JMIR Publications

ABSTRACT

Background:

Falls represent a large percentage of hospitalized trauma patients as they may result in head injuries. Due to the aging population worldwide, the incidence of falls will continue to rise. Brain injury from ground level falls (GLF) in patients is common and has substantial mortality. As fall prevention initiatives have been inconclusive, we changed our strategy to injury prevention. We identified a head protection device (HPD) that is aesthetically pleasing and meets head impact criteria sustained in a GLF. HPDs, such as helmets are ubiquitous in preventing head injuries in sports and industrial activities, yet they have not been studied for daily activity.

Objective:

We aimed to investigate the usability and wearability of a novel Head protection device from a patient’s perspective to predict future compliance

Methods:

A total of 26 individuals, who sustained head injuries, wore a HPD in hospital, while ambulatory, and were evaluated at baseline (before discharge) and at two months post-discharge. Clinical and demographic data were collected; a Usability Survey captured HPD domains. Nonparametric tests were used for intragroup comparisons (Wilcoxon S-R test, McNemar’s test). Descriptive statistics analyzed patient demographics; frequencies and percentages were recorded for categorical variables. Differences between categorical variables (gender, age group1, 55-77 years; group2, 78+) and compliance were tested using the chi-squared statistic.

Results:

Findings show 46% were female, median age 77 (55 92); 69% on anticoagulants; and 96% were admitted with a head injury due to a GLF. After two months 85% wore the device, with zero falls recorded, and no GLF hospital readmissions. Usability assessment with 26 users revealed good scores for the HPD’ utility. Nonparametric tests showed positive results with no significant differences between two observations regarding device credibility (.42), satisfaction (.60), usability (.80), adherence (.06), effectiveness (.53), and relevance (.09). One issue emerged for the domain of aesthetics; post-discharge, 33% of patient had a concern about device weight. Chi-squared analysis showed differences in compliance regarding age X2 (1, N = 26) = 4.27, p = .04 but not sex X2 (1, N = 26) = 1.58, p = .23 or race X2 (1, N = 26) = .75, p = .60. Age group1 was more likely to wear the device for normal daily activities. Patients most often wore the device ambulating and protection was identified as the primary benefit.

Conclusions:

Our protective HPD is likely to have a reasonably high compliance in a population at risk for GLFs. The feasibility and wearability of the device in GLF patients with head injury will inform future directions, which includes a multi-center study to evaluate device compliance and effectiveness in the event of a fall. Our work will guide other institutions interested in pursuing cost-effective treatments and innovative strategies for the delivery of clinical care that serves this population.