Functional Outcomes After Hip Fracture Before and During the COVID-19 Pandemic in Adults Aged 65 Years and Older: A Retrospective Comparative Study

Functional Outcomes After Hip Fracture Before and During the COVID-19 Pandemic in Adults Aged 65 Years and Older: A Retrospective Comparative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Functional Outcomes After Hip Fracture Before and During the COVID-19 Pandemic in Adults Aged 65 Years and Older: A Retrospective Comparative Study Motoyuki Horii, Norikazu Hishikawa, Maki Asada, Suzuyo Ohashi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8235235/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: The coronavirus disease (COVID-19) pandemic substantially altered the social environment and activity levels of older adults, potentially affecting their functional recovery following hip fractures. This study examined whether the pandemic influenced functional outcomes in adults aged ≥65 years admitted to a convalescent rehabilitation ward after hip fracture surgery. Methods: We retrospectively reviewed patients aged ≥65 years admitted to our rehabilitation ward after hip fracture surgery between January 2016 and December 2022. Patients were classified into two groups based on the date of injury: prepandemic (2016–2019) and pandemic (2020–2022). The functional Independence Measure (FIM) motor, cognitive, and total scores were calculated at discharge and compared between the two groups stratified by pre-injury living arrangements (home or facility). We also assessed baseline characteristics including age, sex, fracture type, surgical procedure, preoperative waiting time and length of hospital stay, to identify potential confounders. Results: Among the 650 eligible patients (median age, 85 years; 551 women), 357 sustained fractures before the pandemic and 293 during the pandemic. No significant differences were observed between the two groups in terms of age, sex distribution, fracture type, surgical procedure, or length of postoperative hospital stay. The preoperative waiting time was slightly shorter during the pandemic. The median motor FIM score at discharge decreased from 75 (prepandemic) to 71 (pandemic) in the overall cohort (p = 0.017) and from 78 to 75 among patients who lived at home before injury (p = 0.029). No significant differences were observed in cognitive or total FIM scores. The decline in motor FIM scores was significant among women but not among men. Conclusions: Functional recovery after hip fracture, as measured by the motor FIM score at discharge, significantly declined during the COVID-19 pandemic, particularly among older adults who lived at home before the injury. This decline likely reflects reduced pre-injury physical and ADL capacity resulting from lifestyle restrictions during the pandemic, rather than differences in in-hospital care. These findings highlight the long-term impact of societal restrictions on physical function in older adults and underscore the importance of maintaining opportunities for physical activity and rehabilitation even during public health crises. hip fracture older adults Functional Independence Measure COVID-19 pandemic activities of daily living rehabilitation physical function convalescent rehabilitation ward living arrangement Japan Background The coronavirus disease (COVID-19) pandemic has significantly altered living environments worldwide, including in Japan. Opportunities for going out decreased, and interactions with others were restricted. Long-term care facilities, also limited family visits, and socialization among residents also declined. These changes may have contributed to a decline in activities of daily living (ADL) among older adults. Hip fractures are among the most common injuries in older adults and a leading cause of admission to convalescent rehabilitation wards. Most cases occur because of indoor falls (1, 2) and are common in both home- and care facility-dwelling older adults. In convalescent rehabilitation wards, the primary focus of rehabilitation after hip fracture is to improve ADLs, which are often assessed using the functional independence measure (FIM) (3), and to support discharge whenever possible. Therefore, we hypothesized that the COVID-19 pandemic may negatively affect functional recovery after hip fractures in older adults. This study aimed to examine whether the COVID-19 pandemic has influenced the ADL status of patients aged 65 years and older with hip fractures admitted to our convalescent rehabilitation ward. Methods Data of patients who sustained a hip fracture and were admitted to our convalescent rehabilitation ward were retrospectively reviewed. We collected information on pre-injury living arrangements (home or facility), age, sex, and FIM scores (motor, cognitive, and total) at discharge. Facilities included nursing homes, service-provided housing for older adults (Japan’s “assisted living” system), group homes for dementia patients, special nursing homes, and long-term care medical institutions, excluding short-term respite stays. Preadmission living arrangements were used for patients who were injured during their acute hospital stay. We excluded patients who were unexpectedly transferred back to acute care hospitals because of complications such as new trauma or illness because their discharge destinations were diverse and could not always be traced in the available records. The patients were divided into two groups based on the date of injury: prepandemic (January 1, 2016, to December 31, 2019) and pandemic (January 1, 2020, to December 31, 2022). We compared the total, motor, and cognitive FIM scores at discharge between the two groups stratified by pre-injury living arrangement (home or facility). In addition, age, sex, number of days from injury to surgery (preoperative days), number of days from surgery to discharge from the convalescent rehabilitation ward (postoperative stay), distribution of fracture type (femoral neck or trochanteric), and surgical procedure (hemiarthroplasty or internal fixation) were compared between the groups to assess baseline differences unrelated to the pandemic. The normality of continuous variables was assessed via skewness and kurtosis tests using StatFlex ver.6 (Artech Co., Ltd., Osaka, Japan). Age and FIM scores demonstrated significant deviation from normal distributions, continuous variables were compared between the groups using the Mann–Whitney U test. Categorical variables, including living situation, sex, fracture type, and surgical procedure, were analyzed using the chi-squared test. All statistical tests were two-sided, and a p-value < 0.05 was considered statistically significant. Results A total of 676 patients aged 65 years or older were admitted to our rehabilitation ward after hip fracture surgery during the study period. Of these, 26 were transferred to acute hospitals and were excluded. The remaining 650 patients (99 men and 551 women) had a median age of 85 years (Q1, 79.0; Q3, 89.0), with the oldest patient being 102 years. Among these, 357 patients were included in the prepandemic group, with 295 living at home and 62 living in a facility before injury. The pandemic group comprised 293 patients, with 248 living at home and 45 living in a facility before injury. The median age of the patients in each subgroup is shown in Table 1 Table 1. Median age of patients in the prepandemic and pandemic groups, stratified by preinjury living arrangement Period Median [Q1-Q3] Total Home Facility Prepandemic 85 [78.0-880.] 