Attitude and practices of district-level HMIS managers towards malaria routine reporting in Uganda: a 2024 cross-sectional study.

Hip fractures in the elderly have become a global public health challenge. In 2021, the number of elderly individuals experiencing hip fractures due to falls increased by approximately 8.2 million compared to 30 years earlier []. Although the age-standardized incidence of hip fractures has shown a declining trend over time, the absolute number of cases continues to rise, largely driven by population aging and increased life expectancy. Consequently, the annual number of new hip fracture cases is projected to reach approximately 16.8 million worldwide by 2036, reflecting demographic expansion rather than an increase in individual risk []. Such fractures not only carry an extremely high mortality rate but also severely compromise patients' mobility [–]. Research indicates that only 40–60% of survivors regain pre-fracture mobility levels or functional independence, with approximately 18.7% remaining unable to walk independently one year post-surgery [, ]. Consequently, identifying predictable and modifiable indicators of functional outcomes is crucial for reducing long-term disability rates. Among the numerous factors influencing functional recovery, fear of falling may play a critical role. In elderly hip fracture patients, the prevalence of fall fear can reach 47–68% [, ]. This fear is not merely a subjective concern and it is frequently accompanied by marked activity avoidance []. Reduced mobility leads to diminished muscle strength and endurance, subsequently compromising balance and gait stability []. Concurrently, prolonged inactivity may accelerate bone mass loss []. These cumulative changes readily form a vicious cycle of progressive deterioration. A meta-analysis by Ma et al. included seven cohort studies with 27,714 participants and demonstrated a significant positive association between fear of falling and worse outcome in middle-aged and older adults []. Previous studies have also indicated that fear of falling at 12 weeks post-surgery is significantly associated with poorer functional recovery at one year []. Furthermore, a comprehensive systematic review by Gadhvi et al. included 36 studies and 5099 participants, confirming that fear of falling after hip fracture is consistently associated with poorer physical function, including balance, gait speed, and self-reported function []. Although studies have reported an association between fear of falling and postoperative functional recovery, existing evidence predominantly focuses on short-term outcomes within 6 months to 1-year post-surgery [, , ]. Evidence remains lacking to determine whether fear of falling is sustainedly associated with functional outcomes three years post-surgery. Concurrently, research examining the relationship between preoperative fear of falling and functional recovery remains relatively scarce. If preoperative fear of falling could serve as an indicator of functional recovery risk, clinicians could identify high-risk individuals earlier during the perioperative period and implement targeted interventions promptly. This would help reduce activity avoidance and promote faster, more complete functional recovery. Therefore, this study aims to evaluate the predictive value of preoperative fear of falling on long-term postoperative mobility and quality of life.