Predictive factors of gait recovery after hip fracture: a scoping review

Cristina González de Villaumbrosia ^1 2 3, Raquel Barba ^4 5, Cristina Ojeda-Thies ⁶, Eulalia Grifol-Clar ⁷, Noelia Álvarez-Diaz ⁸, Teresa Álvarez-Espejo ^4 5, Jose Manuel Cancio-Trujillo ⁹, Jesús Mora-Fernández ¹⁰, Teresa Pareja-Sierra ¹¹, Raquel Barrera-Crispín ¹, Alicia Calle-Egusquiza ¹², Aina Capdevila-Reniu ¹³, Cristina Carrasco-Paniagua ¹, Mª Carmen Cervera Díaz ¹⁴, Patricia Condorhuamán-Alvarado ¹⁵, Laura Cotano-Abad ¹, Leonor Cuadra-Llopart ¹⁶, Verónica García-Cárdenas ¹, Sofía González-Chávez ¹, Luisa Alejandra Hernández-Sánchez ¹⁷, Beatriz Herrero-Pinilla ¹, Jose López-Castro ¹⁸, Nuria Montero-Fernández ¹⁹, Angélica Muñoz-Pascual ²⁰, Marta Muñoz-Vélez ²¹, Raquel Ortés-Gómez ²², Andrea Sáenz-Tejada ¹, Javier Sanz-Reig ²³, Sonia Torras-Cortada ¹, Miriam Ramos Cortés ²⁴, Pilar Sáez-López ²⁵

Objective: This scoping review aimed to identify predictive factors influencing gait recovery post-hip fracture surgery among adults aged 65 and older.

Design: A systematic search of MEDLINE, Embase and CINAHL databases was conducted, focusing on studies assessing predictive factors of gait recovery within one month to one-year post-surgery. Two independent reviewers carried out study selection, quality assessment and data extraction using the Quality in Prognosis Studies Tool to gauge evidence levels.

Results: About 10,627 articles were initially identified. After duplicates were removed, 7665 were screened based on title and abstract, then 796 based on full text; 138 articles were finally included.The review identified a total of 77 predictive factors. However, just under half (34) of these were supported by studies with a low risk of bias. Higher-level evidence-supported factors were age, pre-fracture independence in daily activities, cognitive impairment, delirium, orthogeriatric multidisciplinary co-management, specific surgical interventions, allowing weight-bearing, comorbidities, nutritional status, rehabilitation treatments and polypharmacy.

Conclusion: The identified factors influencing gait recovery include both non-modifiable factors [such as younger age, pre-fracture independence in activities of daily living, absence of cognitive impairment, fewer comorbidities and lower anaesthetic risk] and modifiable factors, including rehabilitation treatments, organisational factors, absence of delirium, orthogeriatric co-management, surgical factors such as implant type and unrestricted weight-bearing, better nutritional status and strength, and reduced polypharmacy. We believe the latter should be prioritised in managing patients with hip fractures to achieve optimal recovery.