Nutritional status modifies the effect of rehabilitation strategy on functional recovery after hip fracture in older adults

Abstract

Objectives: To compare the effectiveness of integrated rehabilitation and conventional rehabilitation after hip fractures and evaluate whether nutritional status modifies the effect of rehabilitation strategies on functional recovery in older adults.

Study design: This prospective observational cohort study included adults aged ≥65 years who underwent hip fracture surgery and received either integrated or conventional rehabilitation at a tertiary hospital.

Main outcome measures: Malnutrition was assessed using the Global Leadership Initiative for Malnutrition (GLIM) criteria. Functional recovery was evaluated using the modified Barthel index at admission, discharge, and at 3 and 6 months postoperatively. Linear mixed-effects models were used to examine the associations between nutritional status, rehabilitation strategy, and their interactions with longitudinal modified Barthel index trajectories and baseline-adjusted changes. Missing data were handled using multiple imputations, with complete-case analyses as sensitivity analyses.

Results: Among 107 participants (mean age 81.8 ± 6.2 years), both modified Barthel index trajectories and baseline-adjusted changes improved significantly over time (all p < 0.001). At 6 months, integrated rehabilitation was associated with greater functional improvement among patients with malnutrition compared with conventional rehabilitation (estimate = 13.5; p = 0.030). Baseline-adjusted change scores of the modified Barthel index further demonstrated significantly greater 6-month functional gains with integrated rehabilitation in malnourished patients (estimate = 14.5; p = 0.008).

Conclusions: Malnourished patients responded more to structured multidisciplinary rehabilitation after hip fractures than to conventional rehabilitation. These findings highlight the importance of early nutritional assessment and support for a stratified rehabilitation approach based on nutritional risk to optimize postoperative functional recovery after hip fractures.

Clinicaltrials: gov registration number NCT03430193.