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Association between early sitting and functional mobility recovery after hip-fracture surgery in older patients: a prospective cohort study

BMC Geriatrics volume 25, Article number: 184 (2025) Cite this article

Abstract

Background

Hip fractures significantly impact older adults, leading to compromised mobility and various adverse outcomes. The importance of early post-surgery mobilization in regaining pre-fracture levels of mobility is recognized, but lacks standardized definitions and implementation strategies. This study aimed to assess the impact of early sitting position 24 h after hip-fracture surgery on functional mobility recovery after 30 days using data from the Spanish National Hip Fracture Registry (RNFC).

Methods

Prospective cohort study, including patients aged ≥ 75 years admitted for hip-fracture surgery between 2017 and 2020 at Sant Camil Residential Hospital. Data from the RNFC were analyzed, and linear regression models were developed to assess the association between early sitting after surgery (ESAS) and mobility recovery at 30 days after surgery.

Results

Of 486 identified patients, 321 were included, with an estimated ESAS prevalence of 38.32% (95% CI: 32.97–43.88). ESAS was significantly associated with improved mobility recovery at 30 days. Multivariate regression models consistently revealed ESAS as a modest independent predictor of better post-surgery mobility. Factors such as age, cognitive capacity, and general health also impacted mobility recovery.

Conclusion

The ESAS effect, while modest, emerges as a significant predictor of hip mobility recovery among older patients with hip fractures 30 days after surgery. These findings underscore the potential of this low-risk, low-cost intervention in enhancing functional mobility recovery strategies and emphasize the need for further research to uncover its broader implications in post-operative care. Implementation of early sitting could be enhanced, as only a third of patients in our study underwent this simple intervention.

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Background

Hip fractures are one of the most prevalent injuries among the older adults [1, 2]. Incomplete recovery of patients’ mobility after surgery often leads to significant alterations in their management of activities of daily living, independent lifestyle and living arrangements, psychological deterioration, and overall reduction of their well-being [3,4,5]. Furthermore, hip fractures in older adults are associated with high rates of morbidity, mortality, and health care financial burden [5,6,7].

A critical aspect influencing patients’ quality of life and independent functioning following hip-fracture surgery relies on regaining pre-fracture levels of mobility [3, 8]. In this context, patients’ early mobilization after surgery has become a gold standard for improving functional recovery. Early mobility after surgery positively correlates with a reduced length of hospital stays, post-operative complications, and pain, while enhancing walking abilities and elevating overall quality of life. Moreover, it is associated with reduced readmission rates, lower mortality rates, decreased total hospitalization costs, higher satisfaction levels, and a lower incidence of fracture displacement or implant failure [9]. In this regard, one of the quality standards developed by the National Institute for Health and Care Excellence (NICE) recommended starting mobilization at least once a day, no later than the day after surgery [10]. On the other hand, although evidence-based clinical practice guidelines from the United States recommend supervised physical therapy after hip-fracture surgery across the continuum of care [11], there is no indication of when mobilization should start. Additionally, these guidelines do not provide any additional recommendations about what type of mobilization is adequate when tolerated.

Despite the increasing evidence supporting the many benefits of early mobilization after hip-fracture surgery, the definition of early mobilization is still inconsistent [12, 13] and its implementation, suboptimal [14]. Geriatric patients presenting with a hip fracture may have a range of health problems that limit early mobilization, including reduced preexisting mobility or cognitive impairment [14]. Moreover, fear of experiencing another fall, pain management, and patient confusion are frequently factored in. These elements frequently impose limitations, restricting more high-risk interventions like ambulation [14, 15].

Other factors may also limit early mobilization in postoperative patients, including surgical complications or excessive bleeding. Additionally, barriers such as a lack of health education, absence of standardized protocols, and limitations in the availability of nursing or physiotherapy support further hinder early mobilization efforts. Addressing these challenges requires a multidisciplinary approach and systemic improvements in care delivery [16]. In older patients, prolonged bed rest is associated with various complications, particularly muscle mass loss and functional decline [17]. Early mobilization may range from sitting in bed to hospital ambulation. While the benefits of early mobilization and rehabilitation after hip fracture have been reported, there are no known studies specifically addressing the act of “getting out of bed,” that is, transitioning from the bed to a chair at an early stage.

