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The Importance of Cognitive Executive Functions in Gait Recovery After Total Hip Arthroplasty

Published:January 06, 2020DOI:https://doi.org/10.1016/j.apmr.2019.12.004

      Abstract

      Objective

      To determine the influence of cognitive functioning on gait recovery after total hip arthroplasty.

      Design

      Prospective cohort study.

      Setting

      Rehabilitation hospital.

      Participants

      Patients (N=40) who underwent a total hip arthroplasty, with normal cognitive functioning and without any other relevant medical condition, were recruited and studied before surgery and at the beginning and the end of the rehabilitation program.

      Main Outcome Measures

      Gait speed (10-Meter Walk Test [10MWT]) and gait functional mobility (Timed Up and Go [TUG] test), measured at the time of discharge from the rehabilitation unit, were the primary outcomes. The candidate predictors were the cognitive and psychological variables collected in the presurgery phase, together with other potentially informative measures such as age, education, perceived pain, body mass index, presurgical gait speed and functional mobility.

      Results

      Our results suggest the existence of a direct relationship between cognitive functioning, with specific reference to high-level frontal executive functions, and the postoperative gait progress: the better the cognitive functioning in the preoperative phase, the better the course of recovery in terms of gait speed and functional mobility.
      In particular, the performance of the Frontal Assessment Battery test, together with age, perceived pain. Presurgical gait speed and functional mobility, was the best predictor of recovery of walking measured by 10MWT and TUG.

      Conclusions

      The present study highlights the importance of cognitive functioning, together with clinical and demographic features, in the postsurgical recovery of walking, even in the absence of cognitive decline.
      In particular, these data show the crucial role of higher-order cognitive processes, such as executive functions, involved in the formulation of motor plans and their integration with proprioceptive and visual cues.

      Keywords

      List of abbreviations:

      10MWT (10-Meter Walk Test), AIC (Akaike information criterion), BDI (Beck Depression Inventory), DSB (Digit Span Backward), FAB (Frontal Assessment Battery), MMSE (Mini-Mental State Examination), STAI-X (State-Trait Anxiety Inventory), THA (total hip arthroplasty), TUG (timed Up and Go), VAS (visual analog scales)
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