Outdoor Mobility After Hip Fracture Trial

Overview

Older people who broke their hip said they felt better once they could go for a walk, go shopping, meet friends and family, or work as a volunteer again. However, we know from national records that only one in four people can go outside four months after breaking their hip. Helping people get back to going outside could lower their chances of new illness, loneliness, or needing more support from friends and family. But currently healthcare after a broken hip rarely includes support to go outside the home.  

This study wanted to see if it is possible for the NHS to support people who break their hip to get back to going outside their home.

What we found

We invited older people with a broken hip to take part. All had usual care. Half, selected by chance, had extra ‘OUTDOOR’ care delivered by a trained physiotherapist/occupational therapist. They helped practice going outside, talked about worries about falling, and advised going out with family/friends.  

We collected information on who could take part. For those who took part, information was collected at the study beginning, middle, and end, and for some, six months later. We invited a small group of people to wear an activity monitor to see when they were physically active. 

Overall, 36% of people with hip fracture were able to take part, 26% signed up, and 85% got usual care or 'OUTDOOR'. 'OUTDOOR' was acceptable. 61% of people allocated to 'OUTDOOR' had the right extra care. We measured outcomes at 12-weeks for 74% of people, and at 6-months for 52% of people. Seventeen safety events were noted, but none were linked to 'OUTDOOR'. Twenty-one people were invited to take part in the activity monitor part of the study, and 18 took part. They found it easy to use and acceptable.   

It was possible for the NHS to support people with hip fracture to get back to going outside. People who took part found OUTDOOR acceptable, as did the therapists who helped to deliver it. There are changes to the design that need to be made before a bigger study to see if ‘OUTDOOR’ improves outdoor mobility or not.

Why it matters

The research showed that the NHS could deliver OUTDOOR to help people get back outside in their communities.  The findings suggest new ways of working in community rehabilitation that could be tested further in future research. 

Early work with patients and the public, along with the development of the OUTDOOR intervention, highlighted a gap in understanding how worries about falling can be helpful or unhelpful after a hip fracture. This formed the basis of Jodie Adam’s successful NIHR Doctoral Research Fellowship, which started at Bone & Joint Health in September 2025. 

This research supported a patient and public involvement (PPI) group called TROOP, giving older adults after hip fracture and their carers a voice in this and future research. It supported members to feel recognised, have a say in what matters to them, and help ensure other older adults are informed about new developments in rehabilitation.

Outputs and reach

Publications:  

The protocol: https://doi.org/10.1371/journal.pone.0306871 

The results are being prepared for publication. 

Presentations:  

The protocol was presented at the British Geriatric Society, London and the Global Fragility Fracture Network, Oslo (2023).  

Symposium on psychological strategies to address concerns about falls after fracture based on the OUTDOOR intervention (Fragility Fracture Network, Istanbul 2024). 

Patient and professional perspectives on the OUTDOOR intervention after hip fracture (Fragility Fracture Network, Porto 2025) 

Sub-study:  

The Royal Osteoporosis Society provided a small grant to enable objective physical activity data collection during the OUTDOOR study. This allowed for better measurement of how much physical activity people do (and where).

Who was involved

Study Lead: Katie J Sheehan, Bone & Joint Health, QMUL 
Study co-lead: Emma Godfrey, Kings College London  

We worked with patients and carers from TROOP to plan and deliver the study. They helped us develop materials on the study findings which were shared with patients and the public.    

Study collaborators: 

Denise Bastas, Bone & Joint Health, QMUL 
Siobhan Creanor, University of Exeter 
Claire Hulme, University of Exeter 
Sallie Lamb, University of Exeter 
Finbarr C. Martin, Kings College London 
Catherine Sackley, University of Nottingham 
Toby O Smith, University of Warwick 
Philip Bell, PPI representative from TROOP 
Melvyn Hillsdon, University of Exeter  
Heather Cook, University of Exeter 
James Connors, University of Exeter 
Carina Carter, Bone & Joint Health, QMU