83[77.3-88.0] 87[84.0-90.0] Pandemic 85 [79.0-89.0] 84 [78.0-88.0] 88[84.8-92.0] p value p = 0.611 p = 0.733 p = 0.297 There were no significant differences in age or sex, fracture type, or surgical procedure between the two groups, both in the overall cohort and when stratified by preinjury living arrangement (home or facility) (Table 2). Table 2a. Sex distribution in the prepandemic and pandemic groups, stratified by preinjury living arrangement Period Total n (%) Home n (%) Facility n (%) Male Female Male Female Male Female Prpandemic 53 (14.8%) 304 (85.2%) 50 (16.9%) 245 (83.1%) 3 (4.8%) 59 (95.2%) Pandemic 46 (15.7%) 247 (84.3%) 42 (16.9%) 206 (83.1%) 4 (8.9 % ) 41 (91.1%) p value p = 0.763 p = 0.997 p = 0.403 Table 2b. Fracture type distribution in the prepandemic and pandemic groups, stratified by preinjury living arrangement Period Total n (%) Home n (%) Facility n (%) NF* TF ** NF* TF ** NF* TF ** Prepandemic 192 (53.8%) 165 (46.2%) 164 (55.6%) 131 (44.4%) 28 (45.2%) 34 (54.8%) Pandemic 163 (55.6%) 130 (44.4%) 148 (59.7%) 100 (40.3%) 15(33.3%) 30 (66.7%) p value p = 0.637 p = 0.338 p = 0.218 * NF: femoral neck fracture ** TF:trochanteric fracture Table 2c. Surgical procedure distribution in the prepandemic and pandemic groups, stratified by preinjury living arrangement Period Total n (%) Home n (%) Facility n (%) HA* IF** HA* IF** HA* IF** Prepandemic 147 (41.2%) 210 (58.8%) 122 (41.4%) 173 (58.6%) 25 (40.3%) 37 (59.7%) Pandemic 119 (40.6%) 174 (59.4%) 107 (43.1%) 141 (56.9%) 12 (26.7%) 33 (73.3%) p value p = 0.885 p = 0.674 p = 0.143 * HA:hemiarthroplasty ** IF: internal fixation Footnote : Aplied to Table 1a-1c. Data are presented as number (%). p values indicate comparisons between two groups within each catefory. The preoperative days were significantly shorter during the pandemic than the prepandemic period among patients living in a facility (p = 0.002) and in the overall cohort (total) (p = 0.009) (Table 3a). In contrast, the postoperative stay did not differ significantly between the two periods either in the overall cohort or when stratified by pre-injury living arrangements (Table 3b). Table 3a . Median preoperative days in the prepandemic and pandemic groups, stratified by preinjury living arrangement Period Median [Q1-Q3] Total Home Facility Prepandemic 4 [2.0-6.3] 4 [2.0-6.0] 4 [3.0-7.0] Pandemic 3 [1.0-6.0] 3 [2.0-6.0] 2 [1.0-4.0] p value p = 0.009 p = 0.124 p = 0.002 Preoperative days: number of days from injury to surgery. Table 3b . Median postoperative stay in the prepandemic and pandemic groups, stratified by preinjury living arrangement Period Median [Q1-Q3] Total Home Facility Prepandemic 83 [62.0-99.3] 84 [63.0-99.8] 80 [58.0-97.0] Pandemic 81 [62.0-95.0] 82 [62.0-96.0] 79[61.8-88.0] p value p = 0.166 p = 0.241 p = 0.470 Postoperative stay: number of days from surgery to discharge from the convalescent rehabilitation ward. Table 4 shows the FIM scores at discharge. In the overall cohort, the median motor FIM score decreased from 75 during the prepandemic period to 71 during the pandemic period (p = 0.017). Among the patients who lived at home before the injury, the median motor FIM score decreased from 78 to 75 (p = 0.029). Among the facility residents, the median motor FIM score decreased from 60 to 55, although this difference was not statistically significant. The cognitive FIM scores showed no similar trends, and the total FIM score, which was the sum of the motor and cognitive FIM scores, did not differ significantly between the periods. Table 4. FIM scores at discharge in the prepandemic and pandemic groups, stratified by preinjury living arrangement Total FIM score Period Median [Q1-Q3] Total Home Facility Prepandemic 102 [82.0 – 115.0] 105 [90.0–116.0] 80.5 [65.0–99.0] Pandemic 100 [75.8–114.3] 104 [81.0–116.0] 74 [57.8–94.0] p value p = 0.225 p = 0.268 p = 0.350 Motor FIM score Period Total Home Facility Prepandemic 75 [62.0–83.3] 78 [66.0–84.0] 60 [48.0–72.0] Pandemic 71 [54.0–83.0] 75 [57.0–84.0] 55 [43.0–66.0] p value p = 0.017 p = 0.029 p = 0.124 Cognitive FIM score Period Total Home Facility Prepandemic 27 [20.0–32.3] 28 [23.0–33.0] 20 [16.0–26.0] Pandemic 29 [20.0–34.0] 30 [22.0–35.0] 20 [16.0–27.3] p value p = 0.165 p = 0.192 p = 0.728 Total FIM score ranges from 18 to 126, motor FIM 13–91, cognitive FIM 5–35 Table 5 presents the FIM scores at discharge stratified by sex, showing that the motor FIM scores decreased in both sexes during the pandemic; however, the difference was significant only among women (p = 0.022). Table 5 . Comparison of FIM scores at discharge in the prepandemic and pandemic groups, stratified by sex Total FIM score Period Median [Q1-Q3] Male Female p value* Prepandemic 105 [83.5–115.0] 102 [82.0–116.0] p＝0.485 Pandemic 104 [80.0–118.0] 99 [75.3–114.0] p＝0.229 p value** p＝0.795 p＝0.207 Motor FIM score Male Female p value* Prepandemic 78 [60.8–83.0] 75 [62.0–84.0] p＝0.450 Pandemic 75 [54.0–84.0] 71 [54.0–81.8] p＝0.314 p value** p＝0.448 p＝0.022 Cognitive FIM score Male Female p value* Prepandemic 27 [21.0–33.3] 27 [20.0–32.0] p＝0.482 Pandemic 29.5 [22.0–35.0] 28 [20.0–34.0] p＝0.263 p value** p＝0.295 p＝0.283 *p-values for comparisons between male and female patients within each period **p-values for prepandemic vs pandemic comparisons within each sex †Group sizes: Prepandemic Male n = 53, Female n =304; Pandemic Male n = 46, Female n = 247 Discussion Previous studies have reported that the COVID-19 pandemic has affected both physical and cognitive functions in community-dwelling older adults (4). This is likely due to a substantial reduction in opportunities for going out, as many day service centers were temporarily closed whenever COVID-19 cases occurred, and access to gyms and public spaces was similarly restricted. Therefore, it is possible that older adults with proximal femoral fractures also had lower pre-injury ADL abilities than during the prepandemic period. Although this is a major concern, it is practically impossible to directly assess pre-injury ADL function. In contrast, proximal femoral fractures are known to cause a decline in ADL ability (5). Therefore, the FIM scores at discharge evaluated in this study reflected both the preoperative ADL capacity and fracture-related ADL decline. Notably, there were no significant differences between the preoperative and pandemic periods in terms of factors that could influence ADLs, such as age, sex distribution, fracture type, surgical method, or length of hospital stay after surgery. The only difference observed was that the number of days from injury to surgery was significantly shorter during the pandemic among patients who had been living in facilities before injury. However, early surgery after a hip fracture generally reduces postoperative complications (6). This factor is unlikely to have negatively affected the outcomes during the pandemic. With respect to life during hospitalization, the pandemic has reduced opportunities for communication owing to restrictions on the use of common rooms and family visits. Consequently, we were concerned that cognitive decline might have progressed more