamin D, whereas in severe vitamin D insufficiencies recommendations may be certainly higher.After surgical repair of the hip fracture, an anti-resorptive medication may be started. While balance training and performing of Tai Chi has been shown to reduce fall risk and thereby also decrease hip fracture risk, the use of hip protectors is still under evaluation and cannot be generally advocated.

Effectiveness of Hip Protectors to Reduce Risk for Hip Fracture from Falls in Long-Term Care

ObjectiveTo generate evidence of the effectiveness of hip protectors to minimize risk of hip fracture at the time of falling among residents of long-term care (LTC) by contrasting rates of hip fractures between falls with and without hip protectors. DesignA 12-month, retrospective cohort study. We retrospectively reviewed fall incident reports recorded during the 12 months prior to baseline in participating homes. Setting and participantsA population-based sample comprising all residents from 14 LTC homes owned and operated by a single regional health authority, who experienced at least 1 recorded fall during the 12-month study. ResultsAt baseline, the pooled mean (standard deviation) age of residents in participating homes was 82.7 (11.3) years and 68% were female. Hip protectors were worn in 2108 of 3520 (60%) recorded falls. Propensity to wear hip protectors was associated with male sex, cognitive impairment, wandering behavior, cardiac dysrhythmia, use of a cane or walker, use of anti-anxiety medication, and presence of urinary and bowel incontinence. The incidence of hip fracture was 0.33 per 100 falls in falls with hip protectors compared with 0.92 per 100 falls in falls without hip protectors, representing an unadjusted relative risk (RR) of hip fracture of 0.36 (95% confidence interval 0.14–0.90, P = .029) between protected and unprotected falls. After adjusting for propensity to wear hip protectors, the RR of hip fracture was 0.38 (95% confidence interval 0.14–0.99, P = .048) during protected vs unprotected falls. Conclusions and implicationsHip protectors were worn in 60% of falls, and the risk of hip fracture was reduced by nearly 3-fold by wearing a hip protector at the time of falling. Given that most clinical trials have failed to attain a similar level of adherence, our findings support the need for future research on the benefits of dissemination and implementation strategies to maximize adherence with hip protectors in LTC.

Test systems for the biomechanical evaluation of hip protectors: a systematic review.

Various mechanical and biomechanical test systems to evaluate the effectiveness of hip protectors designed to prevent hip fracture as a result of falls were examined in this review. The articles considered were selected systematically. The effect of differences in design criteria was demonstrated, and it was observed that the impact energy employed during testing dramatically affects the performance of the hip protector. Over the past three decades, researchers have continuously experimented with various systems to determine the efficacy of various hip protectors. The primary aim has been to make informed decisions in optimizing hip protector design. This article provides a systematic review of various test systems employed in the determination of the biomechanical efficacy of hip protectors. A systematic literature search was carried out, and 28 relevant articles were included to demonstrate the effect of test systems in the evaluation of the biomechanical effectiveness of hip protectors. Methodological studies illustrated the appropriate use of impact testing systems for the simulation of hip anatomy and fall dynamics in evaluating the effectiveness of hip protectors in preventing a hip fracture. This systematic review has demonstrated the effect of the variability of test systems on the evaluation of impact attenuation by various hip protectors. The lack of standardized test systems accounts for the inconsistencies in the test results of the efficacy of hip protectors. This has been a major challenge in the efforts of researchers to optimize the interventions. The standardization of test systems may require needed improvements immediately as opposed to the development of new interventions in order to ensure that only hip protectors with adequately proven efficacies are deployed for clinical trials or for the protection of the hips of vulnerable individuals from sideways impact.

Protector de cadera: la vida sigue igual

Background and objectiveIn 2004, a descriptive study evaluated the knowledge and use of the hip protector (HP) in private and subsidized private nursing homes of the Community of Madrid (Social Services Council), showing that the HP was little known and thus hardly used. The aim of this work is to determine, fourteen years later, whether the degree of knowledge on the HP and its use has improved. MethodsDescriptive study. Health professionals of private, subsidized private and public management nursing homes (n=216) and day centres (n=170) for the elderly (Social Policies and Family Council) in the Community of Madrid were interviewed by phone, between January and October, 2018. They were asked about the knowledge, use and prescription criteria of the HP. ResultsWe contacted 216 nursing homes and 209 responded. Thirty-four percent knew about the HP, and 7.2% used it. Of the 170 day centres, information was obtained from 158. Thirty-one point six percent knew about it, and 7.6% used it. ConclusionsKnowledge about the HP and its use has improved slightly, compared to 2004, in nursing homes and day centres of the Community of Madrid. However, it continues to be an underestimated and hardly used prevention measure.

