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Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis

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Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusions

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)

NCT00133640.

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Funding

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).

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Authors and Affiliations

  1. Department of Geriatrics and Aging Research, Geriatric Clinic, University Hospital Zurich and University of Zurich, RAE B1, Rämistrasse 100, 8091, Zurich, Switzerland

    K. Fischer, M. Trombik, G. Freystätter, A. Egli, R. Theiler & H.A. Bischoff-Ferrari

  2. Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland

    K. Fischer, M. Trombik, G. Freystätter, A. Egli, R. Theiler & H.A. Bischoff-Ferrari

  3. Centre for Senior Trauma Care, University Hospital Zurich, Zurich, Switzerland

    G. Freystätter, R. Theiler & H.A. Bischoff-Ferrari

  4. City Hospital Waid, University Clinic for Acute Geriatric Care, Zurich, Switzerland

    H.A. Bischoff-Ferrari

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  1. K. Fischer
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  2. M. Trombik
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  3. G. Freystätter
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  4. A. Egli
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  6. H.A. Bischoff-Ferrari
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Correspondence to H.A. Bischoff-Ferrari.

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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.

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K. Fischer and M. Trombik are shared first authorship.

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Fischer, K., Trombik, M., Freystätter, G. et al. Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis. Osteoporos Int 30, 1371–1381 (2019). https://doi.org/10.1007/s00198-019-04944-5

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