Evidence-based refinement of these recommendations is essential to improve the adherence to, and implementation of, standardized and effective protocols. In that regard, this prospective study aimed to evaluate the impact of a low-risk intervention, early sitting position 24 h after surgery (ESAS), in recovering functional mobility after a hip fracture using data from the National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera, or RNFC [18]). In this study, early postoperative seating was defined as having documented evidence, during any of the three 8-h nursing shifts following surgery, that the patient had been seated in a chair. We developed multivariate regression models to investigate how ESAS contributes to functional mobility recovery at 30 days after surgery for hip fractures.

Methods

Study design and population

This prospective cohort study included all patients aged 75 years and older, included in the RNFC, admitted for surgery due to a hip fracture between 2017 and 2020 to the Sant Camil Residential Hospital (Barcelona, Spain). The service of traumatology at the Hospital Residencia Sant Camil performs more than 100 hip fracture surgeries annually and consists of a team of 13 traumatologists, supported by geriatricians who collaborate in the care of older patients. The hospital is part of the Consorci Sanitari de l’Alt Penedès i Garraf, a network comprising three second-level hospitals with a total of 457 beds, serving a reference population of over 247,300 inhabitants. Patient data were collected from the RNFC. Exclusion criteria were patients with pathological, periprosthetic, or high-impact fractures, patients who died within the first 30 days after surgery, and those with incomplete data on key variables.

Patient data were collected from the RNFC, a prospective, multicenter, observational, and descriptive registry that gathers epidemiological, clinical, and care-related data during hospitalization, progression, and one month after suffering a fragility hip fracture. The registry includes a representative sample of Spanish National Health Service hospitals. Since 2017, the RNFC has involved 105 hospitals and has included data from over 56,000 cases of hip fractures in patients aged 75 and older. Exclusion criteria were patients with pathological, periprosthetic, or high-impact fractures, patients who died within the first 30 days after surgery, and those with incomplete data on key variables.

Centers participating in the RNFC received approval from their local Ethics Committee; Comitè d’Ètica d’Investigació de la FUNDACIÓ UNIO CATALANA HOSPITALS for the center that conducted this study (Approval reference: CEI 17/25). All patients included in the RNFC gave their prior informed consent. This study was therefore performed according to the ethical standards laid down in the 1964 Declaration of Helsinki.

Data source

The RNFC [18] is a prospective voluntary registry that collects anonymized sociodemographic and hospitalization data on patients aged 75 and older admitted for hip fracture in participating hospitals, including dates of admission, surgery and discharge, pre-fracture place of residence and mobility, cause of discharge and destination at discharge, among other variables. Additionally, the RNFC captures information about post-surgical care provided, encompassing whether patients sat up the day after surgery and their 30-day follow-up, covering mobility, residence, and vital status. The registry is filled in directly using a data collection template proposed in the Fragility Fracture Network Minimum Common Dataset (FFN MCD) [19].

Objectives and variables

The primary objective was to assess the impact of ESAS (recorded dichotomously, “Yes/No”) on mobility 30 days after intervention, measured using the RNFC [18] scale, scoring mobility from 1 (maximum mobility) to 10 (minimum mobility). ESAS was defined, according to the RNFC data collection form, as sitting no later than 24 h after surgery. A patient was considered to have been seated early after surgery if it was documented during the clinical course of any of the three 8-h nursing shifts following the operation that the patient had been seated in a chair. In our center, for postoperative hip fracture patients, a physician must prescribe the medical order to get out of bed and sit in a chair during the day for the nursing staff to implement it. Once this order is given, the nursing staff strives to minimize the patient’s time in bed and encourages them to sit in a chair during daylight hours, adjusting for the patient’s tolerance for sitting. Those patients who remained bedridden performed exercises in bed, while those who were seated performed exercises while sitting, and at most, they achieved standing (bipedal stance) and a few steps, and then returned to sitting. We considered additional variables based on existing evidence, showing their impact on mobility: demographic characteristics (gender and age), pre-fracture mobility (RNFC scale), pre-intervention cognitive capacity, pre-surgical health status, time to surgery (time in hours from patient admission to surgery), and type of surgery (prosthesis vs. osteosynthesis). Cognitive capacity was recorded using Pfeiffer’s mental status questionnaire [20, 21], with scores ranging from 0 to 10: a 0–2 score indicated normal cognitive functioning; 3–4, mild cognitive impairment; 5–7, moderate cognitive impairment; and > 8, severe cognitive impairment. Pre-surgery health status was recorded following the American Society of Anesthesiologists (ASA) classification [22, 23] as follows: ASA I meant a normal healthy patient; ASA II, a patient with mild systemic disease; ASA III, a patient with severe systemic disease; and ASA IV, a patient with severe systemic disease that is a constant threat to life.

