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

Table 1 Observational evidence linking sense of coherence to recovery-relevant outcomes in hip-fracture and older-adult cohorts

Ref.	Population and setting	Design and SOC measure	Outcome(s)	Key finding (direction)	Notes
Wu et al[1], 2025	Intertrochanteric femoral fracture; postoperative inpatients	Cross-sectional; SOC (instrument per paper)	PTG; Hospital Anxiety and Depression Scale-A/D	Conversion between higher SOC and higher PTG; anxiety/depression inversely related to PTG	Positions psychological coherence on the recovery axis
Chen et al[11], 2022	Community-dwelling older adults (China)	Cross-sectional; 13-item SOC	Frailty (multidimensional)	Conversion between lower SOC and higher frailty	Signals broader vulnerability processes
Portegijs et al[12], 2014	Older adults with hip-fracture history undergoing progressive resistance training	Prospective training cohort; SOC (baseline)	Adherence; gains in strength, mobility, balance	Higher SOC transform into better adherence and larger functional gains	Behavioral relevance for day-to-day rehab
Gadhvi et al[2], 2023	Hip-fracture survivors (systematic review)	Systematic review	Fear of falling and related constructs	Fear of falling common; associated with worse function	Companion risk aligned with low coherence patterns
Hikichi et al[8], 2023	Older disaster survivors (Japan)	Prospective outcome-wide study; SOC baseline	Multiple health and well-being outcomes	Higher pre-event SOC buffered adverse impacts	External validity for resilience role of SOC
Taylor et al[4], 2024	Hip fracture (qualitative synthesis)	Systematic review of qualitative studies	Psychosocial impacts	Psychological distress affects participation and recovery	Context for early psychosocial assessment

PTG: Post-traumatic growth; SOC: Sense of coherence.

Table 2 Sense of coherence-informed micro-bundle embedded across orthogeriatric touchpoints

Touchpoint	Primary aim [comprehensibility-manageability-meaningfulness (the three components of the Sense of Coherence framework)]	Responsible role(s)	Core actions/scripts	Escalation triggers	electronic health record documentation
Admission	Comprehensibility	Nurse	One-page care timeline; teach-back of expectations	High Hospital Anxiety and Depression Scale scores; delirium risk flags	Checklist completion; patient understanding recorded
Postoperative days 1 and 2	Manageability	Physiotherapist; nurse	Specific, measurable, achievable, relevant, and time-bound (framework for goal setting) goals; graded mobilization; brief pain-coping (breathing, reappraisal)	Uncontrolled pain; non-progress in mobilization	Daily goal tracking; barriers noted
Early physiotherapy	Manageability + meaningfulness	Physiotherapist; psych/social work	Progressive activity plan; values-based reframing; micro-acts	Low engagement; mood deterioration	Session notes with goal attainment scaling
Discharge education	Comprehensibility + meaningfulness	Nurse; psych/social work	Frequently asked questions sheet; warning signs; community resources; narrative “next steps”	Incomplete self-management plan	Discharge checklist; referrals logged

Psych/social work: Psychology or social work (clinical liaison roles within orthogeriatric care).

Table 3 Near-term research priorities and suggested study designs

Question	Hypothesized mechanism/effect	Design archetype	Sample/setting	Primary outcome(s)	Notes
Mediation: Do early SOC gains drive later mood/mobilization	SOC (increase) transform into HADS (reduce) transform into earlier mobilization	Longitudinal cohort + mediation models	Orthogeriatric wards; n ≥ 300	Indirect effect (SOC transform into HADS transform into time to mobilization)	Adjust for multimorbidity/SES/activity
Moderation: Who benefits most	Effect sizes larger in low-SES, multimorbidity, low activity	Pre-specified subgroup analyses	Routine care registry or stepped-wedge cluster randomized trial	Interaction terms	Equity-focused tailoring
Component efficiency	Full bundle not always needed	Factorial or specific, measurable, achievable, relevant, and time-bound (framework for goal setting) trial	Busy wards; pragmatic recruitment	SOC-13 change; length of Stay	Identify minimal effective package
Durability and maintenance	Structured boosters sustain SOC gains	Adaptive follow-up schedule trial	Post-discharge tele-contacts	SOC-13 at 12-24 weeks	Balance burden vs benefit
Implementation and cost	Feasible at scale with fidelity	Hybrid effectiveness-implementation	Multi-site rollout	Reach, adoption, fidelity, time-motion costs	Inform scale-up decisions

HADS: Hospital Anxiety and Depression Scale; SES: Socioeconomic status; SOC: Sense of coherence; SOC-13: 13-item Sense of Coherence Scale.