Affected-side hip flexion recovery is associated with gait-speed gain during early inpatient rehabilitation after hip fracture: A pilot prospective biomechanical analysis

초록

Background: Hip-fracture gait recovery is multidomain, yet rehabilitation studies often rely on gait speed alone. The movement-specific hip mobility and kinematic changes accompanying early speed gains remain unclear. This study aimed to determine whether recovery of affected-side hip flexion passive range of motion (PROM) and sagittal-plane hip excursion is associated with gait-speed gain during early inpatient rehabilitation. Methods: This pilot prospective biomechanical analysis used participant-level data from a pre-post study following hip-fracture surgery. Sixteen participants completed paired assessments immediately before and after a 10-session early rehabilitation phase that included lower-body positive pressure walking. The primary outcome was change in gait velocity. Prespecified primary explanatory variables were changes in affected-side hip flexion PROM and sagittal-plane hip excursion. Associations were evaluated using Spearman correlation and covariate-adjusted linear models. Findings: Gait velocity increased from 0.48 ± 0.15 to 0.57 ± 0.19 m/s (mean change 0.094 m/s; p = 0.019). Affected-side hip flexion PROM improved by 21.9 ± 16.2 degrees (p < 0.001). Gait-speed change correlated with changes in affected-side hip flexion PROM (rho = 0.58, p = 0.018) and sagittal-plane hip excursion (rho = 0.51, p = 0.042). In adjusted models, a 10-degree increase in hip flexion PROM was associated with 0.042 m/s greater gait-speed gain (p = 0.047), and a 5-degree increase in sagittal-plane hip excursion with 0.046 m/s greater gain (p = 0.021). Interpretation: Early restoration of affected-side hip flexion PROM and sagittal-plane hip excursion is a clinically interpretable biomechanical correlate of walking-speed recovery after hip fracture. This movement-specific signal supports a range-of-motion-to-kinematics-to-speed pathway warranting testing in larger studies. © 2026 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/

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