1,283 research outputs found

    Acceptance and compliance with external hip protectors: A systematic review of the literature

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    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. (aut.ref.

    Smart clothing for falls protection and detection: User-centred co-design and feasibility study

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    The prevalence and impact of hip fractures on the health and wealth of nations is a global problem and source of health inequalities. This paper reports on the co-design and feasibility testing of a new range of protective, smart clothing. The feasibility of research in a population of older adults in supported living is explored, as are the conceptualisation and measurement of adherence

    The optimisation of flexible impact-protection systems for varying strain rates and energies.

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    The need for smarter and active, energy absorbing systems designed especially for human protection applications has sparked interest in highly strain rate sensitive compounds. This thesis describes the iterative design, development and optimisation of a novel form of energy absorbing, body worn protection. The original contribution to knowledge is the development of a novel strain rate sensitive protection system incorporating synergetic internal architecture. Co-continuous blends of silicone based dilatant and thermoplastic elastomer have been developed through a recursive design process to develop a new material specifically optimised for body worn protection. Failure mechanisms were analysed, and from these results techniques have been developed to mitigate internal fracture mechanisms. This enabled the development of a strain rate sensitive material utilised with an internal architecture. The novel material properties were examined and developed using monolithic samples, tested at a variety of energies, speed and environmental conditions. Methods for designing and developing auxetic structures that work synergistically with the new material have been developed. The novel system has also been combined with textiles, and the merit of this combination explored. An improvement in performance has been validated, as well as a design improvement through being able to attach parts directly to garments. The resulting impact protectors are applicable over a range of strain rates. Systems have been designed to incorporate this novel technology in pre-production prototypes in three selected market areas, which typify low, medium and high impact speeds. The work also explores the systems ability to manage multiple impacts at the same location with a surprisingly low loss in performance, effectively making a protector that can withstand repeat impacts. This work has contributed to the methods previously used in testing personal protective equipment. The techniques developed in this work have enabled new revision of these PPE standards, as well as directly contributing to two new standards.Open Acces

    Objective methods of monitoring usage of orthotic devices for the extremities: a systematic review

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    Orthoses are commonly prescribed to relieve symptoms for musculoskeletal and neurological conditions; however, patients stop wearing orthoses as recommended for many reasons. When considering the effectiveness of orthoses, there needs to be an objective way to monitor whether participants wear the orthosis as instructed, because if this is not followed, the orthoses will not work as intended. This review aimed to identify, summarise, and compare objective methods used to measure compliance with orthoses applied to the extremities. Databases (Scopus, Web of Science, Embase, CINAHL, and MEDLINE) were searched for eligible studies. Twenty-three studies were accepted in the final review, including five studies that employed upper limb orthoses, two that employed hip orthoses, and fifteen that employed lower limb orthoses. To measure compliance objectively, studies utilised temperature sensors, pressure sensors, accelerometers, a step counter, or a combination of sensors. All sensor types have their own advantages and disadvantages and should be chosen based on study-specific parameters. Sensor-derived monitoring provides quantitative, objective data that are beneficial in both clinical and research settings. The ideal solution to monitoring compliance would consist of both objective and user-reported aspects that, in combination, would provide an all-encompassing picture of the orthotic treatment prescribed

    Determining impact intensities in contact sports

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    Most sports Personal Protective Equipment (PPE) consist of varying levels of foam – more foam equals more protection. This has led to bulky, cumbersome PPE which restricts user movement. However, before existing PPE can be modified, their performance must be assessed and a baseline for necessary protection must be explicitly determined. This is a major limitation since current techniques for assessing PPE performance and impact intensity measurements from sport have used surrogate anvils and impactors which were not validated for the sports-related impact they tried to replicate. Through a series of independent studies, a better understanding of human impact response in sporting impacts was sought. This included investigating methods for improving the measurement of impact intensities in sports and the assessment of PPE performance. Human impact response revealed that tensed muscle led to a significant increase in impact force but was associated with less perceived discomfort. At low impact intensities common to sport, the increased local stiffness helped to dissipate impact energy and reduce soft tissue compression. As previous anvils omitted this soft tissue response, modifications were made to a martial arts dummy, BOBXL, to increase its biofidelity. This anvil was validated using in vivo kicks and an impact force – impact velocity relationship. Using this validated anvil, existing methods of assessing PPE performance were evaluated. Current methods were found to create artificially comparable levels of force but did so by using an incorrect effective mass and impact velocity. In all tests, PPE performance was found to depend on weight providing evidence of the ‘more protection, more foam’ concept. As it is impractical to use in vivo kicks to assess PPE performance, kick kinematics were investigated to assess its variability in terms of the impact force – impact velocity relationship and its accuracy. This aided in the development of a mechanical kicking robot which could more properly assess PPE performance. This research was applied to the design of form-fitting, impact-mitigating sports PPE with the capability for integrated technology. Proposed amendments to the current methods of assessing PPE will help to develop better testing and better performing PPE in the future

