Background Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) may impede rehabilitation after hip fracture. An updated systematic review to synthesize the existing literature on FoF after hip fracture is needed.

Aim This study aims to review and synthesize existing literature to answer four research questions about the 1.) prevalence of FoF, 2.) psychometric properties of measurement instruments, 3.) association with physical function, and 4.) effectiveness of interventions in reducing FoF, in hip fracture patients.

Methods A systematic electronic search was undertaken in the EBSCO Health, Scopus and PsychINFO databases in January 2021 for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The methodological quality of the studies was critically appraised using the ‘Risk of Bias Tool for Prevalence Studies’, ‘COSMIN Risk of Bias checklist for Patient-reported outcome measures’, modified version of the ‘Appraisal Tool for Cross-sectional studies’, and the ‘Cochrane Risk of Bias 2’ tools for each research question, respectively.

Results 35 articles (34 studies) with 3809 participants were included. Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and the prevalence tended to decrease as time progressed post hip fracture. The ‘Falls Efficacy Scale – International’ (FES-I) and ‘Fear of Falling Questionnaire – Revised’ (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture. Motivational interviewing and accelerated/ supported discharge with home based rehabilitation may have some impact on FoF, however, more high quality trials are needed to confirm this finding. Overall, there was insufficient evidence to conclude about the effectiveness of interventions in reducing FoF after hip fracture.

Conclusion The literature on FoF after hip fracture has grown in the last decade. FoF is prevalent after hip fracture and is associated with poorer physical function. Only two instruments have been validated for measuring FoF in the hip fracture population. However, there is a need for more robust and larger studies to guide clinical practice regarding interventions to address FoF after hip fracture.