Association between additional non-weekday rehabilitation and discharge function after hip fracture, modified by age and admission function: a retrospective study - 20/09/25

Doi : 10.1016/j.rehab.2025.102035

Tsubasa Bito ^a,^⁎ , Shinji Takahashi ^b , Ryota Kawai ^a , Ayumi Shintani ^a
^a Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan
^b Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Hospital, 1-4-3 Asahi-machi, Abeno-ku, Osaka City, Osaka Prefecture, 545-8585, Japan

^⁎Correspondence to: Tsubasa Bito, Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka City, Osaka Prefecture 545-8585, Japan; Tel.: 816-6645-3894Department of Medical StatisticsGraduate School of MedicineOsaka Metropolitan University1-4-3 Asahi-machi, Abeno-kuOsaka CityOsaka Prefecture545-8585Japan

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Saturday 20 September 2025

Highlights

•	Additional non-weekday rehabilitation is associated with higher discharge function
•	Additional non-weekday rehabilitation is beneficial for older people
•	Additional non-weekday rehabilitation is helpful for those with lower function

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Abstract

Background

Hip fractures are a significant health concern, particularly among elderly individuals. Postoperative rehabilitation, including additional non-weekday rehabilitation, plays a crucial role in improving functional outcomes.

Objectives

To explore the factors that modify the association between additional non-weekday rehabilitation and the activities of daily living (ADL) levels at discharge in people with hip fractures.

Methods

A retrospective study was conducted using administrative claims data to analyze people aged ≥ 60 years with hip fractures who underwent surgery. The primary outcome was the Barthel Index as ADL scores at hospital discharge. Multivariable non-linear regression models were used to assess the modification of the association between additional non-weekday rehabilitation and ADL scores by different characteristics such as age, body mass index, ADL scores at admission, dementia, and surgery the day before or not before the non-weekday.

Results

A total of 77 947 people were included. People who received additional non-weekday rehabilitation had significantly better ADL scores at discharge than those who received weekday-only rehabilitation. The association between additional non-weekday rehabilitation and better ADL scores at hospital discharge was greater in older people (mean differences between the rehabilitation groups [95% CI] at ages 60 were 2.53 [0.50-4.56], and at ages 90 were 5.47 [4.89-6.05]), and in those with lower ADL scores at admission. Furthermore, people without dementia had significantly better ADL scores at discharge than those with dementia, and people who underwent additional non-weekday rehabilitation had better ADL scores at discharge than those who underwent weekday-only rehabilitation, regardless of dementia.

Conclusions

Tailoring rehabilitation strategies for individual characteristics, particularly age and baseline functional status, may optimize outcomes in people with hip fractures. Additional non-weekday rehabilitation may be particularly beneficial for older people and those with lower ADL scores at admission.

Le texte complet de cet article est disponible en PDF.

Keywords : hip fracture, weekend rehabilitation, activities of daily living