during the pandemic. It was somewhat surprising that, in the present study, the cognitive FIM scores did not decrease during the pandemic compared to those during the prepandemic period. However, this score mainly reflects the minimal cognitive ability necessary for daily living; previous studies have suggested that although the pandemic may accelerate cognitive decline, its clinical impact may be limited (7). Therefore, our findings do not necessarily indicate that cognitive function was unaffected by the COVID-19 pandemic. In contrast, a decline in motor FIM scores was observed in the total cohort and in those who were discharged home. Because we deliberately maintained the quality and amount of rehabilitation during the pandemic at levels comparable to those during the prepandemic period, this decline is presumed to have been largely influenced by decreased pre-injury physical function resulting from the broader impact of the pandemic. Previous studies have documented a decline in muscle mass and strength among older adults during the pandemic (8, 9, 10). Mild muscle weakness alone may not immediately result in an overt impairment of ADL (11). In our cohort, the motor FIM scores significantly declined in women during the pandemic, whereas men showed no significant difference. This non-significant result requires cautious interpretation, because the small sample size of male patients may have limited statistical power. Given that previous studies reported more pronounced muscle loss in men during the pandemic (9), further investigations into sex-specific effects are warranted. Considering these findings, the observed decline in motor FIM scores during the pandemic highlights the potential impact of societal restrictions on physical function in older adults, and underscores the importance of maintaining rehabilitation and support even during public health crises. Limitations This study has several limitations. Most patients (85%) were women, reflecting the known sex differences in hip fracture incidence; therefore, the findings may not be generalizable to men. Patients who were not admitted to the rehabilitation ward after surgery could not be evaluated. FIM scores at discharge may not necessarily adequately reflect pre-injury functioning. Despite these limitations, focusing on a common condition such as hip fracture without major neurological deficits has broader implications for the ADL capacity of older individuals, particularly women, during the pandemic. Conclusion This study investigated the impact of the COVID-19 pandemic on the functional outcomes of adults aged 65 years and older who were admitted to a rehabilitation ward after hip fracture surgery. Motor FIM scores at discharge were significantly lower, which likely reflects reduced pre-injury ADL capacity due to lifestyle restrictions during the pandemic rather than differences in in-hospital care. Abbreviations ADL = activities of daily living; FIM = Functional Independence Measure Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of our hospital (RAKUOTORI-RIN-19-001). In accordance with the approved protocol, the study was conducted using an opt-out approach by posting information about the research on the hospital’s website to ensure that patients had the opportunity to decline participation. The study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding No funding was received for this study. Author contributions MH: Conceptualization, Investigation, Data curation, Writing – original draft NH: Conceptualization (later addition of perspectives during manuscript preparation), Writing – review & editing MA: Investigation (literature review for discussion), Writing – review & editing (including English language review prior to professional editing) SO: Methodology (study design and statistical approach), Writing – review & editing HO: Writing – review & editing KS: Writing – review & editing YM: Writing – review & editing Acknowledgment The authors acknowledge the assistance of ChatGPT (OpenAI; San Francisco, CA, USA) in improving the English language and clarity of the manuscript. All suggestions were reviewed and approved by the authors, who take full responsibility for the final content. The authors also wish to express their sincere gratitude to the hospital staff and related personnel who assisted in the identification and listing of eligible patients. Their cooperation was essential to this study, and while it is not feasible to list all individuals by name, their contributions are deeply appreciated. We would also like to thank Editage (www.editage.jp) for English language editing. References Committee for Osteoporosis Treatment of The Japanese Orthopaedic Association: Nationwide survey of hip fractures in Japan. J Orthop Sci. 2004, 9: 1-5. 10.1007/s00776-003-0741-8. Horii M, Fujiwara H, Ikeda T, Ueshima K, Ikoma K, Shirai T, Terauchi R, Nagae M, Kuriyama N, Kubo T. Urban versus rural differences in the occurrence of hip fractures in Japan’s Kyoto prefecture during 2008–2010: a comparison of femoral neck and trochanteric fractures. BMC Musculoskelet Disord. 2013;25:304. doi: 10.1186/1471-2474-14-304. Uniform Data System for Medical Rehabilitation. Guide for the Uniform Data Set for Medical Rehabilitation (including the FIM Instrument). Version 5.1. Buffalo: State University of New York at Buffalo; 1997. Fukase, Y., Kamide, N., Sakamoto, M, et al. An in-person survey of the influence of the COVID-19 pandemic on physical function, functional capacity, cognitive function, and mental health among community-dwelling older adults in Japan from 2016 to 2022. BMC Geriatr 24, 457 (2024). https://doi.org/10.1186/s12877-024-05055-5 Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C: A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016; 16(1):158. doi: 10.1186/s12877-016-0332-0. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609–1616. doi:10.1503/cmaj.092220 Resciniti NV, Yoon H, Eckstrom E, Choi SK, Rhee TG, Kaufman BG, et al. COVID-19 pandemic impact on the trajectories of cognitive decline and depression symptoms in long-term care facility residents. J Am Med Dir Assoc. 2023;24(12):1805–1812.e1. doi:10.1016/j.jamda.2023.08.004 Yamada M, Kimura Y, Ishiyama D, Otobe Y, Suzuki M, Koyama S, et al. Characteristics of Japanese older adults whose trunk muscle mass decreased during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(2):814. doi:10.3390/ijerph19020814 Kimura Y, Yamada M, Otobe Y, Ishiyama D, Suzuki M, Koyama S, et al. Sex differences in reduction of trunk muscle mass related to falls and cognitive function during the COVID‐19 pandemic in older adults. Geriatr Gerontol Int. 2024;24(1):27–33. doi:10.1111/ggi.14976 Shinohara T, Saida K, Taniguchi Y, Osuka Y, Nishita Y, Tange C, et al. An in-person survey of the influence of the COVID-19 pandemic on physical function, functional capacity, cognitive function, and mental health among community-dwelling older adults in Japan from 2016 to 2022. BMC Geriatr. 