Early postoperative functional exercise adherence and its association with 3-month hip functional recovery among older adults after femoral neck fracture surgery: a prospective observational study

Older adults recovering from femoral neck fracture surgery transition rapidly from supervised inpatient mobilisation to increasingly self-managed exercise. This study examined before-discharge early postoperative functional exercise adherence, factors associated with adherence, and its association with 3-month hip functional recovery. A prospective observational study was conducted among 230 adults aged 60 years or older who underwent surgery for femoral neck fracture. Functional exercise adherence, kinesiophobia, rehabilitation self-efficacy, social support and pain intensity were assessed before discharge. Hip functional recovery was evaluated using the Harris Hip Score (HHS) at 3 months. Descriptive statistics, group comparisons, Spearman correlation analysis and multivariable linear regression were used. The mean age was 71.5 ± 4.1 years, and 52.6% of participants were women. The mean before-discharge functional exercise adherence score was 49.9 ± 6.9, indicating a moderate level. Adherence was negatively correlated with kinesiophobia ( r = -0.753, p < 0.001) and pain intensity ( r = -0.399, p < 0.001), and positively correlated with rehabilitation self-efficacy ( r = 0.754, p < 0.001), social support ( r = 0.893, p < 0.001) and 3-month HHS ( r = 0.838, p < 0.001). In adjusted analyses, kinesiophobia, rehabilitation self-efficacy, social support, pain intensity, osteoporosis status, documented rehabilitation guidance and a documented post-discharge rehabilitation plan were associated with adherence. Adherence was positively associated with 3-month HHS (B = 0.842, p < 0.001). Before-discharge early postoperative functional exercise adherence was moderate and was associated with psychological, social and continuity-of-care factors. Higher adherence was associated with better 3-month hip function, but the observational design does not establish causality. Multidisciplinary rehabilitation support, with nurses contributing assessment, symptom management, education and care coordination, should prioritise modifiable barriers and continuity across discharge.