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

Objective: To determine the influence of cognitive functioning on gait recovery after total hip arthroplasty.<br> Design: Prospective cohort study.<br> Setting: Rehabilitation hospital.<br> Participants: Patients (NZ40) 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.<br> 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.<br> 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.<br> 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.<br> 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.<br> 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.研究目的：明确认知功能对全髋关节置换术（total hip arthroplasty）后步态恢复的影响。<br>研究设计：前瞻性队列研究。<br>研究场所：康复医院。<br>研究对象：招募接受全髋关节置换术、认知功能正常且无其他相关基础疾病的患者（NZ40），分别于术前、康复计划启动初期及康复计划结束时纳入研究并开展评估。<br>主要结局指标：以康复单元出院时测得的步态速度（10米步行试验[10-Meter Walk Test, 10MWT]）与步态功能移动能力（计时起身行走试验[Timed Up and Go, TUG]）作为主要结局指标。候选预测变量包括术前阶段收集的认知与心理变量，以及年龄、受教育程度、自觉疼痛程度、体质量指数（body mass index, BMI）、术前步态速度与功能移动能力等其他潜在信息指标。<br>研究结果：本研究结果提示，认知功能（尤其针对高级额叶执行功能）与术后步态恢复进程存在直接关联：术前认知功能越好，步态速度与功能移动能力的恢复效果越佳。<br>具体而言，额叶评估量表（Frontal Assessment Battery）测试表现结合年龄、自觉疼痛程度、术前步态速度与功能移动能力，是通过10MWT与TUG评估的步行恢复情况的最佳预测因子。<br>研究结论：本研究凸显了认知功能联合临床与人口学特征在术后步行恢复中的重要性，即便在无认知衰退的人群中亦是如此。<br>具体而言，本研究数据揭示了高阶认知过程（如执行功能（executive functions））在运动计划制定及其与本体感觉、视觉信号整合过程中的关键作用。