Browsing by Author "Howe, Tet Sen"

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    Systems modelling as an approach for eliciting the mechanisms for hip fracture recovery among older adults in a participatory stakeholder engagement setting.
    (Frontiers in rehabilitation sciences, 2023-01) Ansah, John Pastor; Chia, Aloysius Wei-Yan; Koh, Vanessa Jean Wen; Lai, Wei Xuan; Koh, Joyce Suang Bee; Goh, Kiat Sern; Yeo, William; Howe, Tet Sen; Seow, Dennis Chuen Chai; Mamun, Kaysar; Balasubramanian, Diraviyam; Varman, Surendra Doraiswamy; Yeo, Andy Kuei Siong; Elamin, Amal; Chan, Angelique Wei-Ming; Matchar, David Bruce

    Introduction

    Due to an aging population, the rising prevalence and incidence of hip fractures and the associated health and economic burden present a challenge to healthcare systems worldwide. Studies have shown that a complex interplay of physiological, psychological, and social factors often affects the recovery trajectories of older adults with hip fractures, often complicating the recovery process.

    Methods

    This research aims to actively engage stakeholders (including doctors, physiotherapists, hip fracture patients, and caregivers) using the systems modeling methodology of Group Model Building (GMB) to elicit the factors that promote or inhibit hip fracture recovery, incorporating a feedback perspective to inform system-wide interventions. Hip fracture stakeholder engagement was facilitated through the Group Model Building approach in a two-half-day workshop of 25 stakeholders. This approach combined different techniques to develop a comprehensive qualitative whole-system view model of the factors that promote or inhibit hip fracture recovery.

    Results

    A conceptual, qualitative model of the dynamics of hip fracture recovery was developed that draws on stakeholders' personal experiences through a moderated interaction. Stakeholders identified four domains (i.e., expectation formation, rehabilitation, affordability/availability, and resilience building) that play a significant role in the hip fracture recovery journey..

    Discussion

    The insight that recovery of loss of function due to hip fracture is attributed to (a) the recognition of a gap between pre-fracture physical function and current physical function; and (b) the marshaling of psychological resilience to respond promptly to a physical functional loss via uptake of rehabilitation services is supported by findings and has several policy implications.
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    The Association Between Psychological Resilience and Physical Function Among Older Adults With Hip Fracture Surgery.
    (Journal of the American Medical Directors Association, 2020-02) Lim, Ka Keat; Matchar, David B; Tan, Chuen Seng; Yeo, William; Østbye, Truls; Howe, Tet Sen; Koh, Joyce SB

    Objectives

    To examine the associations of prefracture psychological resilience and prefracture general mental health with physical function among older adults with hip fracture surgery.

    Design

    Single-center observational study.

    Intervention

    None.

    Setting and participants

    Patients aged ≥50 years who underwent first hip fracture surgery between January 2017 and December 2017 (N = 152).

    Methods

    We used data collected prospectively from the hospital's hip fracture registry. We performed generalized estimating equations to examine the associations of prefracture psychological resilience (10-item Connor-Davidson Resilience Scale) and prefracture general mental health (Short Form-36 mental health subscale) with physical function (Short Form-36 physical functioning subscale) at 4 time points-prefracture (based on recall), and 1.5, 3, and 6 months after surgery.

    Results

    Prefracture psychological resilience had an association with physical function; a 1-unit increase in psychological resilience score was associated with 1.15 units [95% confidence interval (CI) 0.71, 1.59] higher physical function score across 4 time points. In contrast, the association between general mental health and physical function varied over time; a 1-unit increase in general mental health score was associated with 0.42 units (95% CI 0.18, 0.66) higher physical function score at prefracture, 0.02 units (95% CI -0.18, 0.22) lower at 1.5 months, 0.23 units (95% CI -0.03, 0.49) higher at 3 months, and 0.39 units (95% CI 0.09, 0.68) higher at 6 months after surgery.

    Conclusions and implications

    Psychological resilience is associated with physical function among older adults with hip fracture surgery, independent from general mental health. Our findings suggest the potential for interventions targeting psychological resilience for these patients and call for more studies on psychological factors affecting physical function recovery after hip fracture surgery.
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    The Role of Prefracture Health Status in Physical and Mental Function After Hip Fracture Surgery.
    (Journal of the American Medical Directors Association, 2018-11) Lim, Ka Keat; Yeo, William; Koh, Joyce SB; Tan, Chuen Seng; Chong, Hwei Chi; Zhang, Karen; Østbye, Truls; Howe, Tet Sen; Matchar, David Bruce

    Objectives

    To examine the associations of 3 measures of prefracture health status (physical function, mental function, and comorbidity count) with trajectories of physical and mental function at 1.5, 3, 6, and 12 months after hip fracture surgery.

    Design

    Single-center observational study.

    Setting

    Singapore General Hospital (an acute hospital).

    Participants

    Patients aged ≥60 years who underwent first hip fracture surgery between June 2011 and July 2016 (N = 928).

    Intervention

    None.

    Measurements

    We used data collected prospectively from the hospital's hip fracture registry. We used the Short Form-36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) as indicators of physical and mental function, respectively, collected at admission and at 1.5, 3, 6, and 12 months after hip fracture surgery. Comorbidity count at admission was the sum from a list of 10 common diseases associated with poorer physical function.

    Results

    Prefracture physical function and prefracture mental function demonstrated time-varying associations (interaction P < .001 and P = .001, respectively) with postfracture physical function; the associations were small initially but increased in strength up to 6 months and stabilized thereafter. In contrast, the strength of the association between comorbidity count and postfracture physical function were time-invariant (-0.52, P = .027). The strength of the associations between all 3 measures of prefracture health status and postfracture mental function were also constant over time (0.09, P = .004, for physical function; 0.38, P < .001, for mental function; -0.70, P = .034, for comorbidity count).

    Conclusions/implications

    The time-varying associations between prefracture health status and postfracture physical function suggest that even for patients with good prefracture health status, initial recovery may be slow. Our findings can be useful to clinicians and therapists in their prognostic evaluations and in management of patients' expectation for recovery.