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

Francesco Negrini; Matteo Preti; Eleonora Zirone; Daniele Mazziotti; Marco Biffi; Catia Pelosi; Giuseppe Banfi; Laura Zapparoli

doi:10.1016/j.apmr.2019.12.004

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

Arch Phys Med Rehabil. 2020 Apr;101(4):579-586. doi: 10.1016/j.apmr.2019.12.004. Epub 2020 Jan 7.

Authors

Francesco Negrini¹, Matteo Preti¹, Eleonora Zirone¹, Daniele Mazziotti¹, Marco Biffi¹, Catia Pelosi¹, Giuseppe Banfi², Laura Zapparoli³

Affiliations

¹ IRCCS Orthopedic Institute Galeazzi, Milan, Italy.
² IRCCS Orthopedic Institute Galeazzi, Milan, Italy; Vita-Salute San Raffaele University Milan, Italy.
³ IRCCS Orthopedic Institute Galeazzi, Milan, Italy. Electronic address: laura.zapparoli@grupposandonato.it.

PMID: 31917194
DOI: 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.

Trial registration: ClinicalTrials.gov NCT03624998.

Keywords: Cognition; Executive functions; Rehabilitation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthroplasty, Replacement, Hip / rehabilitation*
Cohort Studies
Exercise Test
Female
Gait Analysis*
Humans
Male
Middle Aged
Recovery of Function*
Walking Speed

Associated data

ClinicalTrials.gov/NCT03624998