User test of HappyHip hip protectors in a Swedish retirement home

Background:

Falls are a big problem among the elderly in Sweden. It is estimated that 30-40 % of people over 70 are likely to fall at least once per year (1).

In Sweden, there are approximately 17,500 hip fractures yearly. The average age of people with hip fractures is 82 years, and two thirds are women. The injury mechanism is often fall in the same plane. Hip fractures cost SEK 1.5 Billion annually.  The incidents are slightly decreasing, but as the population is growing older, the elderly still occupies a forth of total days in hospital within orthopaedics (2). 

21% of patients with a hip fracture lose the ability to walk outside on their own, and 13% lose the ability to walk at all. 3% of the patients die during the hospital stay whilst being treated for their hip fracture, and 38% die within 2 years of their hip fracture. (3)

You also have people that fall that do not cause a hip fracture but still might require care at a hospital, or increased age care support. Regardless of the outcome of the fall injury, it has great impact on the individual’s social needs and increases the overall need for health care.

There are several studies that demonstrate benefits using fall protection pants.  However, identified problems are lack of user acceptance, and health care workers not advocating fall protection pants, resulting in low compliance. Also, if the fall protection pants are not used properly they are not going to be helpful. (4)

In Sweden, the use of fall protection pants within municipalities are fairly common. Fall protection pants are for example recommended in ”Senior Alert”, a guide for what to do when there is increased risk of fall injuries for seniors. In the public sector fall protection pants can be reimbursed and the tender process is regulated by LOU (5). 

Methods and Results:

The study was performed at a retirement home, Lindgården, in Sundsvall during spring 2019. During two months one of the wards using fall protection pants got to trial HappyHip and used them in daily clinical practice. The users were chosen by the staff according to the existing guidelines for when to use fall protection pants.

Hipsafety provided the HappyHip pants at no cost.  After the study period, all HappyHip pants were returned.

The evaluation was conducted by filling out a questionnaire including 9 questions put together by the Innovation department. At the end of the study, each staff member filled out the questionnaire, and if possible, also the user.

A control group at a similar ward at the same retirement home, using the existing fall protection pant purchased through the tender process, also filled out the questionnaire at the end of the study.

Test period: Spring 2019

Test Location: Lindgården's retirement home in Sundsvall

Number of users:

The HappyHip test group 17

Control group 11

In total, there were approximately 600 handling opportunities in both groups, with about 360 in the HappyHip  group.

 Questions evaluated:

1. Have you lost the pads at any point during the trial? Yes/No
2. What do you think about how the pants are handled in preparation for washing? Ok/ Not ok
3. Is the shape retained after washing? Yes/No
4. Was there any damage to the hip protection pants been while putting them on or taking them off? Yes/No
5. Is the hip protection pant easy to put on and take off outside of bed? Yes/No
6. Is the hip protection pant easy to put on and take off in bed? Yes/No
7. What is your experience using the hip protection pants when going to the toilet?
8. In summary, please describe what you think about the hip protection pants?

 

    

For the last two questions there were written comments, as shown below.

7. What is your experience using the hip protection pants when going to the toilet?
8. In summary, please describe what you think about the hip protection pants

Control Group Using alternative hip protection pants	HappyHip Group
Works if the right size is used, and depends on patient participation	Easy to put on / take off
Works when using the right size (multiple comments), usually needs help if the pants are too small	Agile, easier to put on compared to other pants.
Ok if washed up to a maximum of 60 degrees C although approved for washing at 95C	Good, easy to use, flexible
A bit difficult to use with a diaper	Easy to put on and take off, easy to use for all, good for users that risk to fall
Increased fall risk if the user goes to the bathroom by them self (3 comments)	Easy to pull up
Difficult to pee in bottle at night (with the pants on)	Thin with nice fabric, much better than the once used before, soft
Waistband broke	The Velcro curls up and gets stuck (2pcs)
Hard to pull up/down if they are too tight
Sometimes a little difficult to put on, hard for the back
A little tricky to put on

Conclusion/Discussion

The use of hip protectors to decrease the risk for hip fractures when falling is well established worldwide.

The protective pads used in Hipsafety’s products are made in Germany and used in other type of products, e.g. motorcycle apparels, with long-term clinical use and data available.  The pads have fulfilled all the requirements for CE certification as motorcycle protection, the highest protective level for these types of products.

In this study, we have not addressed the ability for HappyHip to reduce the risk for fracture, but have concentrated on user friendliness and ergonomics, factors highlighted in studies being the major problems of existing hip protectors on the market.

The results show that there is no difference between the reference hip protector and HappyHip, with regards to quality of seams, handling when washing, and not losing the protective pads when washing. This is interesting since HappyHip have ”open” pockets for the pads, so that they can be removed when washing the pants and used in another pair of pants. An economic and environmentally important issue.

Regarding user friendliness and ergonomics, HappyHip demonstrate significant better results. This increases the possibility that the elderly and caretakers make sure the hip protectors, e.g. HappyHip, are used every day, and also during the night so that the user is protected at all times.

Note:

The project was a cooperation between Doctorlundh AB, owner of the brand Hipsafety, and the Innovation department at Sundsvall municipality.  The Innovation department’s aim is to find innovative solutions for the municipality.

References:

1. WHO global report on falls prevention in older age. 2007
2. Rikshöft. Årsrapport 2014.http://rikshoft.se/wp-content/uploads/2013/07/%C3%A5rsrapport_20141.pdf
3. Söderqvist A, Ekström W, Ponzer S, et al. Prediction of mortality in elderly patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology. 2009;55(5):496-504. 
4. Santesso N, Carrasco-Labra A, Brignardello-Petersen R.Hip protectors for preventing hip fractures in older people.Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD001255. DOI: 10.1002/14651858.CD001255.pub5.