Factors influencing mobility among people post-surgery for hip fractures: A cross-sectional study


hip fracture
social support

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Yoryuenyong, C., Jitpanya, C., & Sasat, S. (2023). Factors influencing mobility among people post-surgery for hip fractures: A cross-sectional study. Belitung Nursing Journal, 9(4), 349–358. https://doi.org/10.33546/bnj.2759
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Accepted for publication: 2023-08-01
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Background: After hip fracture surgery, patients often experience complications and a decline in mobility, leading to physical disability and increased dependency on caregivers. This may result in reduced independence, institutionalization, and higher mortality rates. However, there is limited research on mobility and its influencing factors in patients undergoing hip fracture surgery in Thailand.

Objective: This study aimed to determine the factors influencing mobility in patients with fractured hips within one year after surgery. 

Methods: A cross-sectional study was conducted involving 143 randomly selected participants who had undergone hip fracture surgery between August 2022 to February 2023. Mobility and its influencing factors were measured using standardized questionnaires, including the De Morton Mobility Index, Parker Mobility Scale, Charlson Comorbidity Index, General Practitioner Assessment of Cognition, Groningen Orthopedic Social Support Scale, Fatigue Severity Scale, Pain Rating Scale, and Pittsburgh Sleep Quality Index. Descriptive statistics and multiple regression were utilized for data analysis.

Results:  The mean mobility score for the patients was 48.86 out of 100 (SD = 17.89). The study found that comorbidity (β = -0.156, p = 0.009), cognitive function (β = 0.310, p <0.001), social support (β = 0.145, p = 0.010), pain (β = -0.176, p = 0.004), fatigue (β = -0.249, p <0.001), and sleep (β = -0.169, p = 0.009) collectively influenced mobility in patients after hip fracture surgery, explaining 61.8% of the variance (R2 = 0.618; F = 36.598; p <0.001).

Conclusion: The study’s results provide valuable insights for nurses to target these modifiable factors to enhance patients’ mobility. However, it is essential to note that patients with comorbidity and poor cognitive function may face difficulty maintaining mobility. Nurses should be attentive to these patients and provide appropriate management. Additionally, early rehabilitation should be initiated promptly to optimize outcomes.


Supporting Agencies

This research was funded by the National Research Council of Thailand (NRCT) NO. N41A660170. Recipient: Miss Chanipa Yoryuenyong


Copyright (c) 2023 Chanipa Yoryuenyong, Chanokporn Jitpanya, Siriphan Sasat

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

There was no potential conflict of interest in this study.


The authors extend their heartfelt gratitude to all the participants who made valuable contributions to this study. Additionally, appreciation is given to the National Research Council of Thailand for providing the funding support that made this research possible.

Authors’ Contributions

All authors contributed significantly to the conception, design, and completion of this study and have approved the final version of the manuscript for submission. Specifically, CY and CJ made substantial contributions to the conception and research design, data collection, analysis, and interpretation of data. They were involved in drafting the manuscript and critically revising it for important scholarly content. CY, CJ, and SS provided final approval of the version to be published and have agreed to be accountable for all aspects of the work, ensuring that any potential issues have been thoroughly investigated and resolved.

Data Availability

The datasets generated during and analyzed during the current study are available from the corresponding author upon reasonable request.

Declaration of Use of AI in Scientific Writing

None to declare.


Adulkasem, N., Phinyo, P., Khorana, J., Pruksakorn, D., & Apivatthakakul, T. (2021). Prognostic factors of 1-year postoperative functional outcomes of older patients with intertrochanteric fractures in Thailand: A retrospective cohort study. International Journal of Environmental Research and Public Health, 18(13), 6896. https://doi.org/10.3390/ijerph18136896

Agmon, M., Shochat, T., & Kizony, R. (2016). Sleep quality is associated with walking under dual-task, but not single-task performance. Gait & Posture, 49, 127-131. https://doi.org/10.1016/j.gaitpost.2016.06.016

