SARC-F predicted slow recovery after hip fracture better than grip strength or calf circumference

Design

Prospective cohort with 1-year follow-up

Population

430 adults aged 70 and over with hip fracture

Primary outcome

Early mobilisation, walking ability and Barthel Index

Effect

Impaired mobilisation day 3 OR 7.56 (3.61 to 15.81); Barthel change -17.5 vs -11.2 at 4 months

This prospective cohort at a Finnish university hospital followed 430 adults aged 70 and over with hip fracture for a year, comparing three sarcopenia measures: handgrip strength, calf circumference and the five-item SARC-F questionnaire (strength, assistance walking, rising from a chair, climbing stairs, falls).

Only SARC-F consistently predicted outcomes after adjustment for age, sex, ASA grade, cognition and nutrition. A positive SARC-F was associated with impaired mobilisation on day 1 (OR 1.99), day 2 (OR 4.90) and day 3 (OR 7.56), worse walking from one to four months, and a larger decline in Barthel Index at four months (-17.5 vs -11.2). Neither group improved further between 4 and 12 months. Grip strength and calf circumference were not consistently associated with outcome.

SARC-F takes a minute, needs no equipment and can be asked of the patient or family on admission. It identifies the patients who need more intensive and earlier rehabilitation, and a realistic discussion of recovery with families — and the plateau after four months suggests the early window is where effort pays off.

• Ask the five SARC-F questions on admission for every older patient with hip fracture
• Use a positive SARC-F to prioritise early and intensive physiotherapy
• Set realistic expectations with families; recovery plateaued after about four months
• Pair a positive screen with nutritional assessment and protein supplementation
• Grip strength and calf circumference were less useful in this setting

Why it matters

It gives a one-minute bedside tool to target scarce rehabilitation where it matters most.

Don't overread it

This is a prognostic cohort from one hospital; it does not show that acting on SARC-F improves outcomes.

The statistics, in plain English

An odds ratio of 7.56 on day 3 means much higher odds of poor mobilisation, but the wide interval (3.61 to 15.81) reflects small numbers in some groups.

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