Pre-discharge prognostic factors of physical function among older adults with hip fracture surgery: a systematic review

  • K. K. LimEmail author
  • D. B. Matchar
  • J. L. Chong
  • W. Yeo
  • T. S. Howe
  • J. S. B. Koh
Review Article



To identify, organize, and assess the evidence level of pre-discharge prognostic factors of physical function beyond discharge after hip fracture surgery.


We performed a systematic search of four databases (PubMed, Embase, CINAHL, PsycINFO) for longitudinal studies of prognostic factors of physical function at ≥ 1 month among older adults ≥ 50 years old with surgically treated hip fracture, complemented with hand-searching. Two reviewers independently screened papers for inclusion and assessed the quality of all the included papers using the Quality in Prognosis Studies (QUIPS) tool. We assigned the evidence level for each prognostic factor based on consistency in findings and study quality.


From 98 papers that met our inclusion criteria, we identified 107 pre-discharge prognostic factors and organized them into the following seven categories: demographic, physical, cognitive, psychosocial, socioeconomic, injury-related, and process of care. Potentially modifiable factors with strong or moderate evidence of an association included total length of stay, physical function at discharge, and grip strength. Factors with strong or moderate evidence of no association included gender, fracture type, and time to surgery. Factors with limited, conflicting, or inconclusive evidence included body-mass index, psychological resilience, depression, and anxiety.


Our findings highlight potentially modifiable prognostic factors that could be targeted and non-modifiable prognostic factors that could be used to identify patients who may benefit from more intensive intervention or to advise patients on their expectations on recovery. Examining the efficacies of existing interventions targeting these prognostic factors would inform future studies and whether any of such interventions could be incorporated into clinical practice.


Elderly Hip fracture Older adults Physical function Prognostic factors Systematic review 



We would like to thank Suei Nee Wong (medical librarian) for her help in refining our search strategies.

Compliance with ethical standards

Conflict of interest

Ka Keat Lim, David Bruce Matchar, Jia Loon Chong, William Yeo, Tet Sen Howe, and Joyce SB Koh declare that they have no conflict of interest.

Supplementary material

198_2018_4831_MOESM1_ESM.docx (29 kb)
ESM 1 (DOCX 24 kb)
198_2018_4831_MOESM2_ESM.png (222 kb)
ESM 2 (PNG 222 kb)
198_2018_4831_MOESM3_ESM.docx (33 kb)
ESM 3 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for the reporting of our systematic review. (DOCX 28 kb)
198_2018_4831_MOESM4_ESM.docx (18 kb)
ESM 4 (DOCX 18.3 kb)
198_2018_4831_MOESM5_ESM.docx (37 kb)
ESM 5 (DOCX 37 kb)
198_2018_4831_MOESM6_ESM.docx (35 kb)
ESM 6 (DOCX 34 kb)
198_2018_4831_MOESM7_ESM.docx (20 kb)
ESM 7 (DOCX 20 kb)


