Commentary

The systematic review by Parker et al raises important questions about the effectiveness of programmes that provide older people with hip protectors. An earlier version of this review concluded that hip protectors were effective, but this was based on relatively weak evidence primarily from poorly designed cluster RCTs.¹ More recent evidence includes several individually randomised trials, leading to the overall conclusion that no evidence of effectiveness exists.

Cluster randomised trials are quite appropriate for interventions such as this. It could be that increased vigilance resulting from the use of protectors could “contaminate” control patients in an institution where randomisation is at the level of the individual and thus mask a true effect. Such contamination is unlikely to occur in the community, and so this cannot entirely explain the different conclusions.

Poor patient adherence with hip protectors was noted in most studies and is discussed by Parker et al. However, the point estimate of effect for hip fracture is small and shows a slight risk increase, and so low power and diluted effect, although possible, are unlikely to explain the findings.

Evidence-based practice demands that practitioners be prepared to reappraise their beliefs in light of new evidence. Because there is some laboratory evidence suggesting benefits of hip protector use² and some weak clinical evidence in this review of the benefits of protector use in institutions, it seems premature to advise individuals who wish to use hip protectors to stop. However, other than in these circumstances, given the lack of evidence of effect and the existence of evidence that hip protectors are not generally acceptable to clients, there seems little to justify their use outside of properly designed research programmes. Practitioners would do better to concentrate their efforts on implementing interventions known to prevent falls.³