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S N Robinovitch,
S L Evans,
J Minns,
A C Laing,
P Kannus,
P A Cripton,
S Derler,
S J Birge,
D Plant, I D Cameron,
D P Kiel,
J Howland,
K Khan,
J B Lauritzen
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ABSTRACT: Hip protectors represent a promising strategy for preventing fall-related hip fractures. However, clinical trials have yielded conflicting results due, in part, to lack of agreement on techniques for measuring and optimizing the biomechanical performance of hip protectors as a prerequisite to clinical trials.
In November 2007, the International Hip Protector Research Group met in Copenhagen to address barriers to the clinical effectiveness of hip protectors. This paper represents an evidence-based consensus statement from the group on recommended methods for evaluating the biomechanical performance of hip protectors.
The primary outcome of testing should be the percent reduction (compared with the unpadded condition) in peak value of the axial compressive force applied to the femoral neck during a simulated fall on the greater trochanter. To provide reasonable results, the test system should accurately simulate the pelvic anatomy, and the impact velocity (3.4 m/s), pelvic stiffness (acceptable range: 39-55 kN/m), and effective mass of the body (acceptable range: 22-33 kg) during impact. Given the current lack of clear evidence regarding the clinical efficacy of specific hip protectors, the primary value of biomechanical testing at present is to compare the protective value of different products, as opposed to rejecting or accepting specific devices for market use.
Osteoporosis International 10/2009; 20(12):1977-88. · 4.58 Impact Factor
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I D Cameron,
S Robinovitch,
S Birge,
P Kannus,
K Khan,
J Lauritzen,
J Howland,
S Evans,
J Minns,
A Laing,
P Cripton,
S Derler,
D Plant,
D P Kiel
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ABSTRACT: While 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.
In 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.
Consensus 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.
Osteoporosis International 10/2009; 21(1):1-10. · 4.58 Impact Factor
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ABSTRACT: Cognitive impairment, especially dementia, has been found to be a major risk factor for elder abuse. This paper reports a study of 54 cases of abuse and 100 non-abused people with dementia seen by the Hornsby Rehabilitation & Aged Care Service in 1990–91. The aim of the study was to investigate the relationship between dementia and elder abuse considering the person with dementia as either the victim or abuser. The findings confirmed that when dementia was combined with factors such as psychiatric illness or substance abuse on the part of the carer, or pre-existing family conflict (including domestic violence), there was a significant risk of abuse occurring. However, dementia did not place the sufferer at greater risk of physical and psychological abuse, even when there was disturbed behaviour such as aggression and paranoia. Carers appeared to be at particular risk of physical abuse and psychological abuse. When abuse did occur, extra services of some types were required to maintain the person with dementia in the community, although victims were not at greater risk of institutionalisation than non-abused dementia sufferers.
Australasian Journal on Ageing 12/2008; 14(1):36 - 40. · 0.90 Impact Factor
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ABSTRACT: The fracture predictive value of quantitative ultrasound (QUS) may be modified by previous fracture status. Non-significant associations between QUS parameters and fracture risk were observed among frail older people with a history of fracture. These findings suggest that QUS measurements for frail older people might be more useful in those without a fracture history.
Quantitative ultrasound has been shown to predict risk of fracture in various populations. However, this ability may be modified by the presence of previous fracture in very frail older people.
We assessed bone strength by QUS and clinical risk factors at baseline for 1,982 institutionalised older people. Fractures were ascertained for 2 years from baseline and validated by X-ray reports.
Study participants were very old (mean age = 85.7 +/- 7.1 years) and frail (70% using walking aids). Forty-five percent reported a history of fracture. During a mean follow-up period of 1.64 years, 335 participants suffered a fracture or fractures. Fracture rates were significantly higher in participants with a history of fracture compared with those without a history of fracture (16.0 vs 9.2 per 100 person years, p < 0.001). Significant associations between fracture risk and QUS parameters (broadband ultrasound attenuation and velocity of sound) were observed among participants without a history of fracture (both p < 0.01), but not among those who had a fracture history (both p >/= 0.7).
In very frail older people, QUS measurements may be more useful for assessing fracture risk in those without a history of fracture after age 50.
Osteoporosis International 05/2008; 20(1):105-12. · 4.58 Impact Factor
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I Cameron,
M Crotty,
C Currie,
T Finnegan,
L Gillespie,
W Gillespie,
H Handoll,
S Kurrle,
R Madhok,
G Murray,
K Quinn,
D Torgerson
Health technology assessment (Winchester, England) 02/2000; 4(2):i-iv, 1-111. · 4.26 Impact Factor
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Journal of the American Geriatrics Society 10/1997; 45(9):1158. · 3.74 Impact Factor
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The Medical journal of Australia 11/1996; 165(8):459-60. · 2.81 Impact Factor
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The Medical journal of Australia 12/1993; 159(10):707-8. · 2.81 Impact Factor
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ABSTRACT: This carer study forms part of a wider study which compares accelerated rehabilitation after proximal femoral fracture with conventional care. Two measures of burden on family caregivers were used; social worker's assessment of overall burden and an index of disruption to carers' lives. Participants were carers of 200 patients interviewed at five periods up to 12 months after fracture. Carer burden prior to the fracture was the strongest predictor of subsequent burden, with carers of patients in nursing homes and patients with a cognitive or physical disability being more burdened. Carer burden may increase or decrease after the patient's injury, irrespective of randomization group. There is no simple relationship between burden and randomized group. Accelerated rehabilitation does not impact greatly on carer burden, but already severely burdened carers may benefit from additional counselling/information. Specific ways in which carers; lives were disrupted are reported.
Disability and Rehabilitation 16(4):191-7. · 1.50 Impact Factor
