AIM: To test the hypothesis that hip fracture patients who receive occupational therapy (OT) have better functional ability than those who do not. METHODS: This retrospective observational study utilized data from the Japan Rehabilitation Database spanning 2005-2015. In-hospital hip fracture patients admitted to acute hospitals were identified. In total, 1266 patients were eligible based on the exclusion criteria. The primary outcome was motor Functional Independence Measure (FIM) efficiency. RESULTS: Patients who received OT were 50.9% of hip fracture patients. Patients who received OT had significantly higher scores in motor FIM efficiency (mean 0.79 vs 0.70; P = 0.02) and FIM effectiveness (mean 0.49 vs 0.41; P < 0.01) than the patients who did not receive OT. From multivariate linear regression analysis, OT was identified as a significant factor in motor FIM efficiency (coefficient 1.29, 95% confidence interval 1.14-1.47; P < 0.01) and FIM effectiveness (coefficient 1.07, 95% confidence interval 1.02-1.12; P < 0.01). CONCLUSIONS: The present cohort analysis showed that OT for hip fracture patients in the acute phase likely contributes to improved functional ability. Geriatr Gerontol Int 2019; 19: 611-615.