Neurocognitive measures predict voluntary stepping performance in older adults post-hip fracture

Background: Hip fracture is a debilitating injury, especially in older adults. The purpose of this study was to determine the relationships between Trail-Making test performance and parameters of the choice stepping reaction time test in community-dwelling older adults after hip fracture. Methods: Twenty-four older adults post-hip fracture repair participated in an ancillary study for physical therapy interventions. Measures included Trail-Making test (Parts A & B) scores, movement time (time from foot liftoff to touchdown), step speed, reaction time (time from cue to foot liftoff), and total response time (time from step cue to touchdown) in the forward and lateral directions. Paired t-tests and multiple linear regressions were used for analysis. Findings: Significant differences were found in movement time, speed and reaction time between limbs in the lateral direction, and in movement and reaction time in the forward direction. Trails A predicted step speed, reaction time and total response time for the fractured limb in the lateral direction, as well as reaction time and total response time in the forward direction. However, Trails A could not predict performance for the non fractured limb. Trails B predicted stepping performance for both limbs in the forward and lateral directions. Interpretation: Trails A correlated with the fractured limb's ability to perform the choice stepping test, but not in the non-fractured limb. Meanwhile, Trails B correlated with stepping performance in both limbs, suggesting those with poorer executive function have a lower protective stepping capability and may be at a higher risk for future falls and injury.