Concurrent impact of sarcopenia and cognitive impairment on walking recovery after rehabilitation following hip fracture surgery

Abstract

Background: Cognitive impairment and sarcopenia each negatively impact functional recovery after hip fracture, yet their combined effects remain underexplored. This study investigated the influence of these conditions on 1-year independent walking recovery in older adults undergoing post-fracture rehabilitation.

Methods: This secondary analysis used data from the Fragility Fracture Integrated Rehabilitation Management (FIRM) clinical trial, a parallel-group, single-blind, multicenter superiority RCT, and its preliminary feasibility study. A total of 114 patients aged ≥65 years from three tertiary hospitals in South Korea were included. Patients were classified into four groups based on the presence of cognitive impairment and/or sarcopenia. Walking ability was assessed over a 12-month period. Kaplan-Meier analysis and multivariate Cox regression were used to evaluate independent ambulation rates and associated factors.

Results: Patients with sarcopenia had lower independent ambulation rates than those without (71.9% vs. 84.4%; p = 0.025), as did those with cognitive impairment (65.2% vs. 89.1%; p = 0.010). The lowest rate was in patients with both conditions (60.8%, p = 0.022) and the highest in those without either (90.2%). Post hoc pairwise comparisons confirmed significant differences (p = 0.011). Cox regression showed cognitive impairment reduced independent ambulation likelihood by 45.8% (HR: 0.542, 95% CI: 0.340-0.865, p = 0.010), while both conditions together lowered it by 57% (HR: 0.431, 95% CI: 0.233-0.798, p = 0.007).

Conclusions: Cognitive impairment, especially with sarcopenia, significantly hinders walking recovery after hip fracture. Targeted rehabilitation strategies are crucial to addressing their combined impact in older adults.