journal article·2025-12-23Open access

Bioelectrical Impedance Parameters as Predictors of Functional Outcomes in Patients Undergoing Rehabilitation After Femoral Fracture Surgery: A Pilot Study

Stefania Toselli, Stefania Bandini, Federica Moro, Sofia Marini, Alessia Grigoletto, Sabrina Gabrielli, Angela Cappelletti, Orietta Valentini, Mario Mauro

Applied Sciences· Volume 16· Issue 1

Abstract

Elderly patients with femoral fractures need specific rehabilitation after surgery that aims to improve their self-reliance and life quality, reducing their mortality rate. Although worsening patient body composition increased the risk of an unfavourable prognosis, it remains unclear whether evaluating bioelectrical impedance analysis (BIA) parameters can predict any functional recovery. A longitudinal design was conducted on 45 elders (84.59 ± 7.18 years, 75.6% female) who underwent femoral surgery to examine BIA features as rehabilitation biomarkers. The patient’s body composition, assessed by anthropometry and bioimpedance analysis (BIA), and self-reliance were evaluated three times during follow-up in both healthy and surgical lower limbs. The ANCOVA test, adjusted for gender and side of surgery, found improvements in daily living activities, while only thigh circumferences decreased over time. Regarding the BIA, the surgical leg showed a wider decrement in bioelectrical resistance (R), whereas the bioelectric reactance (Xc) exhibited similar trends. Females who underwent surgery on their dominant leg showed significant changes (p < 0.001) in bioimpedance vectorial analysis (BIVA), with a linear trend from baseline to postoperative time, while males exhibited beneficial variations only between baseline and time 2 (p < 0.01). Geriatric patients exhibit characteristic traits that require additional attention. BIA may be a feasible and non-invasive method for monitoring patient prognosis and reducing national health system costs.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Body Composition Measurement Techniques · Nutrition and Health in Aging · Electrical and Bioimpedance Tomography

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Life Quality Sciences, University of Bologna, 47921 Rimini, Italy

AUSL Imola, 40026 Imola, Italy

Department of Medicine and Aging Sciences, University of Chieti-Pescara, 66100 Chieti, Italy

Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy

References (53)

