Motor Imagery during Action Observation of Locomotor Tasks Improves Rehabilitation Outcome in Older Adults after Total Hip Arthroplasty

Abstract

This study aimed at determining whether the combination of action observation and motor imagery (AO + MI) of locomotor tasks could positively affect rehabilitation outcome after hip replacement surgery. Of initially 405 screened participants, 21 were randomly split into intervention group (N = 10; mean age = 64 y; AO + MI of locomotor tasks: 30 min/day in the hospital, then 3×/week in their homes for two months) and control group (N = 11, mean age = 63 y, active controls). The functional outcomes (Timed Up and Go, TUG; Four Step Square Test, FSST; and single- and dual-task gait and postural control) were measured before (PRE) and 2 months after surgery (POST). Significant interactions indicated better rehabilitation outcome for the intervention group as compared to the control group: at POST, the intervention group revealed faster TUG (p = 0.042), FSST (p = 0.004), and dual-task fast-paced gait speed (p = 0.022), reduced swing-time variability (p = 0.005), and enhanced cognitive performance during dual tasks while walking or balancing (p < 0.05). In contrast, no changes were observed for body sway parameters (p ≥ 0.229). These results demonstrate that AO + MI is efficient to improve motor-cognitive performance after hip surgery. Moreover, only parameters associated with locomotor activities improved whereas balance skills that were not part of the AO + MI intervention were not affected, demonstrating the specificity of training intervention. Overall, utilizing AO + MI during rehabilitation is advised, especially when physical practice is limited.

Figure 1

CONSORT flow diagram of the PANGeA hip study, Valdoltra 2015.

Figure 2

Results from functional locomotor outcome measures (mean ± standard deviation): (a) gait speed in the fast-paced dual-task walking condition; (b) results for the Timed Up and Go test (TUG); (c) swing-time variability in the fast-paced dual-task walking condition; (d) the results for the Four Step Square Test (FSST). Note: ∗ indicates a significant change (p < 0.05) in the Bonferroni-corrected post hoc test from PRE to POST.