| Sumario: | Purpose Falls cause up to 95% of geriatric hip fractures, of which the rates are two- to three-fold higher in care facilities. Hip protectors (HP) have been proven effective against fall-related hip fractures (Korall et al., 2019); however, user compliance with HPs in care facilities remains very low, particularly in Hong Kong (<20%). Recent studies show that user compliance can be facilitated through structured education for caregivers and better design of HP that enhances comfort of wearing (Korall et al., 2015). Therefore, our study sought to promote user compliance with wearable HP among older adults in care facilities in Hong Kong through structured training for caregivers and innovative designs of 3D-printed HP. Method Ninety-four care workers from five care facilities attended a 60-minute educational session on the epidemiology of hip fractures and related consequences, strategies to prevent falls and hip fractures, and effectiveness and approaches for successful implementation of HP. After the education sessions, we recruited 69 residents from the care facilities and provided free hip protectors to them. Resident compliance with wearing hip protectors was recorded on a weekly basis, and the sustained adherence was evaluated after six months. Qualitative feedback on the use of hip protectors from residents and their care givers was collected via phone interviews and incident reports. Meanwhile, based on participants' feedback and previous research evidence, we developed a customized, comfortable and breathable HP through 3D-printing technology. Specifically, selective laser sintering technology was applied to fabricate TPU (Thermoplastic Polyurethane) such that HP could be designed based on the users' hip profile. More importantly, we used our newly invented implicit design method, a conformal TPMS (triply periodic minimal surface) structure-infill generation scheme (Ding et al., 2021), to mass-customize hip protectors, with lattice structures to be automatically generated from the 3D scan data for multiple participants with individually tailored design (Figure 1). The biomechanical performance of the prototype of HP was then tested through an impact on the force plate using a drop tower. Results and Discussion Our preliminary data showed a satisfactory adherence rate [46.4% (32/69)]. For residents who failed to adhere to wearing HP, more than half of them [54.1% (20/37)] stopped using within first two weeks. Common reasons for not using HP include discomfort [62.2% (23/37)] (e.g., protectors are not breathable, too tight, or causing skin irritation), inconvenience [37.8% (23/37)] (e.g., don off garment during toileting), and perceived ineffectiveness [8.1% (3/37)]. The feedback coincided with barriers in promoting HP user compliance identified from previous research (Korall et al., 2015). Clearly, perceived ineffectiveness can be further enhanced by providing education to users. Meanwhile, our novel 3D-printed HP was lighter, more breathable, and better fit than conventional HPs. It would be more suitable for users in Hong Kong, where summer days are hot and humid. Pilot biomechanical tests showed higher force attenuation in our 3D-printed HP than the conventional models. Further investigation on user compliance with the novel 3D-printed HP will be carried out.
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