The Association Between Psychological Resilience and Physical Function Among Older Adults With Hip Fracture Surgery.



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


Single-center observational study.



Setting and participants

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


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.


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.





Published Version (Please cite this version)


Publication Info

Lim, Ka Keat, David B Matchar, Chuen Seng Tan, William Yeo, Truls Østbye, Tet Sen Howe and Joyce SB Koh (2020). The Association Between Psychological Resilience and Physical Function Among Older Adults With Hip Fracture Surgery. Journal of the American Medical Directors Association, 21(2). pp. 260–266.e2. 10.1016/j.jamda.2019.07.005 Retrieved from

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David Bruce Matchar

Professor of Medicine

My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention.
Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analysis and cost-effectiveness analysis; (2) a balancing of methodological rigor the needs of medical professionals; and (3) dependence on interdisciplinary groups of experts.
This approach is best illustrated by the Stroke Prevention Patient Outcome Research Team (PORT), for which I served as principal investigator. Funded by the AHCPR, the PORT involved 35 investigators at 13 institutions. The Stroke PORT has been highly productive and has led to a stroke prevention project funded as a public/private partnership by the AHCPR and DuPont Pharma, the Managing Anticoagulation Services Trial (MAST). MAST is a practice improvement trial in 6 managed care organizations, focussing on optimizing anticoagulation for individuals with atrial fibrillation.
I serve as consultant in the general area of analytic strategies for clinical policy development, as well as for specific projects related to stroke (e.g., acute stroke treatment, management of atrial fibrillation, and use of carotid endarterectomy.) I have worked with AHCPR (now AHRQ), ACP, AHA, AAN, Robert Wood Johnson Foundation, NSA, WHO, and several pharmaceutical companies.
Key Words: clinical policy, disease management, stroke, decision analysis, clinical guidelines

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