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. Design: Prospective cohort study. Setting: Rehabilitation hospital. Participants: 40 patients 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 functional mobility (Timed Up and Go test, TUG), 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 pre-surgery phase, together with other potentially informative measures such as age, education, perceived pain, body mass index, pre-surgical gait speed and functional mobility. Results: The results suggest the existence of a direct relationship between cognitive functioning, with specific reference to high-level frontal executive functions, and the post-operative progress: the better the cognitive functioning in the pre-operative phase, the better the course of recovery in terms of gait speed and functional mobility. In particular, the performance at the Frontal Assessment Battery test, together with age, perceived pain and pre-surgical gait speed/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 post-surgical 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.