The Effect of Frailty on Walking Recovery after Hip Fracture: A Secondary Analysis of the Community Ambulation Project.

BACKGROUND The impact of frailty on walking recovery after hip fracture has not been reported. We describe the prevalence of frailty approximately three months after hip fracture, and identify the impact of baseline frailty on ambulation recovery. METHODS Data from the Community Ambulation Project, that examined the effects of two multi-component home exercise programs on six-minute-walk test (6MWT) in participants post hip fracture, were used to re-construct the 5-item frailty phenotype. We detailed the prevalence of frailty by sub-group and assessed the comparability between frailty groups for the categorical variable of achieving 300-meters in 6MWT (community ambulation threshold), and the continuous variable of total distance in 6MWT before and after 16 weeks of intervention. RESULTS Of the 210 participants, 9% were non-frail, 59% were pre-frail, and 32% were frail. The odds of a non-frail participant achieving the 300-meter threshold were 14.4 (95% CI: 2.4-87.6) times the odds of a frail participant, while a pre-frail participant's odds were 6.1 [95% CI: 1.3-28.4] times after controlling for treatment group and baseline walking distance. The non-frail participants had an increase of 92.1 m in from baseline to 16 weeks, the pre-frail had a 50.8 m increase, and the frail group had the smallest increase of 36.6 m (p<0.001 for all). CONCLUSION Pre-frailty and frailty were highly prevalent in this sample of community-dwelling survivors of a recent hip fracture. Gains in walking distance and attaining a level of community ambulation were impacted significantly by the level of baseline frailty.