Show source-provided references
1. Ukai, T., and Watanabe, M. (2023). Do Metal Implants for Total Hip Arthroplasty Affect Bioelectrical Impedance Analysis? A Retrospective Study. BMC Musculoskelet. Disord., 24.10.1186/s12891-023-06893-x ↗
2. Fragility Fractures in Europe: Burden, Management and Opportunities10.1007/s11657-020-0706-y ↗
3. Predicting Survival after Treatment for Fracture of the Proximal Femur and the Effect of Delays to Surgery10.1016/S0895-4356(03)00129-X ↗
4. Short-Term Changes in Body Composition after Surgical Repair of Hip Fracture
5. Dyer, S.M., Crotty, M., Fairhall, N., Magaziner, J., Beaupre, L.A., Cameron, I.D., and Sherrington, C. (2016). A Critical Review of the Long-Term Disability Outcomes Following Hip Fracture. BMC Geriatr., 16.10.1186/s12877-016-0332-0 ↗
6. Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: An Observational Study10.1007/s11606-016-3848-2 ↗
7. Change in Muscle Mass and Muscle Strength after a Hip Fracture: Relationship to Mobility Recovery10.1093/gerona/55.8.M434 ↗
8. Reduced Morbidity for Elderly Patients with a Hip Fracture after Implementation of a Perioperative Evidence-Based Clinical Pathway10.1136/qshc.2005.017095 ↗
9. Clinical Pathway after Hip Fracture10.1080/09638280500056618 ↗
10. Comparative Effectiveness of Fragility Fracture Integrated Rehabilitation Management for Elderly Individuals after Hip Fracture Surgery: A Study Protocol for a Multicenter Randomized Controlled Trial10.1097/MD.0000000000010763 ↗
11. Prediction of Postoperative Ambulatory Status 1 Year After Hip Fracture Surgery10.1016/j.apmr.2009.09.018 ↗
12. Prefracture Functional Level Evaluated by the New Mobility Score Predicts In-Hospital Outcome after Hip Fracture Surgery10.3109/17453674.2010.487240 ↗
13. Prevalence of Sarcopenia in Acute Hip Fracture Patients and Its Influence on Short-Term Clinical Outcome10.1111/ggi.12590 ↗
14. The Association between Sarcopenia and Functional Outcomes among Older Patients with Hip Fracture Undergoing In-Hospital Rehabilitation10.1007/s00198-017-3929-z ↗
15. Bioelectrical Phase Angle and Impedance Vector Analysis—Clinical Relevance and Applicability of Impedance Parameters10.1016/j.clnu.2012.05.008 ↗
16. Estimation of Skeletal Muscle Mass by Bioelectrical Impedance Analysis10.1152/jappl.2000.89.2.465 ↗
17. Validity and Reliability of Tools to Measure Muscle Mass, Strength, and Physical Performance in Community-Dwelling Older People: A Systematic Review10.1016/j.jamda.2012.10.009 ↗
18. Identifying Low Muscle Mass in Patients with Hip Fracture: Validation of Bioelectrical Impedance Analysis and Anthropometry Compared to Dual Energy X-Ray Absorptiometry10.1007/s12603-016-0686-1 ↗
19. Bioelectric Impedance Phase Angle and Body Composition10.1093/ajcn/48.1.16 ↗
20. Bioelectrical Impedance Analysis: Population Reference Values for Phase Angle by Age and Sex10.1093/ajcn/82.1.49 ↗
21. Bioelectrical Impedance Analysis—Part II: Utilization in Clinical Practice10.1016/j.clnu.2004.09.012 ↗
22. Assessment of Adult Malnutrition and Prognosis with Bioelectrical Impedance Analysis: Phase Angle and Impedance Ratio
23. Phase Angle and Mortality: A Systematic Review10.1038/s41430-018-0159-1 ↗
24. Bioelectrical Impedance Phase Angle as a Prognostic Marker in Chronic Heart Failure10.1016/j.nut.2011.11.033 ↗
25. Cutoff Percentiles of Bioelectrical Phase Angle Predict Functionality, Quality of Life, and Mortality in Patients with Cancer10.3945/ajcn.2010.29215 ↗
26. Low Phase Angle Is Correlated with Worse General Condition in Patients with Advanced Cancer10.1080/01635581.2018.1557216 ↗
27. Phase Angle and Frailty Are Important Prognostic Factors in Critically Ill Medical Patients: A Prospective Cohort Study10.1007/s12603-020-1487-0 ↗
28. New Bioelectrical Impedance Vector References and Phase Angle Centile Curves in 4367 Adults: The Need for an Urgent Update after 30 Years10.1016/j.clnu.2023.07.025 ↗
29. Can Phase Angle Determined by Bioelectrical Impedance Analysis Assess Nutritional Risk? A Comparison between Healthy and Hospitalized Subjects10.1016/j.clnu.2012.04.002 ↗
30. Liquid Phase Condensation in Cell Physiology and Disease10.1126/science.aaf4382 ↗
31. Bioelectric Impedance Phase Angle Is Associated with Hospital Mortality of Geriatric Patients10.1016/j.archger.2009.12.002 ↗
32. Kołodziej, M., Kozieł, S., and Ignasiak, Z. (2022). The Use of the Bioelectrical Impedance Phase Angle to Assess the Risk of Sarcopenia in People Aged 50 and above in Poland. Int. J. Environ. Res. Public Health, 19.10.3390/ijerph19084687 ↗
33. Phase Angle as a Predictor of Functional Outcomes in Patients Undergoing In-Hospital Rehabilitation after Hip Fracture Surgery10.1016/j.archger.2020.104060 ↗
34. Bones, Blood and Steel: How Bioelectrical Impedance Analysis Is Affected by Hip Fracture and Surgical Implants10.5617/jeb.4104 ↗
35. Comparative Outcomes of Inpatient Fragility Fracture Intensive Rehabilitation Management (FIRM) after Hip Fracture in Sarcopenic and Non-Sarcopenic Patients: A Prospective Observational Study10.1007/s41999-018-0089-4 ↗
36. Influence of Localized Edema on Whole-Body and Segmental Bioelectrical Impedance10.1016/j.nut.2008.02.009 ↗
37. A New Method for Monitoring Body Fluid Variation by Bioimpedance Analysis: The RXc Graph10.1038/ki.1994.305 ↗
38. New Frontiers of Body Composition in Sport10.1055/a-1373-5881 ↗
39. (2025, May 13). Valutazione Antropometrica in Clinica, Riabilitazione e Sport: Cagnazzo, Francesco, Cagnazzo, Raffaele: Amazon.It: Books. Available online: https://www.amazon.it/Valutazione-antropometrica-clinica-riabilitazione-sport/dp/8870513297.
40. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity10.1111/j.2047-6310.2012.00064.x ↗
41. Segmental Bioelectrical Impedance Analysis: Theory and Application of a New Technique10.1152/jappl.1994.77.1.98 ↗
42. Iterative weighted least-squares estimates in a heteroscedastic linear regression model10.1016/S0378-3758(01)00285-3 ↗
43. Calculating confidence intervals for relative risks (odds ratios) and standardised ratios and rates10.1136/bmj.296.6632.1313 ↗
44. Missing repeated measures data in clinical trials10.1093/nop/npab043 ↗
45. Body Fat Distribution and Noncommunicable Diseases in Populations: Overview of the 2008 WHO Expert Consultation on Waist Circumference and Waist-Hip Ratio10.1038/ejcn.2009.139 ↗
46. Ishimoto, R., Mutsuzaki, H., Shimizu, Y., Takeuchi, R., Matsumoto, S., and Hada, Y. (2024). Association between Sarcopenia and Balance in Patients Undergoing Inpatient Rehabilitation after Hip Fractures: A Retrospective Cohort Study. Medicina, 60.10.3390/medicina60050742 ↗
47. Clinical Effects of Low Body Mass Index on Geriatric Status in Elderly Patients10.1016/j.exger.2018.05.017 ↗
48. Underweight Is an Important Predictor for Functional Impairment among the Older Adults in Urban West Bengal, India: A Cross Sectional Analytical Study10.4103/jfmpc.jfmpc_1824_21 ↗
49. Mortality after Distal Femur Fractures in Elderly Patients10.1007/s11999-010-1530-2 ↗
50. The pathomechanism of posttraumatic oedema of the lower limbs: II—Changes in the lymphatic system10.1097/01.TA.0000064463.46924.9D ↗
51. Comparison of Bioimpedance Analysis and Dual-Energy x-Ray Absorptiometry Body Composition Measurements in Peritoneal Dialysis Patients According to Edema10.5414/CN107693 ↗
52. Multicomponent Models in Body Composition Research: Opportunities and Pitfalls10.1007/978-1-4899-1268-8_10 ↗
53. Lorenzo, I., Serra-Prat, M., and Carlos Yébenes, J. (2019). The Role of Water Homeostasis in Muscle Function and Frailty: A Review. Nutrients, 11.10.3390/nu11081857 ↗