Alsén, P., & Brink, E. (2013). Fatigue after myocardial infarction–a two‐year follow‐up study. Journal of Clinical Nursing, 22(11-12), 1647-1652. https://doi.org/10.1111/jocn.12114

Ariza-Vega, P., Lozano-Lozano, M., Olmedo-Requena, R., Martín-Martín, L., & Jiménez-Moleón, J. J. (2017). Influence of cognitive impairment on mobility recovery of patients with hip fracture. American Journal of Physical Medicine & Rehabilitation, 96(2), 109-115. https://doi.org/10.1097/PHM.0000000000000550

Barzilay, J. I., Cotsonis, G. A., Walston, J., Schwartz, A. V., Satterfield, S., Miljkovic, I., Harris, T. B., & Health, A. B. C. S. (2009). Insulin resistance is associated with decreased quadriceps muscle strength in nondiabetic adults aged ≥ 70 years. Diabetes Care, 32(4), 736-738. https://doi.org/10.2337/dc08-1781

Brodaty, H., Pond, D., Kemp, N. M., Luscombe, G., Harding, L., Berman, K., & Huppert, F. A. (2002). The GPCOG: A new screening test for dementia designed for general practice. Journal of the American Geriatrics Society, 50(3), 530-534. https://doi.org/10.1046/j.1532-5415.2002.50122.x

Buysse, D. J., Reynolds Iii, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213. https://doi.org/10.1016/0165-1781(89)90047-4

Charlson, M. E., Charlson, R. E., Peterson, J. C., Marinopoulos, S. S., Briggs, W. M., & Hollenberg, J. P. (2008). The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. Journal of Clinical Epidemiology, 61(12), 1234-1240. https://doi.org/10.1016/j.jclinepi.2008.01.006

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373-383. https://doi.org/10.1016/0021-9681(87)90171-8

Cho, M.-R., Song, S.-K., & Ryu, C.-H. (2020). Sleep disturbance strongly related to the development of postoperative delirium in proximal femoral fracture patients aged 60 or older. Hip & Pelvis, 32(2), 93-98. https://doi.org/10.5371%2Fhp.2020.32.2.93

de Morton, N. A., Harding, K. E., Taylor, N. F., & Harrison, G. (2013). Validity of the de Morton Mobility Index (DEMMI) for measuring the mobility of patients with hip fracture during rehabilitation. Disability and Rehabilitation, 35(4), 325-333. https://doi.org/10.3109/09638288.2012.705220

Dyer, S. M., Crotty, M., Fairhall, N., Magaziner, J., Beaupre, L. A., Cameron, I. D., Sherrington, C., & Fragility Fracture Network Rehabilitation Research Special Interest Group. (2016). A critical review of the long-term disability outcomes following hip fracture. BMC Geriatrics, 16, 1-18. https://doi.org/10.1186/s12877-016-0332-0

Foss, N. B., Kristensen, M. T., Palm, H., & Kehlet, H. (2009). Postoperative pain after hip fracture is procedure specific. British Journal of Anaesthesia, 102(1), 111-116. https://doi.org/10.1093/bja/aen345

Gheorghita, A., Webster, F., Thielke, S., & Sale, J. E. M. (2018). Long-term experiences of pain after a fragility fracture. Osteoporosis International, 29, 1093-1104. https://doi.org/10.1007/s00198-018-4399-7

Gonzalez Zabaleta, J., Pita Fernandez, S., Seoane Pillado, T., Lopez Calvino, B., & Gonzalez Zabaleta, J. L. (2016). Comorbidity as a predictor of mortality and mobility after hip fracture. Geriatrics & Gerontology International, 16(5), 561-569. https://doi.org/10.1111/ggi.12510

Griffiths, J., Putthinoi, S., & Pongsuksri, M. (2015). General practitioner assessment of cognition (Thai version) validity and reliability. Asian Journal of Gerontology and Geriatrics, 10(1), 62-62.

