Increasing mobility while in hospital after hip fracture: even the best evidence may not translate to all national health services

Hip fracture rehabilitation is strongly influenced by the healthcare system in which postoperative care is delivered. The WHiTE 15: INITIATE trial represents an important pragmatic attempt to determine whether increasing the frequency and duration of in-hospital physiotherapy after hip fracture improves days at home within 30 days of admission. However, the transferability of such evidence to the Italian National Health System is limited by structural, regulatory and sociocultural factors. Italy has one of the oldest populations in Europe, a high annual burden of proximal femoral fractures, a limited public physiotherapy workforce capacity and a care model in which transfer to inpatient rehabilitation facilities is frequently shaped by patient and family preferences rather than clinical indication alone. Current evidence supports early mobilisation and structured rehabilitation, but it does not establish that a single discharge pathway is universally superior across all healthcare systems. In Italy, direct discharge home is often constrained by insufficient community-based rehabilitation services and strong expectations for post-acute institutional care. Therefore, intensifying in-hospital physiotherapy alone may not increase the number of days at home unless discharge preferences, family support and community rehabilitation capacity are addressed simultaneously. Future research should evaluate Italian-specific discharge pathways, psychosocial determinants of rehabilitation preferences, cost-effectiveness of supported discharge models and policy strategies that align rehabilitation intensity with clinical need.