    Using a community of practice to evaluate falls prevention activity in a residential aged care organisation: a clinical audit

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    Objective This study evaluates whether a community of practice (CoP) could conduct a falls prevention clinical audit and identify gaps in falls prevention practice requiring action. Methods Cross-sectional falls prevention clinical audits were conducted in 13 residential aged care (RAC) sites of a not-for-profit organisation providing care to a total of 779 residents. The audits were led by an operationalised CoP assisted by site clinical staff. A CoP is a group of people with a shared interest who get together to innovate for change. The CoP was made up of self-nominated staff representing all RAC sites and comprised of staff from various disciplines with a shared interest in falls prevention. Results All 13 (100%) sites completed the audit. CoP conduct of the audit met identified criteria for an effective clinical audit. The priorities for improvement were identified as increasing the proportion of residents receiving vitamin D supplementation (mean 41.5%, s.d. 23.7) and development of mandatory falls prevention education for staff and a falls prevention policy, as neither was in place at any site. CoP actions undertaken included a letter to visiting GPs requesting support for vitamin D prescription, surveys of care staff and residents to inform falls education development, defining falls and writing a falls prevention policy. Conclusion A CoP was able to effectively conduct an evidence-based falls prevention activity audit and identify gaps in practice. CoP members were well positioned, as site staff, to overcome barriers and facilitate action in falls prevention practice

    Precaution, governance and the failure of medical implants: the ASR(TM) hip in the UK

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    Hip implants have provided life-changing treatment, reducing pain and improving the mobility and independence of patients. Success has encouraged manufacturers to innovate and amend designs, engendering patient hopes in these devices. However, failures of medical implants do occur. The failure rate of the Articular Surface Replacement metal-on-metal hip system, implanted almost 100,000 times world-wide, has re-opened debate about appropriate and timely implant governance. As commercial interests, patient hopes, and devices’ governance converge in a socio-technical crisis, we analyse the responses of relevant governance stakeholders in the United Kingdom between 2007 and 2014. We argue that there has been a systemic failure of the governance system entrusted with the safety of patients fitted with medical implants. Commercial considerations of medical implants and the status quo of medical implant governance have been given priority over patient safety despite the availability of significant failure data in an example of uncertainty about what constitutes appropriate precautionary action

    Mechanical & compliance study of a modified hip protector for old age home residents in Hong Kong

