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 clinical trial, a parallel-group, single-blind, multicenter superiority randomized controlled trial, 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 = .025), as did those with cognitive impairment (65.2% vs. 89.1%; P = .010). The lowest rate was in patients with both conditions (60.8%, P = .022) and the highest in those without either (90.2%). Post hoc pairwise comparisons confirmed significant differences (P = .011). Cox regression showed cognitive impairment reduced independent ambulation likelihood by 45.8% (HR: 0.542, 95% CI: 0.340–0.865, P = .010), while both conditions together lowered it by 57% (HR: 0.431, 95% CI: 0.233–0.798, P = .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.