Hansson, S., Rolfson, O., Åkesson, K., Nemes, S., Leonardsson, O., & Rogmark, C. (2015). Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients. Injury, 46(11), 2206-2211. https://doi.org/10.1016/j.injury.2015.07.024

Hao, L., Carson, J. L., Schlussel, Y., Noveck, H., & Shapses, S. A. (2020). Vitamin D deficiency is associated with reduced mobility after hip fracture surgery: A prospective study. The American Journal of Clinical Nutrition, 112(3), 613-618. https://doi.org/10.1093/ajcn/nqaa029

Jennison, T., & Yarlagadda, R. (2019). A case series of patients change in mobility following a hip fracture. European Journal of Orthopaedic Surgery & Traumatology, 29, 87-90. https://doi.org/10.1007/s00590-018-2267-y

Jirapramukpitak, T., & Tanchaiswad, W. (1997). Sleep disturbances among nurses of Songklanagarind Hospital. Journal of the Psychiatric Association of Thailand, 42(3), 123-132.

Kanis, J. A., Oden, A., McCloskey, E. V., Johansson, H., Wahl, D. A., Cooper, C., Epidemiology, I. O. F. W. G. o., & Quality of, L. (2012). A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis International, 23, 2239-2256. https://doi.org/10.1007/s00198-012-1964-3

King, L. A., Priest, K. C., Nutt, J., Chen, Y., Chen, Z., Melnick, M., & Horak, F. (2014). Comorbidity and functional mobility in persons with Parkinson disease. Archives of Physical Medicine and Rehabilitation, 95(11), 2152-2157. https://doi.org/10.1016/j.apmr.2014.07.396

Kristensen, M. T. (2013). Hip fracture− related pain strongly influences functional performance of patients with an intertrochanteric fracture upon discharge from the hospital. PM&R, 5(2), 135-141. https://doi.org/10.1016/j.pmrj.2012.10.006

Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The fatigue severity scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46(10), 1121-1123. https://doi.org/10.1001/archneur.1989.00520460115022

Kuo, W.-Y., Shyu, Y.-I. L., Wang, J.-S., Chen, M.-C., Wu, C.-C., & Huang, Y.-F. (2016). The impact of sleep duration on recovery post-hip fracture among older diabetic adults in Taiwan. Geriatric Nursing, 37(2), 137-144. https://doi.org/10.1016/j.gerinurse.2015.11.005

Lenz, E. R., & Pugh, L. C. (2014). The theory of unpleasant symptoms. In M. J. Smith & P. R. Liehr (Eds.), Middle range theory for nursing (3rd ed.). Springer Publishing Company, LLC.

Lenze, E. J., Munin, M. C., Dew, M. A., Rogers, J. C., Seligman, K., Mulsant, B. H., & Reynolds Iii, C. F. (2004). Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. International Journal of Geriatric Psychiatry, 19(5), 472-478. https://doi.org/10.1002/gps.1116

Levasseur, M., Généreux, M., Bruneau, J.-F., Vanasse, A., Chabot, É., Beaulac, C., & Bédard, M.-M. (2015). Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: Results from a scoping study. BMC Public Health, 15, 1-19. https://doi.org/10.1186/s12889-015-1824-0

LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for evidence-based practice (8th ed.). St. Louis: Elsevier Health Sciences.

Maneesriwongul, W., & Dixon, J. K. (2004). Instrument translation process: A methods review. Journal of Advanced Nursing, 48(2), 175-186. https://doi.org/10.1111/j.1365-2648.2004.03185.x

Mariconda, M., Costa, G. G., Cerbasi, S., Recano, P., Orabona, G., Gambacorta, M., & Misasi, M. (2016). Factors predicting mobility and the change in activities of daily living after hip fracture: A 1-year prospective cohort study. Journal of Orthopaedic Trauma, 30(2), 71-77. https://doi.org/10.1097/BOT.0000000000000448

McCaffery, M., & Pasero, C. (1999). Pain: Clinical manual (2nd ed.). St Louis: Mosby.

