Clinical Sciences/Health Conditions
Seung-Kyu Lim, MD, PhD
Associate Professor
Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital
Cheonan, Ch'ungch'ong-namdo, Republic of Korea
Jae-Young Lim, MD, PhD
Professor
Seoul National University Bundang Hospital
Seongnam, Kyonggi-do, Republic of Korea
To examine whether the functional benefit of Fragility Fracture Integrated Rehabilitation Management (FIRM) compared with conventional rehabilitation varies according to sarcopenia status and handgrip strength (HGS) in older adults after hip fracture surgery.
Design:
This study was a secondary analysis of a multicenter randomized controlled trial comparing FIRM with conventional rehabilitation in adults aged ≥65 years undergoing hip fracture surgery. Independent ambulation at 12 months was the primary outcome. Sarcopenia status was defined using three analytic approaches: (1) confirmed sarcopenia versus non-sarcopenia, (2) three-level classification (non-sarcopenia, possible sarcopenia, confirmed sarcopenia), and (3) low versus normal HGS. Logistic regression models were fitted with treatment group, sarcopenia status, and their interaction. Stratum-specific odds ratios (ORs), absolute risk differences (RDs), and numbers needed to treat (NNTs) were estimated using marginal means. Models were sequentially adjusted for age, sex, cognitive impairment, comorbidities, and pre-fracture gait impairment.
Results:
Among 203 randomized participants, 119 (58.6%) completed 12-month follow-up. Formal treatment-by-sarcopenia interaction terms were not statistically significant. However, stratum-specific analyses consistently showed greater benefit of FIRM among participants with sarcopenia or low HGS. In fully adjusted models, FIRM was associated with large absolute increases in independent ambulation among participants with confirmed sarcopenia (OR, 4.01; RD, +32.3%; NNT, 3.1) and those with low HGS (OR, 4.38; RD, +35.3%; NNT, 2.8). Across three-level categories, the magnitude of benefit increased with worsening sarcopenia severity, with the largest effect observed in confirmed sarcopenia (OR, 4.52; RD, +35.9%; NNT, 2.8).
Conclusion:
Older adults with impaired muscle strength or sarcopenia derive disproportionately greater functional benefit from FIRM than from conventional rehabilitation. These findings support a targeted and stratified rehabilitation strategy in which early assessment of HGS is used to identify high-risk patients who should be prioritized for integrated rehabilitation programs to optimize functional recovery.
