Hip Protectors and Hip Fracture—Reply
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In Reply: We appreciate Dr Cummings' suggestion to use the matched risk ratio to present the overall treatment effect from this study design. As there were no bilateral fractures in our study, the calculations are correct as stated in his letter. We have not found an adjustment to the CI for the clustered design, but any adjustment would be minimal since the intraclass correlation is typically very small in studies of this type.
We fully support the use of such estimates of effect sizes as suggested by Cummings. We hope others will use this matched risk ratio in future meta-analyses of hip protector efficacy, and we will include this calculation of the overall treatment effect in any future publications that emerge from our trials using this design.
Financial Disclosures: None reported.
Douglas P. Kiel, MD, MPH
kiel@mail.hrca.harvard.edu
Institute for Aging Research
Hebrew SeniorLife
Boston, Massachusetts
Stanley J. Birge, MD
Division of Geriatrics and Gerontology
Washington University School of Medicine
St. Louis, Missouri
Jay Magaziner, PhD
Department of Epidemiology and Preventive Medicine
University of Maryland
Baltimore
Sheryl Zimmerman, PhD
Program on Aging, Disability and Long-Term Care
Cecil G. Sheps Center for Health Services Research
University of North Carolina
Chapel Hill
Kathleen M. Brown, PhD;
Bruce A. Barton, PhD
Maryland Medical Research Institute
Baltimore
Letters Section Editor: Robert M. Golub, MD, Senior Editor.
JAMA. 2007;298(18):2139.
RELATED LETTER
Hip Protectors and Hip Fracture
Peter Cummings
JAMA. 2007;298(18):2139.
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