van Schoor N M, Devillé W L, Bouter L M, Lips P
Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, The Netherlands.
Osteoporos Int. 2002 Dec;13(12):917-24. doi: 10.1007/s001980200128.
Hip fractures may be prevented by the use of external hip protectors, but compliance is often poor. Therefore, the objective of this study was to assess the determinants of compliance with hip protectors by systematically reviewing the literature. A literature search was performed in PubMed, Embase and the Cochrane Library. Primary acceptance with hip protectors ranged from 37% to 72% (median 68%); compliance varied between 20% and 92% (median 56%). However, in most studies it was not very clear how compliance was defined (e.g., average wearing time on active days and during waking hours, number of user-days per all available follow-up days, percentage falls with hip protector) and how it was measured. To provide more insight in the compliance percentages, the different methods of defining and measuring compliance were presented for the selected studies, when provided. Because of the heterogeneity in study design of the selected studies and the lack of quantitative data in most studies, results regarding the determinants of compliance could not be statistically pooled. Instead a qualitative summary of the determinants of compliance was given. The reasons most frequently mentioned for not wearing hip protectors, were: not being comfortable (too tight/poor fit); the extra effort (and time) needed to wear the device; urinary incontinence; and physical difficulties/illnesses. In conclusion, compliance is a very complex, but important issue in hip protector research and implementation. Based on the experiences of elderly people who wear the hip protectors, adjustments should be made to the protector and the underwear, while maintaining the force attenuation capacity. Furthermore, methods to improve the compliance should be developed, and their effectiveness tested.
使用外部髋部保护器可预防髋部骨折，但依从性通常较差。因此，本研究的目的是通过系统回顾文献来评估髋部保护器依从性的决定因素。在PubMed、Embase和Cochrane图书馆进行了文献检索。对髋部保护器的初次接受率在37%至72%之间（中位数为68%）；依从性在20%至92%之间变化（中位数为56%）。然而，在大多数研究中，依从性的定义（例如，活动日和清醒时间的平均佩戴时间、所有可用随访日中的使用天数、佩戴髋部保护器时跌倒的百分比）以及测量方法并不十分明确。为了更深入了解依从率，在有相关数据的情况下，针对所选研究介绍了定义和测量依从性的不同方法。由于所选研究在研究设计上存在异质性，且大多数研究缺乏定量数据，因此无法对依从性决定因素的结果进行统计学汇总。取而代之的是对依从性决定因素进行了定性总结。最常提到的不佩戴髋部保护器的原因是：不舒服（太紧/不合适）；佩戴该装置需要额外的努力（和时间）；尿失禁；以及身体困难/疾病。总之，依从性在髋部保护器的研究和应用中是一个非常复杂但重要的问题。根据佩戴髋部保护器的老年人的经验，应在保持力衰减能力的同时，对保护器和内衣进行调整。此外，应开发提高依从性的方法，并测试其有效性。