2024;24:115. doi:10.1186/s12877-024-05055-5 Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, et al. Muscle strength as a predictor of onset of ADL dependence in people aged 75 years. J Gerontol A Biol Sci Med Sci. 2003;58(2):M146–M150. doi:10.1093/gerona/58.2.m146 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 28 Dec, 2025 Reviewers agreed at journal 06 Dec, 2025 Reviewers invited by journal 05 Dec, 2025 Editor invited by journal 03 Dec, 2025 Editor assigned by journal 02 Dec, 2025 Submission checks completed at journal 02 Dec, 2025 First submitted to journal 29 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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15:53:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":649549,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8235235/v1/995c5581-92ed-4bd4-ac72-ae2f9b5ea146.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Functional Outcomes After Hip Fracture Before and During the COVID-19 Pandemic in Adults Aged 65 Years and Older: A Retrospective Comparative Study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe coronavirus disease (COVID-19) pandemic has significantly altered living environments worldwide, including in Japan. Opportunities for going out decreased, and interactions with others were restricted. Long-term care facilities, also limited family visits, and socialization among residents also declined. These changes may have contributed to a decline in activities of daily living (ADL) among older adults.\u003c/p\u003e\n\u003cp\u003eHip fractures are among the most common injuries in older adults and a leading cause of admission to convalescent rehabilitation wards. Most cases occur because of indoor falls (1, 2) and are common in both home- and care facility-dwelling older adults. In convalescent rehabilitation wards, the primary focus of rehabilitation after hip fracture is to improve ADLs, which are often assessed using the functional independence measure (FIM) (3), and to support discharge whenever possible. Therefore, we hypothesized that the COVID-19 pandemic may negatively affect functional recovery after hip fractures in older adults.\u003c/p\u003e\n\u003cp\u003eThis study aimed to examine whether the COVID-19 pandemic has influenced the ADL status of patients aged 65 years and older with hip fractures admitted to our convalescent rehabilitation ward.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eData of patients who sustained a hip fracture and were admitted to our convalescent rehabilitation ward were retrospectively reviewed. We collected information on pre-injury living arrangements (home or facility), age, sex, and FIM scores (motor, cognitive, and total) at discharge. Facilities included nursing homes, service-provided housing for older adults (Japan\u0026rsquo;s \u0026ldquo;assisted living\u0026rdquo; system), group homes for dementia patients, special nursing homes, and long-term care medical institutions, excluding short-term respite stays. Preadmission living arrangements were used for patients who were injured during their acute hospital stay. We excluded patients who were unexpectedly transferred back to acute care hospitals because of complications such as new trauma or illness because their discharge destinations were diverse and could not always be traced in the available records.\u003c/p\u003e\n\u003cp\u003eThe patients were divided into two groups based on the date of injury: prepandemic (January 1, 2016, to December 31, 2019) and pandemic (January 1, 2020, to December 31, 2022).\u003c/p\u003e\n\u003cp\u003eWe compared the total, motor, and cognitive FIM scores at discharge between the two groups stratified by pre-injury living arrangement (home or facility). In addition, age, sex, number of days from injury to surgery (preoperative days), number of days from surgery to discharge from the convalescent rehabilitation ward (postoperative stay), distribution of fracture type (femoral neck or trochanteric), and surgical procedure (hemiarthroplasty or internal fixation) were compared between the groups to assess baseline differences unrelated to the pandemic.\u003c/p\u003e\n\u003cp\u003eThe normality of continuous variables was assessed via skewness and kurtosis tests using StatFlex ver.6 (Artech Co., Ltd., Osaka, Japan). Age and FIM scores demonstrated significant deviation from normal distributions, continuous variables were compared between the groups using the Mann\u0026ndash;Whitney U test. Categorical variables, including living situation, sex, fracture type, and surgical procedure, were analyzed using the chi-squared test. All statistical tests were two-sided, and a p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n"},{"header":"Results","content":"\u003cp\u003eA total of 676 patients aged 65 years or older were admitted to our rehabilitation ward after hip fracture surgery during the study period. Of these, 26 were transferred to acute hospitals and were excluded. The remaining 650 patients (99 men and 551 women) had a median age of 85 years (Q1, 79.0; Q3, 89.0), with the oldest patient being 102 years.\u003c/p\u003e\n\u003cp\u003eAmong these, 357 patients were included in the prepandemic group, with 295 living at home and 62 living in a facility before injury. The pandemic group comprised 293 patients, with 248 living at home and 45 living in a facility before injury. The median age of the patients in each subgroup is shown in Table 1\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"443\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 443px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Median age of patients in the prepandemic and pandemic groups, stratified by preinjury living arrangement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003ePeriod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 339px;\"\u003e\n \u003cp\u003eMedian [Q1-Q3]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003eFacility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e85 [78.0-880.]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e83[77.3-88.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e87[84.0-90.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e85 [79.0-89.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e84 [78.0-88.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e88[84.8-92.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003ep = 0.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003ep = 0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003ep = 0.297\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThere were no significant differences in age or sex, fracture type, or surgical procedure between the two groups, both in the overall cohort and when stratified by preinjury living arrangement (home or facility) (Table 2).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"669\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 667px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2a.\u003c/strong\u003e Sex distribution in the prepandemic and pandemic groups, stratified by preinjury living arrangement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePeriod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003eTotal n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003eHome n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 176px;\"\u003e\n \u003cp\u003eFacility n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePrpandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e53 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e304 (85.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e50 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e245 (83.