Biomechanical benefits of hip protectors and compliant flooring for hip fracture prevention: A systematic and quantitative analysis.

Abstract

Our systematic review and quantitative analysis aim to compile current biomechanical evidence on the impact force attenuation capabilities of hip protectors and compliant flooring, which are two widely implemented fall-related hip fracture prevention strategies in older adults. We conducted a systematic review in accordance with PRISMA guidelines, searching five databases (PubMed, MEDLINE, EMBASE, Web of Science, and SportDiscus) for studies evaluating the biomechanical efficacy of hip protectors and compliant flooring. Fifteen studies (5 human experiments and 10 studies selected based on biomechanical guidelines) were included in the quantitative analysis. Our results revealed that protective efficacy was fundamentally outcome-dependent. For peak total impact force, hip protectors exhibited 206.7% greater attenuation than compliant flooring (W = 1971; p < 0.005). Conversely, for peak femoral neck impact force, compliant flooring provided 109% greater attenuation compared to hip protectors (W = 303; p < 0.005). Furthermore, peak total impact force attenuation was affected by the testing methods, being 328.1% and 127.0% greater in the drop tower and impact pendulum tests, respectively, than in falling experiments with humans (both p < 0.005). Our findings suggest a trend that the biomechanical efficacy of hip protectors and compliant flooring is highly dependent on where the force is measured and how they are tested. These results emphasize the need for standardized biomechanical testing protocols and careful interpretation of impact force attenuation data.