Cognitive Function Influences Longitudinal Motor Function Recovery after Proximal Femoral Fracture: A Longitudinal Analysis.

OBJECTIVES: As the incidence of proximal femoral fractures (PFFs) continues to increase, optimizing patient-specific treatment strategies is essential for the efficient use of healthcare resources. The aim of this study was to examine longitudinal postoperative motor function recovery in patients with femoral neck fractures (FNF) and intertrochanteric fractures (ITFs) and to identify which factors, including fracture type and patient-related characteristics, predominantly influence recovery trajectories to inform individualized rehabilitation strategies. METHODS: This retrospective study included patients who underwent bipolar hip arthroplasty for FNF (201 hips) or internal fixation for ITF (224 hips) and completed convalescent rehabilitation. Motor function was assessed using the motor Functional Independence Measure (mFIM) at admission to and discharge from the convalescent rehabilitation ward. Longitudinal mFIM score changes were analyzed using a linear mixed-effects model (LMM), with time, fracture type, cognitive function, pre-fracture mobility status, age, and other covariates as fixed effects. RESULTS: In the LMM, only cognitive function showed a significant interaction with time (P <0.001, 95% confidence interval [CI] 0.38 to 0.66), whereas fracture type did not (P = 0.055, 95% CI -0.06 to 5.13). Fracture type (P <0.001, 95% CI -8.28 to -2.56) and pre-fracture mobility status (P <0.001, 95% CI -6.22 to -3.28) demonstrated only significant main effects. CONCLUSIONS: Postoperative functional recovery trajectories after PFFs were significantly influenced by cognitive function. The use of LMM facilitated detailed assessment of longitudinal recovery patterns beyond single time-point evaluations. These findings highlight the importance of cognitively tailored rehabilitation strategies in optimizing functional recovery.