Effect of standardized early weight-bearing training on postoperative rehabilitation in older adults with intertrochanteric femoral fractures: a randomized controlled trial

To evaluate the impact of standardized early weight-bearing training on postoperative rehabilitation in older adults with intertrochanteric femoral fractures. A total of 54 older adults with intertrochanteric femoral fractures admitted to the Department of Orthopedics, Huashan Hospital, Fudan University, between October 2023 and April 2025 were randomly allocated to a control group (n = 27) or an intervention group (n = 27). The control group received routine orthopedic rehabilitation, with weight-bearing initiated 4 weeks postoperatively, whereas the intervention group additionally received a standardized early weight-bearing program beginning 2–3 days after surgery. Outcomes including hip function, pain, quality of life, exercise adherence, Functional Independence Measure (FIM) scores, and weight-bearing duration were assessed at baseline, one day before discharge, and one month after discharge. Baseline characteristics did not differ significantly between the two groups. Compared with the control group, the intervention group demonstrated significantly greater improvement in hip function, with higher Harris Hip Scores at one day before discharge (Z = − 2.506, PFDR= 0.018, r = 0.34) and at one month after discharge (Z = − 3.239, PFDR= 0.003, r = 0.44), linear mixed-effects modeling revealed a significant group-by-time interaction (β = 6.34, 95% CI: 2.88–9.80; P < 0.001), with the between-group difference reaching approximately 9.6 points at follow-up. Resting pain scores were significantly lower in the intervention group at pre-discharge (Z = − 2.770, PFDR = 0.010) and one month after discharge (Z = − 2.326, PFDR= 0.024), with a significant group-by-time interaction indicating greater early pain relief. At follow-up, the intervention group achieved higher FIM scores, including the motor subscale (Hedges’ g = − 0.892), cognitive subscale (Hedges’ g = − 1.097), and total score (Hedges’ g = − 0.993). Weight-bearing duration was significantly longer in the intervention group (15.52 ± 8.02 vs. 10.59 ± 7.86 min; PFDR = 0.027). The intervention group demonstrated significantly higher scores in the psychological domain of quality of life (P < 0.05). Standardized early weight-bearing training was associated with improved hip function, pain relief, functional independence, exercise compliance, psychological well-being, and weight-bearing performance in older adults with intertrochanteric femoral fractures. The trial was registered at the Chinese Clinical Trials Registry; retrospectively registered; registration number: ChiCTR2500095906; date of registration:2025/01/15.