Statistical analysis

Categorical variables were described as the number of cases and the percentage relative to the total for each category. Continuous variables not following a normal distribution were described using the median and the first (25th percentile, Q1) and third (75th percentile, Q3) quartiles. We estimated the prevalence of ESAS alongside the 95% confidence interval (CI).

The association between early sitting position 24 h after surgery and mobility after 30 days (RNFC scale) was analyzed using linear regression models. The researchers selected the adjustment variables based on their clinical relevance to the study outcome and their distribution across groups. Selected co-variables were gender, age, pre-surgery cognitive capacity, pre-surgery general health, time to surgery, and type of surgery. The analysis was conducted using R software, version 4.0.5.

Results

Demographic and clinical characteristics of study patients

This prospective cohort study identified 486 patients, of which 37 died within 30 days after surgery, and 128 had incomplete data on key variables, resulting in a study population of 321 patients (see Annexe 1, Supplementary Fig. 1). Of these, 123 patients were sat within 24 h after surgery, resulting in an estimated ESAS prevalence of 38.32% (95% CI: 32.97-, 43.88) as shown in Table 1. Patients’ mean (SD) age was 86.5 (5.73) years for the ESAS group and 85.0 (5.29) years for the non-ESAS group. Patients’ demographic, fracture, surgery, and clinical characteristics, including mobility, cognitive capacity (Pfeiffer scale), general health (ASA scale), and pre-surgery housing arrangements are presented in Table 1. The percentage of males and females was similar between the ESAS and non-ESAS groups. The most common type of fracture was trochanteric, with a prevalence of 57.10% for the non-ESAS group and 54.50% for the ESAS group; an intramedullary nail was used in 67.2% of non-ESAS patients and 60.2% of ESAS patients. Over 70% of patients lived in their houses, and most were independent in terms of mobility (23.70% in the non-ESAS group and 38.20% in the ESAS group), both indoors and outdoors, with no technical help. Cognitive capacity ranged from a median of 4 errors in the Pfeiffer scale for the non-ESAS group to 2 errors in the ESAS group. Regarding general health status, 61.6% in the non-ESAS group and 53.70% in the ESAS group presented with severe systemic illness restricting activity but not disabling (ASA III).

Table 1 Pre-surgery characteristics of patients surgically treated for non-pathological hip fractures
Full size table

Supplementary Table 1 (Annexe 1) summarizes patients’ clinical information and pre-surgical treatments. Table 2 summarizes clinical variables 30 days after surgery and housing arrangements. Only one patient was admitted for surgical reintervention during the 30 days after hip-fracture surgery.

Table 2 Clinical characteristics of the study population 30 days after surgery
Full size table

Association between ESAS and mobility at 30 days after surgery

Patients who engaged in ESAS showed lower pre-surgery mobility scores (median value of 2, RNFC scale), indicating better initial mobility than patients from the non-ESAS group, with a median value of 4 (Table 3). The RNFC scale was grouped into three categories to evaluate mobility, as shown in Table 3. We found a higher percentage of patients who were independent indoors and outdoors in the ESAS group, before and after surgery, than in the non-ESAS group.

Table 3 Mobility before and 30 days after surgery, RNFC scale (score)
Full size table

A multivariate regression model, including ESAS and pre-surgery mobility scores, showed that early sitting was associated with lower scores in the RNFC scale, i.e., better mobility 30 days after surgery (Table 4). Similarly, greater mobility before the fracture was significantly associated with better mobility at 30 days (Table 4).

Table 4 Linear regression models for mobility 30 days after surgery
Full size table

A model that also included age, gender (female), and cognitive capacity (increments in the Pfeiffer scale scores) as co-variables confirmed that ESAS and pre-fracture mobility were associated with mobility at 30 days. Age, cognitive capacity, and gender (female) also showed a statistically significant association.

