Harnessing psychological resilience in hip fracture recovery: The overlooked role of sense of coherence

Abstract

Hip fracture recovery hinges on more than fixation and early mobilization; patients’ capacity to interpret the event, regulate emotions, and re-engage with valued roles is equally decisive. Sense of coherence (SOC) - comprising comprehensibility, manageability, and meaningfulness - offers a concise resilience lens that connects perioperative education, symptom self-management, and values-based rehabilitation. Converging evidence links stronger SOC with lower anxiety/depression and greater post-traumatic growth, suggesting an underused lever for improving both psychological and functional trajectories. This article synthesizes conceptual and clinical signals around SOC in orthogeriatric care and outlines a practical pathway to integrate it without adding burden: (1) Plain-language mapping of the care timeline to strengthen comprehensibility; (2) Brief goal-setting, graded activity, and pain-coping skills to enhance manageability; and (3) Narrative reframing plus small prosocial actions to cultivate meaningfulness. Routine tracking with the 13-item Sense of Coherence Scale, the Hospital Anxiety and Depression Scale, and the Post-Traumatic Growth Inventory can be paired with pragmatic endpoints - time-to-mobilization, length of stay, and 90-day events - to evaluate feasibility and impact. Positioning SOC as a modifiable resilience target may help bridge psychology and rehabilitation in standard hip-fracture pathways and yield measurable gains in emotional recovery and participation.

Keywords: Adaptation psychological; Anxiety; Depression; Geriatrics; Hip fractures; Orthopedic procedures; Patient-reported outcome measures; Perioperative care; Rehabilitation; Sense of coherence

Core Tip: Sense of coherence provides an actionable resilience framework for hip fracture recovery: Making care comprehensible (simple timelines and expectations), manageable (brief goals, graded activity, pain-coping), and meaningful (values-based reframing and micro-acts) can be embedded into routine ortho-geriatric workflows. Tracking 13-item Sense of Coherence Scale, Hospital Anxiety and Depression Scale, Post-Traumatic Growth Inventory alongside mobilization time, length of stay, and short-term readmissions enables low-burden evaluation and supports iterative improvement in both psychological and functional outcomes.