Mueller-Schotte, S., Bleijenberg, N., van der Schouw, Y. T., & Schuurmans, M. J. (2016). Fatigue as a long-term risk factor for limitations in instrumental activities of daily living and/or mobility performance in older adults after 10 years. Clinical Interventions in Aging, 1579-1587. https://doi.org/10.2147/CIA.S116741

Münter, K. H., Clemmesen, C. G., Foss, N. B., Palm, H., & Kristensen, M. T. (2018). Fatigue and pain limit independent mobility and physiotherapy after hip fracture surgery. Disability and Rehabilitation, 40(15), 1808-1816. https://doi.org/10.1080/09638288.2017.1314556

Nuotio, M., & Luukkaala, T. (2016). Factors associated with changes in mobility and living arrangements in a comprehensive geriatric outpatient assessment after hip fracture. Disability and Rehabilitation, 38(12), 1125-1133. https://doi.org/10.3109/09638288.2015.1074728

Parker, M. J., & Palmer, C. R. (1993). A new mobility score for predicting mortality after hip fracture. The Journal of Bone & Joint Surgery British Volume, 75(5), 797-798. https://doi.org/10.1302/0301-620X.75B5.8376443

Pipatyaokul, R. (2017). Outcome after hip fracture in elderly patients. Medical Journal of Srisaket Surin Buriram Hospitals, 32(1), 21-32.

Pope, J. E. (2020). Management of fatigue in rheumatoid arthritis. RMD Open, 6(1), e001084. http://dx.doi.org/10.1136/rmdopen-2019-001084

Promchat, L., Chanruangvanich, W., Utriyaprasit, K., & Riansuwan, K. (2015). Influence of sleep quality, comorbidity and hemoglobin level on hip fracture patients’ initial ambulatory ability after hemiarthroplasty. Thai Journal of Nursing Council, 30(2), 75-85.

Reppas Rindlisbacher, C., Ahuja, M., Wong, E., Gormley, J., Siddhpuria, S., Lee, J., Conroy, M., & Patterson, C. (2021). Researching the effects of sleep on step count during the postoperative period. Journal of the American Geriatrics Society, 69(10), 2990-2992. https://doi.org/10.1111/jgs.17305

Roobsoong, A., Permyao, J., & Chantiratikul, S. (2020). Clinical outcomes of peritrochanteric hip fracture in the intermediate postoperative care project between the regional and district hospitals in Chiang Rai Province: Preliminary comparative results. Journal of Health Systems Research, 14(1), 88-100.

Rosendahl-Riise, H., Dierkes, J., Ådnanes, S., Skodvin, V. A., Strand, E., & Ranhoff, A. H. (2020). Weight changes and mobility in the early phase after hip fracture in community-dwelling older persons. European Geriatric Medicine, 11, 545-553. https://doi.org/10.1007/s41999-020-00342-x

Salpakoski, A., Portegijs, E., Kallinen, M., Sihvonen, S., Kiviranta, I., Alen, M., Rantanen, T., & Sipilä, S. (2010). Physical inactivity and pain in older men and women with hip fracture history. Gerontology, 57(1), 19-27. https://doi.org/10.1159/000315490

Sawasdee, A., Preechawoong, S., & Jitpanya, C. (2017). Relationships between pain, sleep quality, depressive symptoms, and fatigue in post stroke patients. Kuakarun Journal of Nursing, 24(2), 7-22.

Shyu, Y. I. L., Chen, M. C., Wu, C. C., & Cheng, H. S. (2010). Family caregivers’ needs predict functional recovery of older care recipients after hip fracture. Journal of Advanced Nursing, 66(11), 2450-2459. https://doi.org/10.1111/j.1365-2648.2010.05418.x

Sperber, A. D., Devellis, R. F., & Boehlecke, B. (1994). Cross-cultural translation: Methodology and validation. Journal of Cross-Cultural Psychology, 25(4), 501-524. https://doi.org/10.1177/0022022194254006

Steihaug, O. M., Gjesdal, C. G., Bogen, B., Kristoffersen, M. H., Lien, G., Hufthammer, K. O., & Ranhoff, A. H. (2018). Does sarcopenia predict change in mobility after hip fracture? A multicenter observational study with one-year follow-up. BMC Geriatrics, 18, 65. https://doi.org/10.1186/s12877-018-0755-x

