Hip Fracture: Early Mobility and Discharge Rehabilitation

Clinical framework

Hip fracture recovery requires more than bone healing. Mobility, strength, cognition, balance and home support influence independence.

Assessment

• Confirm surgical loading instructions and medical readiness.
• Assess bed mobility, sit-to-stand, walking aid use and assistance level.
• Ask about preinjury function, falls, home stairs and family support.
• Record walking distance, transfer independence and patient-specific goals.

Safety and differential reasoning

• Unexpected clinical deterioration or new severe symptoms require medical review.
• Consider pain, dizziness on standing, delirium, deconditioning and fear of falling as distinct barriers.
• Follow individualized surgical precautions; do not assume one protocol fits every procedure.

Early rehabilitation

• NICE recommends physiotherapy assessment and mobilization the day after surgery unless contraindicated.
• Offer daily mobility practice with regular review.
• Start with safe transfers and short assisted walks; build repetitions and distance based on response.
• Add lower-limb strengthening and balance tasks as appropriate.

Progression

• Practice turning, toileting, walking with the planned aid and steps needed at home.
• Increase task complexity as safety and endurance improve.
• Coordinate nutrition, falls prevention and community rehabilitation.

Outcome measures

• Recheck mobility assistance, walking performance and goal attainment.
• Assess cognition, confidence and home access before discharge.
• Arrange follow-up for ongoing mobility limitations.

Common mistakes

• Delaying all movement without a clinical reason.
• Using age alone to limit rehabilitation.
• Ignoring the actual home environment.

Summary

Early, repeated, goal-linked mobility with team coordination supports safer recovery and meaningful independence.