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

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.