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e3 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e59 (95.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e46 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e247 (84.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e42 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e206 (83.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e4 (8.9\u003cs\u003e%\u003c/s\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e41 (91.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003ep = 0.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003ep = 0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 176px;\"\u003e\n \u003cp\u003ep = 0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 667px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2b.\u003c/strong\u003e Fracture type distribution in the prepandemic and pandemic groups, stratified by preinjury living arrangement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePeriod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003eTotal n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003eHome n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 176px;\"\u003e\n \u003cp\u003eFacility n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eNF*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eTF **\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eNF*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eTF **\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eNF*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eTF **\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e192 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e165 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e164 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e131 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e28 (45.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e34 (54.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e163 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e130 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e148 (59.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e100 (40.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e15(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e30 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003ep = 0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003ep = 0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 176px;\"\u003e\n \u003cp\u003ep = 0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 199px;\"\u003e\n \u003cp\u003e* NF: femoral neck fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 199px;\"\u003e\n \u003cp\u003e** TF:trochanteric fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 667px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2c.\u003c/strong\u003e Surgical procedure distribution in the prepandemic and pandemic groups, stratified by preinjury living arrangement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePeriod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003eTotal n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003eHome n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 176px;\"\u003e\n \u003cp\u003eFacility n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eHA* \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eIF** \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eHA*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eIF**\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eHA*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eIF**\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e147 (41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e210 (58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e122 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e173 (58.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e25 (40.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e37 (59.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e119 (40.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e174 (59.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e107 (43.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e141 (56.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e12 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e33 (73.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003ep = 0.885\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 195px;\"\u003e\n \u003cp\u003ep = 0.674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 176px;\"\u003e\n \u003cp\u003ep = 0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 199px;\"\u003e\n \u003cp\u003e* HA:hemiarthroplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 199px;\"\u003e\n \u003cp\u003e** IF: internal fixation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" rowspan=\"3\" style=\"width: 667px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFootnote\u003c/strong\u003e: Aplied to Table 1a-1c.\u003cbr\u003e\u0026nbsp;Data are presented as number (%). p values indicate comparisons between two groups within each catefory.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"36\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe preoperative days were significantly shorter during the pandemic than the prepandemic period among patients living in a facility (p = 0.002) and in the overall cohort (total) (p = 0.009) (Table 3a). In contrast, the postoperative stay did not differ significantly between the two periods either in the overall cohort or when stratified by pre-injury living arrangements (Table 3b).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"497\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 497px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3a\u003c/strong\u003e. Median preoperative days in the prepandemic and pandemic groups, stratified by preinjury living arrangement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003ePeriod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 390px;\"\u003e\n \u003cp\u003eMedian [Q1-Q3]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eFacility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e4 [2.0-6.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e4 [2.0-6.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e4 [3.0-7.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e3 [1.0-6.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e3 [2.0-6.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e2 [1.0-4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003ep = 0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003ep = 0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003ep = 0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 497px;\"\u003e\n \u003cp\u003ePreoperative days: number of days from injury to surgery.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 497px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3b\u003c/strong\u003e. Median postoperative stay in the prepandemic and pandemic groups, stratified by preinjury living arrangement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003ePeriod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 390px;\"\u003e\n \u003cp\u003eMedian [Q1-Q3]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eFacility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e83 [62.0-99.