A prospective cohort followed 430 adults aged 70 and over with hip fracture at a single university hospital from 2021 to 2023, with one-year follow-up. Three sarcopenia measures were compared as predictors of rehabilitation outcome: handgrip strength, calf circumference and the SARC-F questionnaire, which asks about strength, assistance walking, rising from a chair, climbing stairs and falls. Analyses adjusted for age, sex, ASA score, cognition and nutritional status.
Only SARC-F predicted consistently. For impaired early mobilisation, odds ratios rose across the first postoperative days — 1.99 (95% CI 1.14 to 3.45) on day one, 4.90 (2.84 to 8.44) on day two, 7.56 (3.61 to 15.81) on day three. SARC-F-defined sarcopenia also predicted worse walking ability from one to four months and greater functional decline on the Barthel Index at four months, with mean change of -17.5 against -11.2. Handgrip strength and calf circumference did not consistently predict anything. And neither group improved on the Barthel Index between four and 12 months.
Two practical consequences. First, a five-question interview that needs no equipment outperformed a dynamometer, which matters in any hospital where the dynamometer is either absent or in a drawer. Ask the questions on admission and use a high score to flag the patient for intensive rehabilitation input from day one. Second, the flat trajectory after four months should reset expectations for families: the recovery that happens, happens in the first four months. Rehabilitation effort concentrated there is worth more than a plan that assumes gradual improvement over a year.
- Administer SARC-F on admission; it needs no equipment and takes two minutes.
- Use a high SARC-F to escalate physiotherapy input from day one, not after a failed mobilisation.
- Do not rely on grip strength or calf circumference to triage rehabilitation here.
- Tell families that most functional recovery occurs within four months, and plan support accordingly.
- Reassess nutrition alongside, since it was adjusted for and remains independently treatable.
The statistics, in plain English
Odds ratios climbing from 1.99 on day one to 7.56 on day three do not mean the risk grows; they mean that by day three, failing to mobilise is unusual enough that the marker separates patients sharply. That handgrip and calf circumference failed does not make them poor measures of muscle — it means self-reported function captures something about recovery that muscle bulk and strength alone do not. A single-centre cohort of 430 patients supports use as a screen, not as a rule.
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