Experiences and challenges of in-hospital rehabilitation exercise among older adults with hip fracture arthroplasty in a fast-track program: a qualitative study

Introduction – Hip fractures are a major global health problem for older adults and fast-track programs are now widely used to improve outcomes. However, older adults following hip fracture arthroplasty often faced difficulties in rehabilitation exercise during hospitalization, and little is known about the factors shaping their exercise behaviors within fast-track care. Objective – The purpose of this study is to explore the experiences, dilemmas, and needs related to in-hospital rehabilitation exercise among older adults following hip fracture arthroplasty in a fast-track program, to inform strategies for improving rehabilitation support and recovery. Methods: A qualitative interview study was conducted using purposive sampling at a tertiary hospital in Shanghai, China, from January to March 2025. Sixteen older adults with hip fracture arthroplasty aged 65–90 years were recruited. Interviews were audio-recorded, transcribed verbatim, uploaded into NVivo 15.0, and analyzed using thematic analysis. Results – Four main themes during hospitalization rehabilitation within a fast-track program were identified: (1) Negotiating recovery motivation and rehabilitation-related vulnerability; (2) Disjunction between rehabilitation advice and patients’ understanding; (3) The double-edged role of social networks; (4) Unmet need for rehabilitation support. Conclusion – This study highlights the urgent need to optimize rehabilitation in older adults after hip fracture arthroplasty, particularly within fast-track care. Optimizing rehabilitation may therefore require greater attention to psychosocial support, clearer and more actionable education, and a more interactive rehabilitation environment, with strengthened involvement from nurses, family caregivers, and peers.