In a more comprehensive model including general health, time to surgery, and type of surgery, ESAS demonstrated a modest effect on mobility at 30 days and remained an independent predictor alongside the aforementioned factors. Patients in the ESAS group had decreased RNFC mobility scores by −0.57 (95% CI: −1.05, −0.09) (p = 0.02) compared to those in the non-ESAS group. Age, cognitive capacity, and specific health factors also showed significant associations, while time to surgery and type of surgery showed no significant impact on the recovery of mobility after surgery.

Discussion

The multivariate regression analysis in this study aimed to understand the impact of ESAS on mobility recovery at 30 days after hip-fracture surgery. ESAS consistently emerged as a modest but significant predictor across all models in our study, suggesting its association with better mobility recovery at 30 days after surgery.

The recovery of functional mobility after a hip fracture is a multiple variable-dependent outcome, especially in the older adults [6, 24,25,26,27,28,29,30]. In that regard, three sequential models were constructed, each expanding on the co-variables considered for mobility recovery after surgery. In all the models, ESAS showed a modest, yet significant correlation with improved post-surgery mobility scores based on the RNFC scale, confirming the validity of ESAS as an independent predictor of the functional recovery of mobility after hip-fracture surgery. Furthermore, the multivariate models evolved from focusing solely on immediate post-surgery factors, i.e., ESAS and pre-fracture mobility, to encompassing demographic (age, gender), cognitive (Pfeiffer scale), and broader health (ASA category) factors. The consistency of the significance of the co-variables across all models and the fact that those co-variables have been validated by other studies as predictors (age, cognitive capacity, female sex, general health, etc.) highlights the potential importance of ESAS in enhancing hip mobility recovery. On the other hand, the impact of different mobilization maneuvers, such as early ambulation, has been previously investigated [24, 31], but, to our knowledge, the specific impact of ESAS remained unassessed. Furthermore, the measures used to assess mobility (before and after surgery) are widely heterogeneous among studies [5, 8, 13, 28, 32,33,34,35], often precluding direct comparisons.

Among other significant co-variables in our study, a worse pre-fracture mobility was associated with poorer mobility 30 days after surgery. Indeed, several independent studies have reported similar associations [28,29,30, 35, 36]. Age and pathological cognitive decline have also been linked to delayed functional recovery in mobility from many angles. It is easy to see that cognitive status may limit mobilization and increase the risk of falling, reinforcing the notion that aging and cognitive capacity contribute to poorer mobility recovery [26, 27, 34, 35]. Additional significant co-variables in our study associated with better functional recovery outcomes in previous studies included less systemic disease [21] (ASA scale) and the female gender [24, 37,38,39], the latter with a marginally significant impact on mobility recovery. Furthermore, other multivariate analyses have also linked early mobilization after surgery, age, and general health to better mobility outcomes [38, 40], strengthening our findings. However, our results underscore the potential benefit of a very specific and simple, low-risk, low-cost intervention in this population: sitting 24 h after surgery.

Regaining basic mobility after hip-fracture surgery is a primary goal of rehabilitation during acute hospitalization [11] and a strong predictor of reduced mortality among the older adults [4,5,6,7, 36]. Although the underlying physiological and pathological reasons for early mobilization in regaining basic functional mobility after hip surgery are yet poorly understood, some studies show early mobilization as an effective non-pharmacological preventive measure of additional comorbidities, such as post-operative infections, including concomitant urinary tract infections, acute thromboembolic complications, post-operative delirium, sarcopenia or functional decline [41], to name a few. The list of post-surgery complications after hip-fracture surgery in the older adults is inevitably long. The impact of these complications on functional mobility recovery is complex and yet unclear at best, untested at most, and will require further research.

Overall, in our study, less than half of the operated patients were moved out of bed and seated in a chair within the first 24 h. While in some cases the patient’s medical condition may justify this delay in achieving a seated position, the percentage is notably low and underscores the need for protocols designed to reduce time spent in bed. Prolonged bed rest may often be attributed to delays in issuing the physician’s order to seat the patient or the absence of necessary diagnostic tests, such as a blood test to assess hemoglobin levels during the physician’s rounds, to confirm the safety of the maneuver.

