Neuromotor rehabilitation in Parkinsonian syndromes: outcomes and disability after hip fracture

Abstract

Background: Patients with Parkinsonian syndromes, including Parkinson's disease (PD) and atypical parkinsonism (AP), are at increased risk of disability following hip fracture. Limited data are available on their functional recovery after inpatient rehabilitation. This study aimed to compare rehabilitation outcomes in patients with parkinsonism versus non-parkinsonian controls after hip fracture surgery and to identify clinical predictors of worse recovery within the parkinsonian group.

Methods: A retrospective study was conducted on 60 patients with parkinsonism (45 PD, 15 AP) and 60 age- and sex-matched non-parkinsonian controls undergoing inpatient rehabilitation after hip fracture surgery. Functional status was assessed at admission and discharge using the Modified Barthel Index (MBI) and modified Rankin Scale (mRS). Linear mixed-effects models were applied to explore associations between clinical variables (including diagnosis, dementia, dysphagia, postural instability) and outcomes.

Results: Patients with parkinsonism had significantly lower functional scores at both admission and discharge as compared to controls (p < 0.001), with AP patients performing worse than PD patients (p = 0.02). Among parkinsonian individuals, dementia, dysphagia, and postural instability were independently associated with worse outcomes (p < 0.001). Although MBI change scores (delta-MBI) did not differ significantly between groups, mRS change (delta-mRS) was greater in controls, suggesting that parkinsonian patients experienced a higher overall disability burden at both admission and discharge, despite a smaller relative improvement. These findings indicate that non-motor symptoms substantially influence rehabilitation trajectories and should be considered in planning care.

Conclusions: Parkinsonian patients, particularly those with atypical parkinsonism, experience worse functional outcomes after hip fracture rehabilitation when compared with non-parkinsonian individuals. The presence of dementia, dysphagia, and postural instability further impairs recovery.

Keywords: Atypical parkinsonism; Dementia; Dysphagia; Hip fracture; Parkinson’s disease; Rehabilitation.

Fig. 1

Functional outcomes in Parkinsonism and control patients after hip fracture. a Bar plots showing MBI scores (mean ± SD) at pre-fracture, admission, discharge, and for delta-MBI. b Bar plots showing mRS scores (mean ± SD) at pre-fracture, admission, discharge, and for delta-mRS. Error bars represent standard deviations. Asterisks indicate between-group differences (*p < 0.05, **p < 0.01, ***p < 0.001, ns = non-significant). MBI Modified Barthel Index, mRS modified Rankin Scale, SD standard deviation

Fig. 2

Functional outcomes in PD and AP after hip fracture. a Bar plots showing MBI scores (mean ± SD) at pre-fracture, admission, discharge, and for delta-MBI. b Bar plots showing mRS scores (mean ± SD) at pre-fracture, admission, discharge, and for delta-mRS. Error bars represent standard deviations. Asterisks indicate between-group differences (*p < 0.05, **p < 0.01, ***p < 0.001, ns = non-significant). AP atypical parkinsonism, MBI Modified Barthel Index, mRS modified Rankin Scale, PD Parkinson’s disease, SD standard deviation

Fig. 3

Forest panels showing association analysis between disability outcome and clinical variables. Panels summarize slope (β) and 95% confidence intervals for predictors across outcomes: a MBI at discharge; b delta-MBI; c mRS at discharge; d delta-mRS. Variables are listed in alphabetical order. Point color encodes the direction of association (blue for β > 0, vermillion for β < 0). Transparency encodes statistical significance (opaque for p < 0.05; semi-transparent for p ≥ 0.05). A vertical dashed line marks the null (β = 0). CI confidence interval, delta-MBI change in Modified Barthel Index from admission to discharge, delta-mRS change in modified Rankin Scale from admission to discharge, MBI Modified Barthel Index, mRS modified Rankin Scale, PD Parkinson’s disease, β regression coefficient