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e84 [63.0-99.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e80 [58.0-97.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e81 [62.0-95.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e82 [62.0-96.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e79[61.8-88.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003ep = 0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003ep = 0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003ep = 0.470\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 497px;\"\u003e\n \u003cp\u003ePostoperative stay: number of days from surgery to discharge from the convalescent rehabilitation ward.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4 shows the FIM scores at discharge. In the overall cohort, the median motor FIM score decreased from 75 during the prepandemic period to 71 during the pandemic period (p = 0.017). Among the patients who lived at home before the injury, the median motor FIM score decreased from 78 to 75 (p = 0.029). Among the facility residents, the median motor FIM score decreased from 60 to 55, although this difference was not statistically significant. The cognitive FIM scores showed no similar trends, and the total FIM score, which was the sum of the motor and cognitive FIM scores, did not differ significantly between the periods.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"596\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 596px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e FIM scores at discharge in the prepandemic and pandemic groups, stratified by preinjury living arrangement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal FIM score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ePeriod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 452px;\"\u003e\n \u003cp\u003eMedian [Q1-Q3]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eFacility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e102 [82.0 \u0026ndash; 115.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e105 [90.0\u0026ndash;116.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e80.5 [65.0\u0026ndash;99.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e100 [75.8\u0026ndash;114.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e104 [81.0\u0026ndash;116.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e74 [57.8\u0026ndash;94.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ep = 0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ep = 0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ep = 0.350\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMotor FIM score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ePeriod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eFacility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e75 [62.0\u0026ndash;83.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e78 [66.0\u0026ndash;84.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e60 [48.0\u0026ndash;72.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e71 [54.0\u0026ndash;83.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e75 [57.0\u0026ndash;84.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e55 [43.0\u0026ndash;66.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ep = 0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ep = 0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ep = 0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive FIM score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ePeriod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eFacility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e27 [20.0\u0026ndash;32.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e28 [23.0\u0026ndash;33.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e20 [16.0\u0026ndash;26.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e29 [20.0\u0026ndash;34.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e30 [22.0\u0026ndash;35.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e20 [16.0\u0026ndash;27.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ep = 0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ep = 0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ep = 0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 596px;\"\u003e\n \u003cp\u003eTotal FIM score ranges from 18 to 126, motor FIM 13\u0026ndash;91, cognitive FIM 5\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5 presents the FIM scores at discharge stratified by sex, showing that the motor FIM scores decreased in both sexes during the pandemic; however, the difference was significant only among women (p = 0.022).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"512\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 512px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e. Comparison of FIM scores at discharge in the prepandemic and pandemic groups, stratified by sex\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal FIM score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePeriod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 349px;\"\u003e\n \u003cp\u003eMedian [Q1-Q3]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003ep value*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e105 [83.5\u0026ndash;115.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e102 \u0026nbsp;[82.0\u0026ndash;116.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003ep＝0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e104 [80.0\u0026ndash;118.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e99 [75.3\u0026ndash;114.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003ep＝0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ep value**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003ep＝0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003ep＝0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMotor FIM score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003ep value*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e78 [60.8\u0026ndash;83.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e75 [62.0\u0026ndash;84.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003ep＝0.450\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e75 [54.0\u0026ndash;84.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e71 [54.0\u0026ndash;81.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003ep＝0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ep value**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003ep＝0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003ep＝0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 294px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive FIM score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003ep value*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePrepandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e27 [21.0\u0026ndash;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e27 [20.0\u0026ndash;32.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003ep＝0.482\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e29.5 [22.0\u0026ndash;35.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e28 [20.0\u0026ndash;34.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003ep＝0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ep value**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003ep＝0.