Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis
We investigated the timeline of functional recovery after hip fracture over 12 months in adults age ≥ 65 years using objective lower extremity function tests and subjective physical functioning. Objective functional recovery was largely complete in the first 6 months, whereas subjective recovery improved up to 9 months after hip fracture.
Hip fractures are a major cause of loss of function among seniors. We assessed the timeline of objective and subjective functional recovery after hip fracture.
We conducted a prospective observational secondary analysis of a 1-year clinical trial on vitamin D and home exercise treatment and complications after hip fracture among 173 patients age ≥ 65 years (mean age 84 years; 79.2% women; 77.4% community-dwelling) conducted from January 2005 through December 2007. Lower extremity function (Timed Up and Go test (TUG), knee extensor and flexor strength) and grip strength was assessed at baseline and at 6 and 12 months follow-up. Subjective physical functioning was assessed using the SF-36 questionnaire also at 3 and 9 months follow-up. Multivariable-adjusted repeated-measures models were used to assess the timeline of functional recovery in the total population and in subgroups of patients.
Lower extremity function including TUG (− 61.1%), knee extensor (+ 17.6%), and knee flexor (+ 11.6%) strength improved significantly in the first 6 months (P < 0.001). However, between 6 and 12 months, there was no further significant improvement for any of the functional tests. Grip strength decreased from baseline to 6 months (− 7.9%; P < 0.001) and from 6 to 12 months (− 10.8%; P < 0.001). Subjective physical functioning improved from 3 to 9 months (+ 15.2%, P < 0.001), but no longer thereafter.
Functional recovery after hip fracture may be largely complete in the first 6 months for objective functional tests, whereas may extend up to 9 months for subjective recovery, with oldest-old, female, institutionalized, and cognitively impaired patients recovering most poorly.
Clinical trials registry (original trial)
KeywordsFunctional recovery Hip fracture Objective functional tests Subjective physical functioning Timeline
This project was funded by the Baugarten Foundation Centre Grant for the Centre on Aging and Mobility (Dr. Bischoff-Ferrari). The original trial was supported by Swiss National Foundations (NFP-53) (Drs Bischoff-Ferrari and Theiler); Vontobel Foundation (Dr Bischoff-Ferrari; and Swiss National Foundations professorship grant PP00B-114864 (Dr Bischoff-Ferrari).
Compliance with ethical standards
Conflicts of interest
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 1.da Costa JA, Ribeiro A, Bogas M, Costa L, Varino C, Lucas R, Rodrigues A, Araújo D (2009) Mortality and functional impairment after hip fracture—a prospective study in a Portuguese population. Acta Reumatol Port 34:618–626Google Scholar
- 12.Bischoff-Ferrari HA, Dawson-Hughes B, Platz A, Orav EJ, Stähelin HB, Willett WC, Can U, Egli A, Mueller NJ, Looser S, Bretscher B, Minder E, Vergopoulos A, Theiler R (2010) Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med 170:813–820CrossRefGoogle Scholar
- 23.Latham NK, Harris BA, Bean JF, Heeren T, Goodyear C, Zawacki S, Heislein DM, Mustafa J, Pardasaney P, Giorgetti M, Holt N, Goehring L, Jette AM (2014) Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial. JAMA 311:700–708CrossRefGoogle Scholar
- 25.Vochteloo AJ, van Vliet-Koppert ST, Maier AB, Tuinebreijer WE, Röling ML, de Vries MR, Bloem RM, Nelissen RG, Pilot P (2012) Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients. Arch Orthop Trauma Surg 132:823–830CrossRefGoogle Scholar
- 31.Stemmle J, Marzel A, Chocano-Bedoya PO, Orav EJ, Dawson-Hughes B, Freystaetter G, Egli A, Theiler R, Staehelin HB, Bischoff-Ferrari HA (2018) Effect of 800 IU versus 2000 IU vitamin D3 with or without a simple home exercise program on functional recovery after hip fracture: a randomized controlled trial. J Am Med Dir AssocGoogle Scholar
- 32.Nardi M, Fischer K, Dawson-Hughes B, Orav EJ, Meyer OW, Meyer U, Beck S, Simmen HP, Pape HC, Egli A, Willett WC, Theiler R, Bischoff-Ferrari HA (2018) Association between caregiver role and short- and long-term functional recovery after hip fracture: a prospective study. J Am Med Dir Assoc 19:122–129CrossRefGoogle Scholar
- 35.Bischoff HA, Stahelin HB, Monsch AU, Iversen MD, Weyh A, von Dechend M, Akos R, Conzelmann M, Dick W, Theiler R (2003) Identifying a cut-off point for normal mobility: a comparison of the timed 'up and go' test in community-dwelling and institutionalised elderly women. Age Ageing 32:315–320CrossRefGoogle Scholar
- 36.Madsen OR, Lauridsen UB (1995) Knee extensor and flexor strength in elderly women after recent hip fracture: assessment by the Cybex 6000 dynamometer of intra-rater inter-test reliability. Scand J Rehabil Med 27:219–226Google Scholar
- 37.Stoll T (2002) Isometric muscle strength measurement. ThiemeGoogle Scholar
- 46.Savino E, Martini E, Lauretani F, Pioli G, Zagatti AM, Frondini C, Pellicciotti F, Giordano A, Ferrari A, Nardelli A, Davoli ML, Zurlo A, Lunardelli ML, Volpato S (2013) Handgrip strength predicts persistent walking recovery after hip fracture surgery. Am J Med 126:1068–1075.e1061CrossRefGoogle Scholar
- 47.Felicio DC, Pereira DS, Assumpção AM, de Jesus-Moraleida FR, de Queiroz BZ, da Silva JP, de Brito Rosa NM, Dias JM, Pereira LS (2014) Poor correlation between handgrip strength and isokinetic performance of knee flexor and extensor muscles in community-dwelling elderly women. Geriatr Gerontol Int 14:185–189CrossRefGoogle Scholar
- 48.Muangpaisan W, Wongprikron A, Srinonprasert V, Suwanpatoomlerd S, Sutipornpalangkul W, Assantchai P (2015) Incidence and risk factors of acute delirium in older patients with hip fracture in Siriraj Hospital. J Med Assoc Thail 98:423–430Google Scholar