Daily Steps After Hip Fracture in Older Adults and Their Relationship with Functional Recovery

Background: Step count has emerged as an objective indicator of physical activity, yet its association with functional recovery following hip fracture remains unclear. Objective: This study aimed to evaluate daily step counts after hospital discharge in older adults with hip fracture and to determine thresholds associated with functional improvement. Methods: A prospective, observational study was conducted in patients aged over 75 years admitted with hip fracture. Daily steps were recorded using validated activity trackers. Functional status was assessed at one, three, and six months after discharge through telephone interviews. Functional improvement was defined as an increase of at least 5 points on the Barthel Index. Step count thresholds were estimated using Liu's method based on receiver operating characteristic (ROC) analysis. Results: Ninety-four patients were included with a mean age of 83.2 ± 6 years, with 80.8% being female. Of the patients included in the study who recorded their daily steps after hip surgery, 59 patients (72%) improved during the first month after discharge with a median of 220 daily steps (IQR: 103.5-494.5; cut-off point at 150 steps). At the third month after hip fracture, 77 patients (86.5%) showed functional improvement with a median of 778 steps (IQR: 263-1697; cut-off point at 425 steps). At month six, 65 patients (80.2%) showed functional improvement with a median of 1757 steps (IQR: 696-3388; cut-off point at 2404 steps). Conclusions: In older adults discharged after hip fracture, achieving more than 150 steps per day in the first month, 425 steps in the third month, and 2404 steps by the sixth month was associated with functional improvement on the Barthel Index. These findings suggest potential activity targets to support mobility recovery. However, further research is warranted to confirm these associations in larger and more diverse populations. These thresholds, although exploratory, may also assist clinicians in monitoring and identifying patients at risk of poor functional recovery.