  1. 1.
    Papadimitriou N, Tsilidis KK, Orfanos P, Benetou V, Ntzani EE, Soerjomataram I, Künn-Nelen A, Pettersson-Kymmer U, Eriksson S, Brenner H, Schöttker B, Saum KU, Holleczek B, Grodstein FD, Feskanich D, Orsini N, Wolk A, Bellavia A, Wilsgaard T, Jørgensen L, Boffetta P, Trichopoulos D, Trichopoulou A (2017) Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium. Lancet Public Health 2(5):e239–e246Google Scholar
  2. 2.
    Kanis JA et al (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256Google Scholar
  3. 3.
    Ström O, Borgström F, Kanis JA, Compston J, Cooper C, McCloskey EV, Jönsson B (2011) Osteoporosis: burden, health care provision and opportunities in the EU. Arch Osteoporos 6(1):59–155Google Scholar
  4. 4.
    Kanis JA, On behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at primary health-care level. World Health Organization, BelgiumGoogle Scholar
  5. 5.
    Moja L et al (2012) Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One 7(10):e46175Google Scholar
  6. 6.
    Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, DeBeer J, Bhandari M (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. Cmaj 182(15):1609–1616Google Scholar
  7. 7.
    National Clinical Guideline Centre (2011) The management of hip fracture in adults. National Clinical Guideline Centre, London, UKGoogle Scholar
  8. 8.
    Riemen AHK, Hutchison JD (2016) The multidisciplinary management of hip fractures in older patients. Orthop Trauma 30(2):117–122Google Scholar
  9. 9.
    Handoll HHG et al (2009) Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 4:CD007125.
  10. 10.
    Auais MA, Eilayyan O, Mayo NE (2012) Extended exercise rehabilitation after hip fracture improves patients' physical function: a systematic review and meta-analysis. Phys Ther 92(11):1437–1451Google Scholar
  11. 11.
    Diong J, Allen N, Sherrington C (2016) Structured exercise improves mobility after hip fracture: a meta-analysis with meta-regression. Br J Sports Med 50(6):346–355Google Scholar
  12. 12.
    Handoll HH, Sherrington C, Mak JC (2011) Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 3:CD001704.
  13. 13.
    Kerr C, Bottomley C, Shingler S, Giangregorio L, de Freitas HM, Patel C, Randall S, Gold DT (2017) The importance of physical function to people with osteoporosis. Osteoporos Int 28(5):1597–1607Google Scholar
  14. 14.
    Dyer SM et al (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158Google Scholar
  15. 15.
    Peeters CM et al (2016) Quality of life after hip fracture in the elderly: a systematic literature review. Injury 47(7):1369–1382Google Scholar
  16. 16.
    Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol: Series A 55(9):M498–M507Google Scholar
  17. 17.
    Sheehan KJ, Sobolev B, Chudyk A, Stephens T, Guy P (2016) Patient and system factors of mortality after hip fracture: a scoping review. BMC Musculoskelet Disord 17:166Google Scholar
  18. 18.
    Smith T, Pelpola K, Ball M, Ong A, Myint PK (2014) Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 43(4):464–471Google Scholar
  19. 19.
    Hu F, Jiang C, Shen J, Tang P, Wang Y (2012) Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 43(6):676–685Google Scholar
  20. 20.
    Liu Y, Wang Z, Xiao W (2018) Risk factors for mortality in elderly patients with hip fractures: a meta-analysis of 18 studies. Aging Clin Exp Res 30(4):323–330Google Scholar
  21. 21.
    Sheehan KJ, Williamson L, Alexander J, Filliter C, Sobolev B, Guy P, Bearne LM, Sackley C (2018) Prognostic factors of functional outcome after hip fracture surgery: a systematic review. Age Ageing 47:661–670Google Scholar
  22. 22.
    Lim KK, Chong JL, Matchar D (2017) Prognostic factors of physical function and mortality after hip fracture surgery: a systematic review and meta-analysis. Available from: Accessed 20 May 2018
  23. 23.
    de Rooij M, van der Leeden M, Heymans MW, Holla JFM, Häkkinen A, Lems WF, Roorda LD, Veenhof C, Sanchez-Ramirez DC, de Vet HCW, Dekker J (2016) Prognosis of pain and physical functioning in patients with knee osteoarthritis: a systematic review and meta-analysis. Arthritis Care Res 68(4):481–492Google Scholar
  24. 24.
    World Health Organization (2018) International classification of functioning, disability and health (ICF). Available from: Accessed 28 March 2018
  25. 25.
    Hoang-Kim A, Beaton D, Bhandari M, Kulkarni AV, Schemitsch E (2013) The need to standardize functional outcome in randomized trials of hip fracture: a review using the ICF framework. J Orthop Trauma 27(1):e1–e8Google Scholar
  26. 26.
    Hoang-Kim A, Schemitsch E, Kulkarni AV, Beaton D (2014) Methodological challenges in the use of hip-specific composite outcomes: linking measurements from hip fracture trials to the International Classification of Functioning, Disability and Health Framework. Arch Orthop Trauma Surg 134(2):219–228Google Scholar
  27. 27.
