Dual-Trajectory Analysis of Psychological Resilience and Frailty After Surgery in Older Patients With Osteoporotic Thoracolumbar Vertebral Compression Fractures

Abstract Objective To characterize the longitudinal trajectories of psychological resilience and frailty after surgery in older patients with osteoporotic vertebral compression fractures (OVCFs), identify joint recovery patterns and their associated factors, and provide evidence for individualized rehabilitation care. Methods In this longitudinal observational study, psychological resilience and frailty were assessed at four time points (T1-T4) after surgery. A total of 280 patients were included in the analysis. Group-based trajectory modeling (GBTM) was used to identify trajectories of psychological resilience and frailty. Group-based dual trajectory modeling (GBDTM) was then applied to characterize joint recovery patterns, and multinomial logistic regression was used to identify associated factors. Results Psychological resilience generally increased during follow-up, whereas frailty decreased. GBTM identified four psychological resilience trajectories and three frailty trajectories. Their joint distribution yielded three recovery patterns: good recovery (32.1%), intermediate recovery (47.5%), and poor recovery (20.4%). Changes in psychological resilience and frailty differed significantly across the three patterns (all P < 0.001). Older age, female sex, a greater number of comorbidities, and non-use of anti-osteoporosis medications were associated with the poor-recovery pattern, whereas the ability to live independently was protective. Conclusion Postoperative trajectories of psychological resilience and frailty are heterogeneous among older patients with OVCFs and form distinct joint recovery patterns. Patients at risk of poor recovery should be identified early, and stratified rehabilitation nursing should be guided by dynamic changes in psychological resilience and frailty to promote long-term recovery.