Surgical delays beyond 48 h have been associated with poorer survival and functional outcomes in various observational studies [42]. However, there are precedents in the literature suggesting different findings. For instance, in the clinical trial by Reguant et al., surgery performed beyond the first 48 h was not a risk factor for mortality when protocolized and continuous medical care was provided [43]. In our multivariate model, time to surgery was not a determining factor for mobility at 30 days after surgery. This finding, for which the authors do not have a clear explanation, should be interpreted with caution and requires further investigation.

Study limitations

The study focused on patients within a specific residential hospital, potentially limiting the generalizability of findings to broader patient populations. While the study included various predictors, they were limited by the data available in the RNFC, and therefore, other unaccounted confounding factors with a potential influence on mobility recovery outcomes (e.g., individual lifestyle, socio-economic status, or specific comorbidities) remained unaddressed. The study primarily focused on a 30-day post-operative period, which might not capture long-term mobility changes or variations in recovery trajectories beyond this period of time. Additionally, ESAS prevalence was only slightly above one third of the study population and demonstrated a modest but significant correlation with a superior recovery of functional mobility 30 days after surgery in the geriatric population. Despite these limitations, our study identified that ESAS positively impacts mobility recovery at 30 days and should be considered in the management of oder patients after hip-fracture surgery.

Conclusion

In conclusion, this study stresses the importance of early sitting position 24 h after surgery to enhance hip mobility recovery 30 days after surgery. To our knowledge, this is the first report evaluating and validating the impact of such a low-risk intervention as sitting within the first 24 h after hip-fracture surgery on the recovery of functional mobility in older patients. In our study, only a third of the patients underwent such a simple intervention, indicating great potential for improvement in its implementation. Our findings hold promise for refining post-operative care strategies, offering essential insights into low-risk interventions to optimize functional mobility recovery for the geriatric population after hip-fracture surgery.

Data availability

The data that support the findings of this study are available from the authors upon reasonable request and with permission of the RNFC.

References

  1. World Health Organization. Ageing, & life course unit. WHO global report on falls prevention in older age. Geneva: World Health Organization; 2008.

  2. Frenkel Rutenberg T, Rutenberg R, Vitenberg M, Cohen N, Beloosesky Y, Velkes S. Prediction of readmissions in the first postoperative year following hip-fracture surgery. Eur J Trauma Emerg Surg. 2020;46(5):939–46. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00068-018-0997-5.

    Article  PubMed  Google Scholar 

  3. Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016;16(1):158. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-016-0332-0.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Alexiou K, Roushias A, Varitimidis S, Malizos K. Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging. 2018;13:143–50. https://doiorg.publicaciones.saludcastillayleon.es/10.2147/CIA.S150067.

    Article  PubMed  PubMed Central  Google Scholar 

  5. González Marcos E, González García E, González-Santos J, González-Bernal JJ, del Pilar Martín-Rodríguez A, Santamaría-Peláez M. Determinants of lack of recovery from dependency and walking ability six months after hip fracture in a population of people aged 65 years and over. J Clin Med. 2022;11(15):4467. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/jcm11154467.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zaki HE, Mousa SM, El Said SMS, Mortagy AK. Morbidity and mortality following surgery for hip fractures in elderly patients. J Aging Res. 2019;2019:1–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2019/7084657.

    Article  Google Scholar 

  7. Downey C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture - a systematic review. World J Orthop. 2019;10(3):166–75. https://doiorg.publicaciones.saludcastillayleon.es/10.5312/wjo.v10.i3.166.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fujita K, Makimoto K, Tanaka R, Mawatari M, Hotokebuchi T. Prospective study of physical activity and quality of life in Japanese women undergoing total hip arthroplasty. J Orthop Sci. 2013;18(1):45–53. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00776-012-0318-5.

    Article  PubMed  Google Scholar 

  9. Aprisunadi, Nursalam N, Mustikasari M, Ifadah E, Hapsari ED. Effect of early mobilization on hip and lower extremity postoperative: a literature review. SAGE Open Nurs. 2023;9:237796082311678. https://doiorg.publicaciones.saludcastillayleon.es/10.1177/23779608231167825.

    Article  Google Scholar 

  10. National Institute for Health and Care Excellence. Hip fracture in adults (Vol. 16). 2016. https://www.nice.org.uk/guidance/qs16/documents/draft-quality-standard-2.

