[Home-based rehabilitation after hip fracture: results of an integrated protocol]

Hip fracture is a sentinel event in older adults, associated with high morbidity, mortality, and functional decline. Postoperative home-based rehabilitation has been proposed as an alternative or complementary model to outpatient care, although its implementation and functional outcomes in selected populations require further evidence.

To evaluate the functional recovery and safety of a postoperative home-based rehabilitation program following hip fracture surgery, and to identify factors associated with functional outcomes.

A prospective cohort study was conducted in patients aged ≥65years who underwent hip fracture surgery and were referred to the Home Hospitalization Unit (UHD) of Hospital La Fe. A comprehensive geriatric assessment, clinical monitoring, and protocolized home physiotherapy were provided. Clinical variables, functional status (Barthel Index and Rockwood Frailty Index), pain (VAS), and mortality were recorded. Functional recovery was assessed at 45 and 180days. A multivariable model was performed to identify factors associated with clinically relevant functional decline.

A total of 103 patients were included. Gait and transfer ability improved progressively: at 45days, 95% achieved ≥10points in the Barthel gait item and 91% in the transfer item, with similar values at 180days. Between 96% and 97% matched or improved their premorbid gait and transfer capacity. Clinically significant Barthel decline at 180days was associated with poorer 45 day Barthel scores, right sided fracture, lower premorbid transfer scores, and higher ASA classification. Twelve month mortality was 10%, with no serious adverse events attributable to the program and no treatment related adverse effects observed.

Home-based rehabilitation after hip fracture surgery proved safe, feasible, and associated with favorable functional recovery in selected patients. However, given the lack of a comparison group and potential selection bias, these findings should be interpreted cautiously. Controlled studies are needed to determine its effectiveness and applicability in broader clinical settings.