Stenholm, S., Kronholm, E., Sainio, P., Borodulin, K., Era, P., Fogelholm, M., Partonen, T., Porkka-Heiskanen, T., & Koskinen, S. (2010). Sleep-related factors and mobility in older men and women. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 65(6), 649-657. https://doi.org/10.1093/gerona/glq017

Stott-Eveneshen, S., Sims-Gould, J., McAllister, M. M., Fleig, L., Hanson, H. M., Cook, W. L., & Ashe, M. C. (2017). Reflections on hip fracture recovery from older adults enrolled in a clinical trial. Gerontology and Geriatric Medicine, 3, 2333721417697663. https://doi.org/10.1177/2333721417697663

Sucharitpongpan, W., Daraphongsataporn, N., Saloa, S., Philawuth, N., Chonyuen, P., Sriruanthong, K., & Waiwattana, K. (2019). Epidemiology of fragility hip fractures in Nan, Thailand. Osteoporosis and Sarcopenia, 5(1), 19-22. https://doi.org/10.1016/j.afos.2019.03.003

Suwanno, J., Petsirasan, R., Saisuk, W., & Chanpradit, A. (2009). Age and heart failure self-care: A comparison of self-care maintenance between eldery and adults. Songklanagarind Medical Journal, 27(4), 335-346.

Tabachnick, B. G., & Fidell, L. S. (2013). Using multiple statistics Boston: Pearson.

Tam, T.-L., Tsang, K.-K., & Lee, K.-B. (2020). Development of a prognostic model to predict post-operative mobility of patients with fragility hip fractures: A retrospective cohort study. International Journal of Orthopaedic and Trauma Nursing, 38, 100770. https://doi.org/10.1016/j.ijotn.2020.100770

Tan, H., Wutthilert, C., & O'Connor, M. (2011). Spirituality and quality of life in older people with chronic illness in Thailand. Progress in Palliative Care, 19(4), 177-184. https://doi.org/10.1179/1743291X11Y.0000000013

Thai Orthopaedic Nurses Society. (2018). Clinical nursing practice guidelines for patients with hip fracture undergoing hip arthroplasty. Bangkok: N.P. Press.

Van Cauter, E. (2011). Sleep disturbances and insulin resistance. Diabetic Medicine, 28(12), 1455-1462. https://doi.org/10.1111/j.1464-5491.2011.03459.x

Van Den Akker-Scheek, I., Stevens, M., Spriensma, A., & Van Horn, J. R. (2004). Groningen Orthopaedic Social Support Scale: Validity and reliability. Journal of Advanced Nursing, 47(1), 57-63. https://doi.org/10.1111/j.1365-2648.2004.03065.x

Vochteloo, A. J. H., Moerman, S., Tuinebreijer, W. E., Maier, A. B., de Vries, M. R., Bloem, R. M., Nelissen, R. G. H. H., & Pilot, P. (2013). More than half of hip fracture patients do not regain mobility in the first postoperative year. Geriatrics & Gerontology International, 13(2), 334-341. https://doi.org/10.1111/j.1447-0594.2012.00904.x

Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. The Lancet, 370(9596), 1453-1457. https://doi.org/10.1016/S0140-6736(07)61602-X

Wongtriratanachai, P., Luevitoonvechkij, S., Songpatanasilp, T., Sribunditkul, S., Leerapun, T., Phadungkiat, S., & Rojanasthien, S. (2013). Increasing incidence of hip fracture in Chiang Mai, Thailand. Journal of Clinical Densitometry, 16(3), 347-352. https://doi.org/10.1016/j.jocd.2012.07.002

World Health Organization. (2023). A healthy lifestyle - WHO recommendations. https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations

Zaslavsky, O., Zisberg, A., & Shadmi, E. (2015). Impact of functional change before and during hospitalization on functional recovery 1 month following hospitalization. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 70(3), 381-386. https://doi.org/10.1093/gerona/glu168

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