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Forebyggelse af hoftebrud med hoftebeskyttere. Risikofaktorer for fald, hoftebrud og mortalitet samt betydning af frygt for fald hos ældre ortopædkirurgiske patienter

Klaus Hindsø  


  Download file   (1179 KB) (The PhD dissertation is in Danish language)

Accepted by: Faculty of Health Science University of Copenhagen
Defended on: August 28, 1998
Official opponents: Bjarne Lund , Carsten Hendriksen , Peter Frandsen
Tutors: Jes Bruun Lauritzen , Stig Sonne-Holm

Published in the PhD Database: April 14, 2004


English abstract
The primary purpose with this Ph.D-thesis was to assess the primary acceptance and later compliance of hip protectors, and to evaluate the effect of hip protectors on the risk of hip fractures and on fear of falling. Baseline data were collected during a structured interview of 1,684 patients aged 75 years or more and admitted consecutively to one of two orthopaedic departments. The 1,006 patients admitted to one department (intervention group) were offered three pairs of energy dispersing hip protectors (Safehip), whereas the 678 patients admitted to the other department were controls. All patients were followed for 1 ¿ 2.5 years, and the number of new hip fractures was counted. Compliance of hip protectors was evaluated through questionnaires mailed to the users every third month. Median age was 83 years, women accounted for 81%, and 92% lived in their own home. Primary acceptance of hip protectors was 57% and was increased in men (64%) and in patients admitted after a hip fracture (65%). At 6 and 12 months following inclusion in this study 77% and 58% were still registered as users. Tendency for stopping the use of hip protectors was increased in patients admitted after a fall at inclusion and in patients with need for personal assistance when walking outdoors. The best compliance was observed in patients indicating fear of falling. Comparing the risk for new hip fractures between the intervention- and the control group (intention-to-treat analysis) no effect of the hip protectors was observed. Adjusting for the use (treatment-received-analysis) a statistically non-significant reduction of hip fracture risk could be related to the use of hip protectors (0.88 [0.50 ¿ 1.5]). In patients complaining of impaired distant vision hip protectors reduced the risk of hip fractures to 0.25 [0.08 ¿ 0.85] (treatment-received-analysis), and in several high-risk groups the same tendency was observed, however this study had not the power to give statistically significant estimates. Users reported 143 falls with impact on the hip protector. Only two hip fractures occurred while the hip protectors were worn, and in none of these cases an impact on the hip protector was observed. Nearly one half of the patients reported fear of falling, and 40 ¿ 60% of these patients stayed in some instances indoors because of the risk of falling. At the first questionnaire following inclusion 30% and 33% of the users indicated, that the hip protectors gave more confidence when walking in- and outdoors respectively; and 15% had spent more times being outdoors because of the use of hip protectors. In conclusion the primary acceptance of hip protectors in this population was 57%, and 58% of these were still users one year later. Hip protectors offers an effective protection against hip fractures ¿ but only when used. In the light of the described compliance no effect of hip protectors on intention-to-treat-basis could be observed in this population of elderly subjects, predominantly coming from their own home. There seemed to be effect in several high-risk groups, but this study had not the power to give statistically valid estimates in these subgroup analyses. Fear of falling is prevalent in old people, and it could be relevant to offer hip protectors to these patients with high risk of hip fracture, when falling tendency is also present.


Danish abstract
Formålet med phd-afhandlingen var primært at beskrive compliance samt effekten af hoftebeskyttere på risiko for hoftebrud og på frygt for fald hos ældre ortopædkirurgiske patienter. Data blev indsamlet ved interviews og undersøgelse af 1.684 patienter på mindst 75 år, konsekutivt indlagt på de ortopædkirurgiske afdelinger i Hvidovre og Bispebjerg. I Hvidovre blev 1.006 tilbudt hoftebeskyttere af den stødfordelende type (Safehip), mens 678 patienter i Bispebjerg fungerede som kontrolgruppe. Patienterne blev fulgt i 1 ¿ 2,5 år. Alders-median var 83 år, ratio af kvinder var 81% og 92% kom fra eget hjem. I interventionsgruppen accepterede 57% hoftebeskyttere og efter 6 og 12 måneder var hhv. 77% og 58% stadig registreret som brugere. Ved at sammenligne interventionsgruppen og kontrolgruppen fandtes ingen effekt af hoftebeskyttere. Korrigeret for brugen af hoftebeskyttere var effekten marginal (Incidensratio: 0,88 [95% SI: 0,50 ¿ 1,5]). Hos patienter med nedsat afstandssyn var effekten signifikant (0,25 [0,01 ¿ 0,85]), og i flere undergrupper blev der ligeledes fundet effekt, men undersøgelsen havde ikke styrke til at give sikre estimater. Blandt brugerne registreredes 143 fald på hoftebeskytteren. Kun to hoftebrud opstod mens hoftebeskytteren blev anvendt, og i disse tilfælde var der ikke observeret slag mod hoftebeskytteren. Hver tredje angav større tryghed ved færden inden- og udendøre, og 15% angav, at de oftere kom udendøre på grund af hoftebeskytterne. Hoftebeskyttere synes således at beskytte effektivt mod hoftebrud, hvis de anvendes. På baggrund af den beskrevne compliance kunne der ikke observeres effekt på intention to treat-basis. Der kan at være effekt i flere højrisiko-grupper, men undersøgelsen havde ikke styrke til at give statistisk valide estimater. Mange ældre er bange for at falde, og det kan være relevant at tilbyde hoftebeskyttere til disse patienter, hvis der samtidig er tale om manifest faldtendens.