A hip fracture is rarely just a broken bone. For an older adult it usually follows a fall, involves surgery within a day or two, and lands on top of everything else that was already going on, other health conditions, a spouse at home, a house with stairs. The fracture is the emergency. The recovery, which unfolds over the following year, is where the outcome is really decided.
What the research supports
Cochrane’s review of multidisciplinary rehabilitation after hip fracture pulled together 28 studies covering more than 5,300 older people. Compared with usual care, rehabilitation delivered by a coordinated team, physician, nurses, physiotherapy, occupational therapy, and others working to one plan, probably reduced “poor outcome” (death or a move to a higher level of care) at six to twelve months, and may reduce deaths and poorer mobility. No single magic exercise did that. The organised team did.
Two practical themes run through the evidence and through good practice generally: people do better when they get up and start moving early after surgery (usually the day after, with support, unless the surgeon says otherwise), and when rehabilitation continues after hospital discharge rather than stopping at the hospital door.
What recovery looks like, honestly
The first weeks are about the basics: getting out of bed safely, transfers, walking with a walker or crutches, managing stairs if home requires them, and exercises to rebuild the hip and leg muscles that shut down after the fracture and surgery. Pain should be controlled enough to allow movement, pain that stops movement is a problem to raise with the team, not to endure silently.
Progress is measured in months. Many people are walking around their homes within six to eight weeks; building back endurance, outdoor walking, and confidence takes longer, and some never quite return to their pre-fracture level. That is said not to discourage but to plan honestly: the goal is the most independence possible, reached as safely as possible, with the home set up to support it.
Where home-based physiotherapy fits
This is the situation in-home care was made for. The challenges are specific to your house, your stairs, your bathroom, your chair heights, the distance from bed to kitchen. Practising transfers and walking in the actual environment, adjusting the home setup, and coaching family members on how to help (and when to step back) is the work. It also means the person recovering does not spend their limited early energy on travel.
The fall that caused it
A hip fracture is also a warning. Once strength and balance work is underway, falls prevention becomes part of the plan: leg strengthening, balance practice, a medication review with the physician, vision checks, and home hazards, cords, loose rugs, poor lighting on the stairs. A second fracture is the outcome everyone is working to prevent.
References
- Handoll HHG, Cameron ID, Mak JCS, Panagoda CE, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database of Systematic Reviews. 2021;(11):CD007125. doi:10.1002/14651858.CD007125.pub3. PMID 34766330
- Morin SN, Feldman S, Funnell L, et al. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. CMAJ. 2023. doi:10.1503/cmaj.221647. Most hip fractures happen in bones weakened by osteoporosis; the guideline covers assessment and treatment after a fragility fracture.
General information only, not medical advice. Recovery after a hip fracture should be coordinated with the surgical and medical team.