Background Early mobilization to promote functional recovery and reduce the adverse effects of immobilization is one of the main goals of acute postoperative management of hip fracture (HF). The primary objective of this study was to assess, in usual care, the association between the use of a bodyweight-supported treadmill (BWST) and early postoperative walking recovery in older adults after hip fracture surgery. Secondary objectives were to evaluate delays to first sitting and first walking, daily walking distances, functional outcomes, length of stay, discharge destination, mortality, and the safety of BWST-based rehabilitation. Methods We conducted a retrospective cohort study in our perioperative geriatric care unit in Pitié-Salpêtrière hospital, Paris, enrolling all consecutive patients aged <InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\:\ge\:\)</EquationSource> </InlineEquation> 70 years with HF who were admitted to the unit within 48 h after surgery from September 2021 to October 2023. In January 2023, the unit was equipped with a BWST, and patients received daily walking rehabilitation sessions exclusively using the BSWT instead of the previous conventional rehabilitation sessions. Results We included 138 patients (mean [<InlineEquation ID="IEq2"> <EquationSource Format="TEX">\(\:\pm\:\)</EquationSource> </InlineEquation>SD] age 87 [<InlineEquation ID="IEq3"> <EquationSource Format="TEX">\(\:\pm\:\)</EquationSource> </InlineEquation> 6.6] years), 101 (73%) were female, the median age-adjusted Charlson Comorbidity Index (CCI) was 7 (interquartile range 5–9), and the median Activities of Daily Living (ADL) score was 5.5 (3.5-6.0); 48 (35%) received BWST training. On univariate analysis, BWST use was significantly associated with earlier first sitting (p = 0.03) and first walking (p < 0.001), greater walking distances at day 1 and day 6 (p < 0.001), greater difference in walking distance between day 1 and day 6 (p < 0.001), and reduced morphine use at discharge (p = 0.006) as compared with the standard rehabilitation care. After adjustment on CCI, ADL, and time between surgery and unit admission (multivariate mixed model), BWST rehabilitation was still positively associated with daily measured walking distances (β = 3.31, 95% CI [2.47;4.16]). Conclusions The use of a BWST was significantly associated with improved walking ability in the early postoperative care after HF surgery among older adults. Future interventional studies of larger cohorts are needed to confirm these findings. Trial registration Not applicable.

Early postoperative walking recovery using a connected bodyweight-supported treadmill after hip fracture surgery in older patients: a retrospective cohort study (STAND-UP)

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2026年2月3日

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Michael Nicolas,
Bastien Genet,
Judith Cohen-Bittan,
Alicia Amal,
Luca Royer,
Sara Thietart,
Jacques Boddaert,
Lorène Zerah

摘要

Background

Early mobilization to promote functional recovery and reduce the adverse effects of immobilization is one of the main goals of acute postoperative management of hip fracture (HF). The primary objective of this study was to assess, in usual care, the association between the use of a bodyweight-supported treadmill (BWST) and early postoperative walking recovery in older adults after hip fracture surgery. Secondary objectives were to evaluate delays to first sitting and first walking, daily walking distances, functional outcomes, length of stay, discharge destination, mortality, and the safety of BWST-based rehabilitation.

Methods

We conducted a retrospective cohort study in our perioperative geriatric care unit in Pitié-Salpêtrière hospital, Paris, enrolling all consecutive patients aged \(\:\ge\:\) 70 years with HF who were admitted to the unit within 48 h after surgery from September 2021 to October 2023. In January 2023, the unit was equipped with a BWST, and patients received daily walking rehabilitation sessions exclusively using the BSWT instead of the previous conventional rehabilitation sessions.

Results

We included 138 patients (mean [ \(\:\pm\:\) SD] age 87 [ \(\:\pm\:\) 6.6] years), 101 (73%) were female, the median age-adjusted Charlson Comorbidity Index (CCI) was 7 (interquartile range 5–9), and the median Activities of Daily Living (ADL) score was 5.5 (3.5-6.0); 48 (35%) received BWST training. On univariate analysis, BWST use was significantly associated with earlier first sitting (p = 0.03) and first walking (p < 0.001), greater walking distances at day 1 and day 6 (p < 0.001), greater difference in walking distance between day 1 and day 6 (p < 0.001), and reduced morphine use at discharge (p = 0.006) as compared with the standard rehabilitation care. After adjustment on CCI, ADL, and time between surgery and unit admission (multivariate mixed model), BWST rehabilitation was still positively associated with daily measured walking distances (β = 3.31, 95% CI [2.47;4.16]).

Conclusions

The use of a BWST was significantly associated with improved walking ability in the early postoperative care after HF surgery among older adults. Future interventional studies of larger cohorts are needed to confirm these findings.

Trial registration

Not applicable.