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003ep＝0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 512px;\"\u003e\n \u003cp\u003e*p-values for comparisons between male and female patients within each period\u003cbr\u003e\u0026nbsp;**p-values for prepandemic vs pandemic comparisons within each sex\u003cbr\u003e\u0026nbsp;\u0026dagger;Group sizes: Prepandemic Male n = 53, Female n =304; Pandemic Male n = 46, Female n = 247\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrevious studies have reported that the COVID-19 pandemic has affected both physical and cognitive functions in community-dwelling older adults (4). This is likely due to a substantial reduction in opportunities for going out, as many day service centers were temporarily closed whenever COVID-19 cases occurred, and access to gyms and public spaces was similarly restricted. Therefore, it is possible that older adults with proximal femoral fractures also had lower pre-injury ADL abilities than during the prepandemic period. Although this is a major concern, it is practically impossible to directly assess pre-injury ADL function.\u003c/p\u003e\n\u003cp\u003eIn contrast, proximal femoral fractures are known to cause a decline in ADL ability (5). Therefore, the FIM scores at discharge evaluated in this study reflected both the preoperative ADL capacity and fracture-related ADL decline. Notably, there were no significant differences between the preoperative and pandemic periods in terms of factors that could influence ADLs, such as age, sex distribution, fracture type, surgical method, or length of hospital stay after surgery. The only difference observed was that the number of days from injury to surgery was significantly shorter during the pandemic among patients who had been living in facilities before injury. However, early surgery after a hip fracture generally reduces postoperative complications (6). This factor is unlikely to have negatively affected the outcomes during the pandemic.\u003c/p\u003e\n\u003cp\u003eWith respect to life during hospitalization, the pandemic has reduced opportunities for communication owing to restrictions on the use of common rooms and family visits. Consequently, we were concerned that cognitive decline might have progressed more during the pandemic. It was somewhat surprising that, in the present study, the cognitive FIM scores did not decrease during the pandemic compared to those during the prepandemic period. However, this score mainly reflects the minimal cognitive ability necessary for daily living; previous studies have suggested that although the pandemic may accelerate cognitive decline, its clinical impact may be limited (7). Therefore, our findings do not necessarily indicate that cognitive function was unaffected by the COVID-19 pandemic.\u003c/p\u003e\n\u003cp\u003eIn contrast, a decline in motor FIM scores was observed in the total cohort and in those who were discharged home. Because we deliberately maintained the quality and amount of rehabilitation during the pandemic at levels comparable to those during the prepandemic period, this decline is presumed to have been largely influenced by decreased pre-injury physical function resulting from the broader impact of the pandemic.\u003c/p\u003e\n\u003cp\u003ePrevious studies have documented a decline in muscle mass and strength among older adults during the pandemic (8, 9, 10). Mild muscle weakness alone may not immediately result in an overt impairment of ADL (11). In our cohort, the motor FIM scores significantly declined in women during the pandemic, whereas men showed no significant difference. This non-significant result requires cautious interpretation, because the small sample size of male patients may have limited statistical power. Given that previous studies reported more pronounced muscle loss in men during the pandemic (9), further investigations into sex-specific effects are warranted. Considering these findings, the observed decline in motor FIM scores during the pandemic highlights the potential impact of societal restrictions on physical function in older adults, and underscores the importance of maintaining rehabilitation and support even during public health crises.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. Most patients (85%) were women, reflecting the known sex differences in hip fracture incidence; therefore, the findings may not be generalizable to men. Patients who were not admitted to the rehabilitation ward after surgery could not be evaluated. FIM scores at discharge may not necessarily adequately reflect pre-injury functioning.\u003c/p\u003e\n\u003cp\u003eDespite these limitations, focusing on a common condition such as hip fracture without major neurological deficits has broader implications for the ADL capacity of older individuals, particularly women, during the pandemic.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study investigated the impact of the COVID-19 pandemic on the functional outcomes of adults aged 65 years and older who were admitted to a rehabilitation ward after hip fracture surgery. Motor FIM scores at discharge were significantly lower, which likely reflects reduced pre-injury ADL capacity due to lifestyle restrictions during the pandemic rather than differences in in-hospital care.\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003cp\u003eADL = activities of daily living; FIM = Functional Independence Measure\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of our hospital (RAKUOTORI-RIN-19-001). In accordance with the approved protocol, the study was conducted using an opt-out approach by posting information about the research on the hospital\u0026rsquo;s website to ensure that patients had the opportunity to decline participation. The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMH: Conceptualization, Investigation, Data curation, Writing \u0026ndash; original draft\u003c/p\u003e\n\u003cp\u003eNH: Conceptualization (later addition of perspectives during manuscript preparation), Writing \u0026ndash; review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eMA: Investigation (literature review for discussion), Writing \u0026ndash; review \u0026amp; editing (including English language review prior to professional editing)\u003c/p\u003e\n\u003cp\u003eSO: Methodology (study design and statistical approach), Writing \u0026ndash; review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eHO: Writing \u0026ndash; review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eKS: Writing \u0026ndash; review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eYM: Writing \u0026ndash; review \u0026amp; editing\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the assistance of ChatGPT (OpenAI; San Francisco, CA, USA) in improving the English language and clarity of the manuscript. All suggestions were reviewed and approved by the authors, who take full responsibility for the final content.\u003c/p\u003e\n\u003cp\u003eThe authors also wish to express their sincere gratitude to the hospital staff and related personnel who assisted in the identification and listing of eligible patients. Their cooperation was essential to this study, and while it is not feasible to list all individuals by name, their contributions are deeply appreciated.