    Tseng MY, Shyu YI, Liang J (2012) Functional recovery of older hip-fracture patients after interdisciplinary intervention follows three distinct trajectories. Gerontologist 52(6):833–842Google Scholar
  28. 28.
    Hayden JA, Cote P, Bombardier C (2006) Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 144(6):427–437Google Scholar
  29. 29.
    Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C (2013) Assessing bias in studies of prognostic factors. Ann Intern Med 158(4):280–286Google Scholar
  30. 30.
    Webber SC, Porter MM, Menec VH (2010) Mobility in older adults: a comprehensive framework. Gerontologist 50(4):443–450Google Scholar
  31. 31.
    Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M, Bronfort G, van Tulder M, Editorial Board of the Cochrane Back, Neck Group (2015) Updated method guideline for systematic reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976) 40(21):1660–1673Google Scholar
  32. 32.
    Lievense A, Bierma-Zeinstra SM, Verhagen AP, Verhaar JA, Koes BW (2004) Influence of hip dysplasia on the development of osteoarthritis of the hip. Ann Rheum Dis 63(6):621–626Google Scholar
  33. 33.
    Bastick AN, Runhaar J, Belo JN, Bierma-Zeinstra SMA (2015) Prognostic factors for progression of clinical osteoarthritis of the knee: a systematic review of observational studies. Arthritis Res Ther 17:152Google Scholar
  34. 34.
    Ruiz BAA (1992) Hip fracture recovery in older women: the influence of self-efficacy, depressive symptoms and state anxiety (dissertation). University of California, San Francisco, Ann Arbor, MIGoogle Scholar
  35. 35.
    Dawson DK (2000) Determinants of nonrecovery following hip fracture in older adults: a chronic disease trajectory analysis. Virginia Polytechnic Institute and State University, Clarksville, VAGoogle Scholar
  36. 36.
    Mutran EJ et al (1995) Social support, depression, and recovery of walking ability following hip fracture surgery. J Gerontol B Psychol Sci Soc Sci 50(6):S354–S361Google Scholar
  37. 37.
    American Academy of Orthopaedic Surgeons (2014) Management of hip fractures in the elderly: evidence-based clinical practice guideline. American Academy of Orthopaedic Surgeons, IllinoisGoogle Scholar
  38. 38.
    Mountain G, Windle G, Hind D, Walters S, Keertharuth A, Chatters R, Sprange K, Craig C, Cook S, Lee E, Chater T, Woods R, Newbould L, Powell L, Shortland K, Roberts J (2017) A preventative lifestyle intervention for older adults (lifestyle matters): a randomised controlled trial. Age Ageing 46(4):627–634Google Scholar
  39. 39.
    Williams NH, Roberts JL, Din NU, Charles JM, Totton N, Williams M, Mawdesley K, Hawkes CA, Morrison V, Lemmey A, Edwards RT, Hoare Z, Pritchard AW, Woods RT, Alexander S, Sackley C, Logan P, Wilkinson C, Rycroft-Malone J (2017) Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). Health Technol Assess 21(44):1–528Google Scholar
  40. 40.
    Keeler EB, Kahn KL, Draper D, Sherwood MJ, Rubenstein LV, Reinisch EJ, Kosecoff J, Brook RH (1990) Changes in sickness at admission following the introduction of the prospective payment system. JAMA 264(15):1962–1968Google Scholar
  41. 41.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383Google Scholar
  42. 42.
    Groll DL et al (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58(6):595–602Google Scholar
  43. 43.
    Hoang-Kim A, Busse JW, Groll D, Karanicolas PJ, Schemitsch E (2014) Co-morbidities in elderly patients with hip fracture: recommendations of the ISFR-IOF hip fracture outcomes working group. Arch Orthop Trauma Surg 134(2):189–195Google Scholar
  44. 44.
    Kondo A, Zierler BK, Hagino H (2010) Relationship between the length of hospital stay after hip fracture surgery and ambulatory ability or mortality after discharge in Japan. Jpn J Nurs Sci 7(1):96–107Google Scholar
  45. 45.
    Smith TO et al (2015) Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery. Cochrane Database Syst Rev 6:CD010569.
  46. 46.
    Hall AJ, Lang IA, Endacott R, Hall A, Goodwin VA (2017) Physiotherapy interventions for people with dementia and a hip fracture—a scoping review of the literature. Physiotherapy 103(4):361–368Google Scholar
  47. 47.
    Voeten SC, Krijnen P, Voeten DM, Hegeman JH, Wouters MWJM, Schipper IB (2018) Quality indicators for hip fracture care, a systematic review. Osteoporos Int 29(9):1963–1985Google Scholar
  48. 48.
    Shamliyan T, Kane RL, Dickinson S (2010) A systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases. J Clin Epidemiol 63(10):1061–1070Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Programme in Health Services & Systems ResearchDuke–NUS Medical SchoolSingaporeRepublic of Singapore
  2. 2.Department of Medicine (General Internal Medicine)Duke University Medical CenterDurhamUSA
  3. 3.Orthopaedic Diagnostic Centre, Department of Orthopaedic SurgerySingapore General HospitalSingaporeRepublic of Singapore
  4. 4.Department of Orthopaedic SurgerySingapore General HospitalSingaporeRepublic of Singapore
  5. 5.Duke–NUS Medical SchoolSingaporeRepublic of Singapore

Personalised recommendations