  11. Roberts KC, Brox WT, Jevsevar DS, Sevarino K. Management of hip fractures in the elderly. J Am Acad Orthop Surg. 2015;23(2):131–7. https://doiorg.publicaciones.saludcastillayleon.es/10.5435/JAAOS-D-14-00432.

    Article  PubMed  Google Scholar 

  12. Wainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, Yates P, Ljungqvist O. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthop. 2020;91(1):3–19. https://doiorg.publicaciones.saludcastillayleon.es/10.1080/17453674.2019.1683790.

    Article  PubMed  Google Scholar 

  13. Tazreean R, Nelson G, Twomey R. Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements. J Comp Eff Res. 2022;11(2):121–9. https://doiorg.publicaciones.saludcastillayleon.es/10.2217/cer-2021-0258.

    Article  CAS  PubMed  Google Scholar 

  14. Said CM, Delahunt M, Ciavarella V, Al Maliki D, Boys A-M, Vogrin S, Berney S. Factors impacting early mobilization following hip fracture: an observational study. J Geriatr Phys Ther. 2021;44(2):88–93. https://doiorg.publicaciones.saludcastillayleon.es/10.1519/JPT.0000000000000284.

    Article  PubMed  Google Scholar 

  15. Turhan Damar H, Bilik O, Karayurt O, Ursavas FE. Factors related to older patients’ fear of falling during the first mobilization after total knee replacement and total hip replacement. Geriatr Nurs. 2018;39(4):382–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.gerinurse.2017.12.003.

    Article  PubMed  Google Scholar 

  16. Presta R, Brunetti E, Quaranta V, Raspo S, Cena P, Carignano G, Bonetto M, Busso C, Isaia G, Marabotto M, Massazza G, Bo M. Predictors of non-adherence to an erly in-hospital rehabilitation program after surgery for hip frcture in a co-managed orthogeriatric unit. Aging Clin Exp Res. 2024;36(1):206. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s40520-024-02857-w.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kortebein P, Symons T, Ferrando A, Paddon-Jones D, Rønsen O, Protas E, Conger S, Lombeida J, Wolfe R, Evans W. Functional impact of 10 days of bed rest in healthy older adults. J Gerontol A Biol Sci Med Sci. 2008;63(10):1076–81. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/gerona/63.10.1076.

    Article  PubMed  Google Scholar 

  18. Ojeda-Thies C, Sáez-López P, Currie CT, Tarazona-Santalbina FJ, Alarcón T, Muñoz-Pascual A, Pareja T, Gómez-Campelo P, Montero-Fernández N, Mora-Fernández J, Larrainzar-Garijo R, Gil-Garay E, Etxebarría-Foronda I, Caeiro JR, Díez-Pérez A, Prieto-Alhambra D, Navarro-Castellanos L, Otero-Puime A, González-Montalvo JI. Spanish National Hip-Fracture Registry (RNFC): analysis of its first annual report and international comparison with other established registries. Osteoporos Int. 2019;30(6):1243–54. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00198-019-04939-2.

    Article  CAS  PubMed  Google Scholar 

  19. Johansen A, Ojeda-Thies C, Poacher AT, Hall AJ, Brent L, Ahern EC, Costa ML. Developing a minimum common dataset for hip-fracture audit to help countries set up national audits that can support international comparisons. Bone Joint J. 2022;104-B(6):721–8. https://doiorg.publicaciones.saludcastillayleon.es/10.1302/0301-620X.104B6.BJJ-2022-0080.R1.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23(10):433–41. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1532-5415.1975.tb00927.x.

    Article  CAS  PubMed  Google Scholar 

  21. Martínez de la Iglesia J, Dueñas Herrero R, Onís Vilches MC, Aguado Taberné C, Albert Colomer C, Luque Luque R. Adaptación y validación al castellano del cuestionario de Pfeiffer (SPMSQ) para detectar la existencia de deterioro cognitivo en personas mayores de 65 años [Spanish language adaptation and validation of the Pfeiffer’s questionnaire (SPMSQ) to detect cognitive deterioration in people over 65 years of age]. Med Clin. 2001;117(4):129–34. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/s0025-7753(01)72040-4.