\u003c/p\u003e\n\u003cp\u003eWe would also like to thank Editage (www.editage.jp) for English language editing.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCommittee for Osteoporosis Treatment of The Japanese Orthopaedic Association: Nationwide survey of hip fractures in Japan. J Orthop Sci. 2004, 9: 1-5. 10.1007/s00776-003-0741-8.\u003c/li\u003e\n\u003cli\u003eHorii M, Fujiwara H, Ikeda T, Ueshima K, Ikoma K, Shirai T, Terauchi R, Nagae M, Kuriyama N, Kubo T. Urban versus rural differences in the occurrence of hip fractures in Japan\u0026rsquo;s Kyoto prefecture during 2008\u0026ndash;2010: a comparison of femoral neck and trochanteric fractures. BMC Musculoskelet Disord. 2013;25:304. doi: 10.1186/1471-2474-14-304.\u003c/li\u003e\n\u003cli\u003eUniform Data System for Medical Rehabilitation. Guide for the Uniform Data Set for Medical Rehabilitation (including the FIM Instrument). Version 5.1. Buffalo: State University of New York at Buffalo; 1997.\u003c/li\u003e\n\u003cli\u003eFukase, Y., Kamide, N., Sakamoto, M, et al. An in-person survey of the influence of the COVID-19 pandemic on physical function, functional capacity, cognitive function, and mental health among community-dwelling older adults in Japan from 2016 to 2022. BMC Geriatr 24, 457 (2024). https://doi.org/10.1186/s12877-024-05055-5\u003c/li\u003e\n\u003cli\u003eDyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C: A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016; 16(1):158. doi: 10.1186/s12877-016-0332-0.\u003c/li\u003e\n\u003cli\u003eSimunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609\u0026ndash;1616. doi:10.1503/cmaj.092220\u003c/li\u003e\n\u003cli\u003eResciniti NV, Yoon H, Eckstrom E, Choi SK, Rhee TG, Kaufman BG, et al. COVID-19 pandemic impact on the trajectories of cognitive decline and depression symptoms in long-term care facility residents. J Am Med Dir Assoc. 2023;24(12):1805\u0026ndash;1812.e1. doi:10.1016/j.jamda.2023.08.004\u003c/li\u003e\n\u003cli\u003eYamada M, Kimura Y, Ishiyama D, Otobe Y, Suzuki M, Koyama S, et al. Characteristics of Japanese older adults whose trunk muscle mass decreased during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(2):814. doi:10.3390/ijerph19020814\u003c/li\u003e\n\u003cli\u003eKimura Y, Yamada M, Otobe Y, Ishiyama D, Suzuki M, Koyama S, et al. Sex differences in reduction of trunk muscle mass related to falls and cognitive function during the COVID‐19 pandemic in older adults. Geriatr Gerontol Int. 2024;24(1):27\u0026ndash;33. doi:10.1111/ggi.14976\u003c/li\u003e\n\u003cli\u003eShinohara T, Saida K, Taniguchi Y, Osuka Y, Nishita Y, Tange C, et al. An in-person survey of the influence of the COVID-19 pandemic on physical function, functional capacity, cognitive function, and mental health among community-dwelling older adults in Japan from 2016 to 2022. BMC Geriatr. 2024;24:115. doi:10.1186/s12877-024-05055-5\u003c/li\u003e\n\u003cli\u003eRantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, et al. Muscle strength as a predictor of onset of ADL dependence in people aged 75 years. J Gerontol A Biol Sci Med Sci. 2003;58(2):M146\u0026ndash;M150. doi:10.1093/gerona/58.2.m146\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"hip fracture, older adults, Functional Independence Measure, COVID-19 pandemic, activities of daily living, rehabilitation, physical function, convalescent rehabilitation ward, living arrangement, Japan","lastPublishedDoi":"10.21203/rs.3.rs-8235235/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8235235/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe coronavirus disease (COVID-19) pandemic substantially altered the social environment and activity levels of older adults, potentially affecting their functional recovery following hip fractures. This study examined whether the pandemic influenced functional outcomes in adults aged ≥65 years admitted to a convalescent rehabilitation ward after hip fracture surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe retrospectively reviewed patients aged ≥65 years admitted to our rehabilitation ward after hip fracture surgery between January 2016 and December 2022. Patients were classified into two groups based on the date of injury: prepandemic (2016–2019) and pandemic (2020–2022). The functional Independence Measure (FIM) motor, cognitive, and total scores were calculated at discharge and compared between the two groups stratified by pre-injury living arrangements (home or facility). We also assessed baseline characteristics including age, sex, fracture type, surgical procedure, preoperative waiting time and length of hospital stay, to identify potential confounders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 650 eligible patients (median age, 85 years; 551 women), 357 sustained fractures before the pandemic and 293 during the pandemic. No significant differences were observed between the two groups in terms of age, sex distribution, fracture type, surgical procedure, or length of postoperative hospital stay. The preoperative waiting time was slightly shorter during the pandemic. The median motor FIM score at discharge decreased from 75 (prepandemic) to 71 (pandemic) in the overall cohort (p = 0.017) and from 78 to 75 among patients who lived at home before injury (p = 0.029). No significant differences were observed in cognitive or total FIM scores. The decline in motor FIM scores was significant among women but not among men.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunctional recovery after hip fracture, as measured by the motor FIM score at discharge, significantly declined during the COVID-19 pandemic, particularly among older adults who lived at home before the injury. This decline likely reflects reduced pre-injury physical and ADL capacity resulting from lifestyle restrictions during the pandemic, rather than differences in in-hospital care. These findings highlight the long-term impact of societal restrictions on physical function in older adults and underscore the importance of maintaining opportunities for physical activity and rehabilitation even during public health crises.\u003c/p\u003e","manuscriptTitle":"Functional Outcomes After Hip Fracture Before and During the COVID-19 Pandemic in Adults Aged 65 Years and Older: A Retrospective Comparative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 15:43:35","doi":"10.21203/rs.3.rs-8235235/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-29T02:20:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2760162200389740410776572017214696200","date":"2025-12-06T23:44:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-05T12:26:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-03T05:20:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-03T02:58:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-03T02:58:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-11-29T07:26:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d74ab2e-9849-4d38-a253-0c3f9b94dae8","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T15:43:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 15:43:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8235235","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8235235","identity":"rs-8235235","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}