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

Abstract

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