    Article  Google Scholar 

  22. Doyle DJ, H. J. G. E. American Society of Anesthesiologists Classification. Treasure Island: StatPearls Publishing; 2023.

  23. Owens WD, Felts JA, Spitznagel EL. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49(4):239–43. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/00000542-197810000-00003.

    Article  CAS  PubMed  Google Scholar 

  24. Kristensen MT. Factors affecting functional prognosis of patients with hip fracture. Eur J Phys Rehabil Med. 2011;47(2):257–64.

    CAS  PubMed  Google Scholar 

  25. Karagoz B, Erdem M. Risk factors affecting the inability to regain pre-fracture mobility after hip-fracture surgery in elderly patients. Int J Orthop Sci. 2022;8(2):01–6. https://doiorg.publicaciones.saludcastillayleon.es/10.22271/ortho.2022.v8.i2a.3107.

    Article  Google Scholar 

  26. Sheehan KJ, Williamson L, Alexander J, Filliter C, Sobolev B, Guy P, Bearne LM, Sackley C. Prognostic factors of functional outcome after hip-fracture surgery: a systematic review. Age Ageing. 2018;47(5):661–70. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ageing/afy057.

    Article  CAS  PubMed  Google Scholar 

  27. McGilton KS, Chu CH, Naglie G, van Wyk PM, Stewart S, Davis AM. Factors influencing outcomes of older adults after undergoing rehabilitation for hip fracture. J Am Geriatr Soc. 2016;64(8):1601–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/jgs.14297.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tam T-L, Tsang K-K, Lee K-B. Development of a prognostic model to predict postoperative mobility of patients with fragility hip fractures: a retrospective cohort study. Int J Orthop Trauma Nurs. 2020;38:100770. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ijotn.2020.100770.

    Article  PubMed  Google Scholar 

  29. Yoryuenyong C, Jitpanya C, Sasat S. Factors influencing mobility among people post-surgery for hip fractures: a cross-sectional study. Belitung Nurs J. 2023;9(4):349–58. https://doiorg.publicaciones.saludcastillayleon.es/10.33546/bnj.2759.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lee D, Jo JY, Jung JS, Kim SJ. Prognostic factors predicting early recovery of pre-fracture functional mobility in elderly patients with hip fracture. Ann Rehabil Med. 2014;38(6):827. https://doiorg.publicaciones.saludcastillayleon.es/10.5535/arm.2014.38.6.827.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ, Bailey MJ. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg. 2006;76(7):607–11. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1445-2197.2006.03786.x.

    Article  PubMed  Google Scholar 

  32. Kristensen MT, Foss NB, Ekdahl C, Kehlet H. Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip-fracture surgery. Acta Orthop. 2010;81(3):296–302. https://doiorg.publicaciones.saludcastillayleon.es/10.3109/17453674.2010.487240.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Voeten SC, Nijmeijer WS, Vermeer M, Schipper IB, Hegeman JH, De Klerk G, Stevens C, Snoek J, Luning HAF, Van der Velde D, Verleisdonk EJ, Niggebrugge AHP, Regtuijt M, Würdemann FS. Validation of the fracture mobility score against the parker mobility score in hip-fracture patients. Injury. 2020;51(2):395–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.injury.2019.10.035.

    Article  PubMed  Google Scholar 

  34. Tang VL, Sudore R, Cenzer IS, Boscardin WJ, Smith A, Ritchie C, Wallhagen M, Finlayson E, Petrillo L, Covinsky K. Rates of recovery to pre-fracture function in older persons with hip fracture: an observational study. J Gen Intern Med. 2017;32(2):153–8. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s11606-016-3848-2.

    Article  PubMed  Google Scholar 

  35. Stubbs TA, Doherty WJ, Chaplin A, Langford S, Reed MR, Sayer AA, Witham MD, Sorial AK. Using pre-fracture mobility to augment prediction of postoperative outcomes in hip fracture. Eur Geriatr Med. 2023;14(2):285–93. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s41999-023-00767-0.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sieber F, Neufeld KJ, Gottschalk A, Bigelow GE, Oh ES, Rosenberg PB, Mears SC, Stewart KJ, Ouanes J-PP, Jaberi M, Hasenboehler EA, Wang N-Y. Depth of sedation as an interventional target to reduce postoperative delirium: mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial. Br J Anaesth. 2019;122(4):480–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.bja.2018.12.021.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Holt G, Smith R, Duncan K, Hutchison JD, Gregori A. Gender differences in epidemiology and outcome after hip fracture. J Bone Joint Surg Br. 2008;90(4):480–3. https://doiorg.publicaciones.saludcastillayleon.es/10.1302/0301-620X.90B4.20264.