Soft tissue stiffness over the hip increases with age and its implication in hip fracture risk in older adults

Risk of hip fracture depends on the bone strength as well as the impact force delivered to the proximal femur during falls, and femoral soft tissue may help to reduce the hip fracture risk by attenuating the impact force. Femoral soft tissue stiffness was measured from a large sample, and compared how this was affected by age, gender and site.One hundred fifty healthy individuals (fifty-two young (aged between 19 and 29), forty-eight middle-aged (30–64), and fifty old (over 65)) participated. Each age group included an equal number of males and females. Using an automated hand-held indentation device, soft tissue stiffness was measured over twelve sites with respect to the greater trochanter (GT).For both left and right hips, the stiffness was associated with age (p < 0.0005), gender (p < 0.0005), and site (p < 0.0005). On average, the stiffness was 26% greater in older than young adults (321.5 versus 254.3 N/m). On average across twelve sites, the regression analysis indicated that the stiffness increases 1.33 N/m every year (“soft tissue stiffness over the hip = 1.33*age + 221.8”; R = 0.518, p < 0.0005). Furthermore, the stiffness was 18% greater in male than female (308.8 versus 262.6 N/m), and differed across twelve sites over the hip, being greatest (424.2 N/m) at the GT, and least (206.3 N/m) at the superior gluteal region.The results provide insights into the shock absorbing property of soft tissue over the hip, and inform the improvement of fall-related injury prevention interventions (i.e., hip protector, safe landing strategies) in older adults.

Biomechanical testing of hip protectors following the Canadian Standards Association express document.

Each year, over 70,000 patients are admitted to hospital in the UK with hip fractures. There are a variety of commercial hip protectors currently available. However, it is not explicitly clear which is the most effective with regard to maximum force attenuation, whilst still being both comfortable for the user and providing reasonable force reduction if misplaced from the intended position. The numerous test methods reported in the literature have given conflicting results, making objective comparison difficult for users, researchers, and manufacturers alike. The Canadian Standards Association (CSA) has therefore published an express document (EXP-08-17) with a draft standard test method. This paper presents initial results for a range of hip protectors. Eighteen commercially available hip protectors were tested according to EXP-08-17. Each hip protector was impacted five times in correct anatomical alignment over the greater trochanter and once at 50mm displacements in the anterior, posterior, and lateral directions. Considerable differences were identified between individual hip protectors in their ability to reduce impact forces on the femur (between 3% and 36% reduction in peak force). The performance was reduced when misplaced in many cases (maximum reduction only 20%). This is the first study that uses a standard mechanical test on hip protectors. Previous studies have used a variety of methods, making it difficult to interpret results. We hope that these results using a standard test method will facilitate the effective comparison of results, as well as providing useful data for clinicians, users, and purchasers.

Designing better hip protectors: a critical and contextual review examining their acceptance and adoption in older populations

(2019). Designing better hip protectors: a critical and contextual review examining their acceptance and adoption in older populations. The Design Journal: Vol. 22, Running with Scissors: 13th International Conference of the European Academy of Design, Dundee, 10-12th April, 2019, edited by Louise Valentine, Joanna Bletcher and Leon Cruickshank, pp. 331-345.

Development of a stick-on hip protector: A multiple methods study to improve hip protector design for older adults in the acute care environment.

IntroductionOver 90% of hip fractures in older adults result from falls, and hospital patients are at especially high risk. Specific types of wearable hip protectors have been shown to reduce hip fracture risk during a fall by up to 80%, but user compliance has averaged less than 50%. We describe the development and evaluation of a “stick-on” hip protector (secured over the hip with a skin-friendly adhesive) for older patients in acute care.MethodsAn initial version of the product was evaluated with six female patients (aged 76–91) in a hospital ward, who were asked to wear it for one week. We subsequently refined the product through biomechanical testing and solicited feedback from 43 health professionals on a second prototype.ResultsThe first prototype was worn by five of six patients for the full week or duration of their hospital stay. The second prototype (20 mm thick, surface area 19 × 15.5 cm) provided 36% force attenuation, more than common garment-based models (20–21%). Feedback from patients and health professionals highlighted usability, comfort, cost, and appearance.ConclusionsOur results from biomechanical and user testing support the need for further work to determine the value of stick-on hip protectors in acute care.