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    Sze Pan Ching.Thesis (M.Phil.)--Chinese University of Hong Kong, 2006.Includes bibliographical references (leaves 162-178).Abstracts in English and Chinese.ABSTRACT --- p.iABSTRACT (IN CHINESE) --- p.ivACKNOWLEGEMENT --- p.viTABLE OF CONTENTS --- p.viiiLIST OF FIGURES --- p.xvLIST OF TABLES --- p.xviiiLIST OF APPENDIX --- p.xxLIST OF ABBREVIATIONS --- p.xxiLIST OF DEFINITIONS OF TERMS --- p.xxiiChapter I. --- INTRODUCTION --- p.1Chapter 1.1 --- Epidemiology of hip fracture among elderly worldwide --- p.1Chapter 1.2 --- Impact of hip fractures --- p.3Chapter 1.2.1 --- Mortality --- p.3Chapter 1.2.2 --- Hospitalization and institutionalization --- p.4Chapter 1.2.3 --- Morbidity --- p.4Chapter 1.2.4 --- Psychological impact and quality of life --- p.5Chapter 1.2.5 --- Financial burden --- p.6Chapter 1.3 --- Causes of hip fracture --- p.6Chapter 1.3.1 --- Mechanisms of hip fracture --- p.7Chapter 1.3.2 --- Degenerated protective mechanism --- p.8Chapter 1.3.3 --- Poor hip strength indices --- p.9Chapter 1.4 --- Prevention of hip fractures --- p.10Chapter 1.4.1 --- Reduction of the chance of lateral fall --- p.10Chapter 1.4.2 --- Increase hip strength indices --- p.11Chapter 1.4.3 --- Limitations of current strategies --- p.12Chapter 1.5 --- Hip protectors for prevention of hip fractures --- p.12Chapter 1.6 --- Effectiveness of hip protector --- p.14Chapter 1.6.1 --- Laboratory studies on effectiveness in force attenuation --- p.14Chapter 1.6.2 --- Clinical studies on prevention of hip fractures --- p.16Chapter 1.6.3 --- Cost-effectiveness study --- p.17Chapter 1.7 --- Problems on the use of hip protectors --- p.19Chapter 1.7.1 --- Discomfort --- p.19Chapter 1.7.2 --- Extra effort in wearing --- p.20Chapter 1.7.3 --- Appearance after wearing --- p.21Chapter 1.7.4 --- Urinary incontinence --- p.22Chapter 1.7.5 --- Oth er problems --- p.23Chapter 1.8 --- Acceptance and Compliance of hip protectors --- p.23Chapter 1.8.1 --- Acceptance --- p.23Chapter 1.8.2 --- Compliance --- p.24Chapter 1.9 --- Strategies to improve compliance of hip protector --- p.25Chapter 1.9.1 --- Better design of hip protector --- p.25Chapter 1.9.2 --- Encouragement/support to the user --- p.26Chapter 1.9.3 --- Support from nursing staff/carer --- p.27Chapter 1.10 --- Rationale and objectives of present study --- p.28Chapter II. --- METHODOLOGY --- p.36Chapter 2.1 --- Development of hip protector --- p.36Chapter 2.1.1 --- Design of the pads --- p.36Chapter 2.1.2 --- Design of the pants --- p.38Chapter 2.1.2.1 --- Fabric materials --- p.38Chapter 2.1.2.2 --- Anthropometric measurement --- p.42Chapter 2.1.2.3 --- Pattern design --- p.43Chapter 2.1.3 --- Trial use of hip protector --- p.43Chapter 2.1.4 --- Calculation and statistical method --- p.43Chapter 2.2 --- Mechanical test on force attenuation properties --- p.44Chapter 2.2.1 --- Testing system --- p.44Chapter 2.2.2 --- Simulation of impact force and identification of dropping height --- p.45Chapter 2.2.3 --- Testing method --- p.46Chapter 2.2.4 --- Calculation and statistical method --- p.47Chapter 2.3 --- Compliance study --- p.47Chapter 2.3.1 --- Setting --- p.47Chapter 2.3.2 --- Subjects --- p.48Chapter 2.3.3 --- Study design --- p.49Chapter 2.3.4 --- Implementation procedure and intervening Program --- p.49Chapter 2.3.4.1 --- Liaison with the heads and responsible staff in the elderly hostels --- p.49Chapter 2.3.4.2 --- Education program for hostel staff --- p.50Chapter 2.3.4.3 --- Education program for elderly subjects --- p.50Chapter 2.3.4.4 --- Fall and fracture risk counseling --- p.51Chapter 2.3.4.5 --- Consent and Ethical approval --- p.51Chapter 2.3.4.5 --- Provision of hip protector and training program on wearing hip protector --- p.51Chapter 2.3.4.6 --- Follow up and encouragement on the use of hip protector --- p.52Chapter 2.3.5 --- Outcome measures --- p.52Chapter 2.3.5.1 --- Primary outcome --- p.52Chapter 2.3.5.2 --- Secondary outcomes --- p.53Chapter 2.3.6 --- Measurement method --- p.55Chapter 2.3.6.1 --- Compliance --- p.55Chapter 2.3.6.2 --- Falls and fractures incidence --- p.56Chapter 2.3.6.3 --- Adverse effect and feedback after wearing hip protector --- p.56Chapter 2.3.6.4 --- Fear of fall --- p.57Chapter 2.3.6.5 --- Fall and fracture history --- p.57Chapter 2.3.6.6 --- Medical co-morbidities --- p.58Chapter 2.3.6.7 --- Presence of urinary incontinence --- p.58Chapter 2.3.6.8 --- Functional level --- p.58Chapter 2.3.6.9 --- Hand function --- p.58Chapter 2.3.6.10 --- Mobility --- p.59Chapter 2.3.6.11 --- Cognitive function --- p.59Chapter 2.3.7 --- Sample size calculation --- p.59Chapter 2.3.8 --- Calculation and Statistical method --- p.60Chapter III. --- RESULTS --- p.73Chapter 3.1 --- Design of hip protector --- p.73Chapter 3.1.1 --- The design of pants --- p.73Chapter 3.1.1.1 --- The fabric materials --- p.73Chapter 3.1.1.2 --- The size of the pants --- p.74Chapter 3.1.2 --- The design of pads --- p.75Chapter 3.1.2.1 --- Thickness of silicon padding --- p.75Chapter 3.1.1.2 --- Dimension of the hard shield --- p.75Chapter 3.2 --- Mechanical test on force attenuation properties of the pads --- p.76Chapter 3.2.1 --- Impact force --- p.76Chapter 3.2.2 --- Impact duration --- p.78Chapter 3.2.3 --- Selection of th e prototype --- p.78Chapter 3.3 --- Compliance study --- p.79Chapter 3.3.1 --- Demograph ics --- p.79Chapter 3.3.2 --- Primary outcome --- p.79Chapter 3.3.2.1 --- Initial acceptance rate --- p.79Chapter 3.3.2.2 --- Compliance rate --- p.79Chapter 3.3.2.3 --- Percentage of people wearing hip protector across the study period --- p.81Chapter 3.3.2.4 --- Percentage of protected fall --- p.81Chapter 3.3.3 --- Secondary outcomes --- p.81Chapter 3.3.3.1 --- Fall and related injury among the subjects in the study period --- p.81Chapter 3.3.3.2 --- Reasons for non-acceptance --- p.82Chapter 3.3.3.3 --- Feedback in using hip protector --- p.84Chapter 3.3.3.4 --- Factors associated with compliance and non-compliance (feedback in wearing hip protector) --- p.84Chapter 3.3.3.5 --- Factors associated with compliance and non-compliance (subject characteristics) --- p.85Chapter 3.3.3.6 --- Effect on mobility after wearing hip protector --- p.85Chapter 3.3.3.7 --- Fear of fall after wearing hip protector --- p.85Chapter IV. --- DISCUSSION --- p.123Chapter 4.1 --- Development of a hip protector for Chinese elderly --- p.124Chapter 4.1.1 --- Successful modifications made to the pads --- p.124Chapter 4.1.1.1 --- More comfort to wear with silicon cushioning materials added --- p.124Chapter 4.1.1.2 --- Better mechanical properties with semi-flexible plastic and silicon pad --- p.125Chapter 4.1.1.3 --- Smaller in dimension of the present model might improve appearance after wearing --- p.127Chapter 4.1.2 --- No significant improvement on compliance with modification of the pants --- p.128Chapter 4.2 --- Sufficient mechanical properties of hip protector demonstrated --- p.129Chapter 4.2.1 --- Mechanical test set up --- p.130Chapter 4.2.2 --- Mechanism of force attenuation --- p.132Chapter 4.3 --- No significant improvement on compliance shown --- p.134Chapter 4.4 --- Compliance at night time better than other studies --- p.136Chapter 4.5 --- Determinants of compliance mostly related to subjects' feedback of using hip protector rather than on their characteristics --- p.137Chapter 4.6 --- Better compliance observed in hostel with higher staff-to-subject ration and with occupational therapist as contact person --- p.138Chapter 4.7 --- Better acceptance rate of hip protector shown in the present study --- p.139Chapter 4.8 --- Identification of factors influencing acceptance --- p.139Chapter 4.9 --- Percentage of protected fall was higher than mean compliance --- p.141Chapter 4.10 --- No hip fracture occurred while subjects wearing hip protector --- p.141Chapter 4.11 --- Decreased fear of falling after wearing hip protector --- p.142Chapter 4.12 --- Limitation --- p.142Chapter 4.13 --- Recommendation --- p.143Chapter V. --- CONCLUSION --- p.146Chapter VI. --- APPENDIX --- p.148Chapter VII. --- BIBLIOGRAPHY --- p.162Chapter VIII. --- PUBLICATIONS --- p.17

