Efficacy of Fragility Fracture Integrated Rehabilitation Management in Older Adults With Hip Fractures: A Randomized Controlled Trial With 1-Year Follow-Up

Objectives: Comprehensive multidisciplinary rehabilitation has been proven to benefit patients recovering from hip fracture surgery, enhancing postoperative outcomes. However, challenges persist in delivering such rehabilitation due to health care system limitations and inadequate policies. This study aimed to evaluate the clinical effectiveness of Fragility Fracture Integrated Rehabilitation Management (FIRM) in comparison to a conventional rehabilitation after hip fracture surgery.

Design: A parallel-group, single-blind, multicenter randomized clinical trial.

Setting and participants: Three in-hospital rehabilitation settings; 203 hip fracture surgery patients aged 65 years and older were randomized and followed up for 1 year.

Methods: The main outcome assessed ambulatory function, using the Koval and Functional Ambulation Category (FAC) scales. Functional outcomes were evaluated upon rehabilitation admission, discharge, and during follow-up at 3, 6, and 12 months post-surgery. The prevalence of independent ambulation and recovery to prefracture ambulatory status at each follow-up time point were analyzed.

Results: The FIRM group demonstrated superior improvements in Koval and FAC scores, along with most secondary outcomes during the 1-year follow-up. Significant changes from baseline to 12 months were observed in Koval scores (mean difference, -4.13 [95% CI, -4.56 to -3.70] vs -3.22 [95% CI, -3.86 to -2.61], P = .016) and FAC scores (mean difference, 3.37 [95% CI, 3.01 to 3.72] vs 2.56 [95% CI, 2.10 to 3.02], P = .006). At the 12-month follow-up point, this group also showed higher rates of independent ambulation (53 [76.8%] vs 28 [56.0%], P = .016) and recovery to prefracture ambulatory status (56 [81.2%] vs 31 [62.0%], P = .020) than the conventional group.

Conclusions and implications: The FIRM demonstrated superior effectiveness compared with conventional rehabilitation in improving ambulation and other functional outcomes in older adults with hip fracture. This finding provides valuable insights for managing comprehensive multidisciplinary postoperative care for hip fractures in South Korea and beyond.