    Article  CAS  PubMed  Google Scholar 

  38. Kenyon-Smith T, Nguyen E, Oberai T, Jarsma R. Early mobilization post–hip-fracture surgery. Geriatr Orthop Surg Rehabil. 2019;10:215145931982643. https://doiorg.publicaciones.saludcastillayleon.es/10.1177/2151459319826431.

    Article  Google Scholar 

  39. Heiberg KE, Ekeland A, Bruun-Olsen V, Mengshoel AM. Recovery and prediction of physical functioning outcomes during the first year after total hip arthroplasty. Arch Phys Med Rehabil. 2013;94(7):1352–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.apmr.2013.01.017.

    Article  PubMed  Google Scholar 

  40. Mizrahi E-H, Arad M, Fleissig Y, Adunsky A. Gender differences in functional outcome of elderly hip-fracture patients. Geriatr Gerontol Int. 2014;14(4):845–50. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/ggi.12178.

    Article  PubMed  Google Scholar 

  41. Ariza-Vega P, Lozano-Lozano M, Olmedo-Requena R, Martín-Martín L, Jiménez-Moleón JJ. Influence of cognitive impairment on mobility recovery of patients with hip fracture. Am J Phys Med Rehabil. 2017;96(2):109–15. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/PHM.0000000000000550.

    Article  PubMed  Google Scholar 

  42. Cai Q, Fu K, Jia W, Li X, He H, Yao Z, Chen X, Dong Y, Wang Q, Kang B, Qian B, Chen S, Zhang C. In-hospital waiting time to surgery and functional outcomes in geriatric hip fractures: a directed acyclic graph-based preplanned analysis from a prospective multicenter cohort study. Int J Surg. 2023;109:1612–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/js9.0000000000000385.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Reguant F, Arnau A, Lorente J, Maestro L, Bosch J. Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture. J Clin Anesth. 2019;53:11–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jclinane.2018.09.029.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the i2e3 Procomms team (Barcelona, Spain), especially Inmaculada González, Ph.D., and Sara Cervantes, Ph.D., for providing medical writing support during the manuscript preparation.

Funding

This study received no funding.

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Authors and Affiliations

  1. Geriatric Unit, Consorci Sanitari Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, Spain

    Clarissa Catalano-Nadakhovskaia, Laura Alexandra Ivanov & Oscar Macho-Perez

  2. Research Area, Consorci Sanitari Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, Spain

    Carlos Pérez-López & Alejandro Rodríguez-Molinero

  3. Biostatistics Unit, Institut d’Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Spain

    Esther García-Lerma

Authors
  1. Clarissa Catalano-Nadakhovskaia
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Contributions

CCN: Designed the study, contributed to data analysis and interpretation and drafted the manuscript. EGL: Performed the statistical analysis. CPL: Managed the data. LAI, OMP, and CPL: Participated in fieldwork. ARM: Contributed to the study design, data interpretation and manuscript preparation. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Clarissa Catalano-Nadakhovskaia.

Ethics declarations

Ethics approval and consent to participate

All participating centers in the Spanish hip-fracture registry (Registro Nacional de Fracturas de Cadera, or RNFC) received approval from the local Ethics Committee, which in this study was the Comitè d’Ètica d’Investigació de la FUNDACIÓ UNIO CATALANA HOSPITALS. All patients provided written informed consent before inclusion in the RNFC. This study has therefore been performed by the ethical standards laid down in the 1964 Declaration of Helsinki. The RNFC is registered with the Spanish Data Protection Agency [18].

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Not applicable.

Competing interests

The authors declare no competing interests.

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Catalano-Nadakhovskaia, C., Pérez-López, C., García-Lerma, E. et al. Association between early sitting and functional mobility recovery after hip-fracture surgery in older patients: a prospective cohort study. BMC Geriatr 25, 184 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-025-05831-x

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Keywords

BMC Geriatrics

ISSN: 1471-2318

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