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. 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. The authors concluded that compliance is a complex issue in hip protector implementation and that methods to improve compliance should be developed, and their effectiveness tested [160]. Based on the studies that have been published, there is likely to be continued Selleckchem Citarinostat debate and uncertainty about the efficacy of hip protectors because of the heterogeneity of findings, well-documented compliance issues, and potential biases from clustered randomization designs. Nevertheless, recent pooled analyses have suggested that two-sided
devices may potentially reduce the risk of hip fracture, at least in institutionalized elderly [161]. And so it would seem that, although available evidence does not allow firm and final conclusions or recommendations, it may not be appropriate to discount the potential benefit of this intervention in a long-term care setting. Larger and more costly clinical trials are required to Fosbretabulin chemical structure definitively SCH772984 this website investigate effectiveness
of hip protectors. Consensus recommendations for future research include the following: the use of a hip protector that has undergone adequate biomechanical testing, the use of sham hip protectors, the conduct of clinical trials in populations with annual hip fracture incidence of at least 3%, a run-in period with demonstration of adequate adherence, surveillance of falls and adherence, and the inclusion of economic analyses [162]. Vertebroplasty and kyphoplasty Vertebral compression fractures (VCFs) can lead to severe vertebral deformity or hyperkyphosis, which in turn is associated with significant back pain and back dysfunction [163], functional impairment [164], loss of quality of life [165] and even mortality [166]. Standard treatment of painful VCFs is conservative non-surgical management (NSM), consisting of bed rest, analgesics, and bracing. However, in some patients, NSM fails to improve pain and mobility, particularly in cases of chronic pain related to kyphotic deformity [167]. Patients refractory to medical therapy can be considered for vertebroplasty or balloon kyphoplasty, two minimally invasive surgical approaches developed for the management of symptomatic VCFs [168] which are increasingly being proposed as effective and safe [169, 170].