    El Ă­ndice de calidad antioxidante de la dieta (DAQS) estĂĄ asociado con la masa Ăłsea evaluada mediante ultrasonido cuantitativo en el calcĂĄneo en mujeres jĂłvenes

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    Introduction: Evidence suggests that intake of antioxidants could positively infl uence bone mass by preventing bone metabolism against oxidative stress. Objective: We aimed to investigate the possible infl uence of single antioxidant intakes and dietary antioxidant quality score (DAQs) on calcaneal quantitative ultrasound (QUS) in a population of young adults. Methods: A total of 605 young Spanish adults participated in this study (median age 20.38 Âą 2.67). Bone mass was measured by calcaneal QUS to determine broadband ultrasound attenuation (BUA, dB/MHz) parameter. Body composition was assessed by bioelectrical impedance analysis and dietary intakes were determined using a 72-hour diet recall interview. DAQs was applied to calculate antioxidant nutrients intake. Linear regression analyses were performed to investigate the possible infl uence of DAQs on calcaneal QUS. Results: Most of young adults showed a low-quality antioxidant intake (only 17.6% of women and 20.3% of men had a score of 4 or 5 in DAQs). A positive correlation between DAQs and BUA was observed in women (r = 0.117; p = 0.024). Linear regression analysis revealed that DAQs was signifi cantly associated with BUA parameter in women after adjusting by body weight, height, calcium intake and physical activity (PA) (p = 0.035). No signifi cant associations between single antioxidant and calcaneus QUS measurement were found. Conclusion: Our fi ndings suggest that high-quality antioxidant intakes could infl uence bone health in young women. Future studies should further investigate the protective role of antioxidant nutrients against osteoporosis
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