{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:16:47Z","timestamp":1760059007199,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,11]],"date-time":"2025-05-11T00:00:00Z","timestamp":1746921600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ZENKYOREN (National Mutual Insurance Federation of Agricultural Cooperatives)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: The aging population in Japan has led to an increase in traffic accidents involving elderly drivers, highlighting the need for measures to enhance driving safety. Post-total knee arthroplasty (TKA) patients must regain their driving ability to maintain independence; however, clear guidelines for driving resumption are lacking. This study assessed the movement time (MT) and brake pedal force (BPF) using a driving simulator and investigated their associations with lower limb motor function. Methods: This single-center prospective cohort study included 21 patients (mean age: 66.7 \u00b1 7.4 years) who underwent right TKA and intended to resume driving. Driving ability was assessed on postoperative day 13 using a driving simulator to measure MT and BPF. Physical function was evaluated using the following parameters: range of motion (ROM), muscle strength, gait parameters, and pain assessment. Pearson\u2019s correlation and multiple regression analyses were performed to identify significant associations. Results: MT was significantly correlated with knee extension strength (r = \u22120.56, p = 0.02) and walking ratio (r = 0.55, p = 0.03). BPF was significantly correlated with walking ratio (r = 0.52, p = 0.04) and pain levels VAS (r = \u22120.54, p = 0.02). Multiple regression analysis identified walking ratio (\u03b2 = 0.54, p = 0.02) as a significant predictor of MT. For BPF, significant predictors included walking ratio (\u03b2 = 0.49, p = 0.03) and VAS (\u03b2 = \u22120.54, p = 0.02). Discussion: The findings of this study suggest that MT is associated with walking ratio, while BPF is significantly associated with both walking ratio and VAS scores. In particular, walking ratio was found to have a significant impact on both MT and BPF, indicating that it may be an important factor influencing postoperative driving performance. Conclusion: Improvement in the walking ratio and pain management affect accelerator and brake operation during driving after TKA.<\/jats:p>","DOI":"10.3390\/life15050768","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T09:26:48Z","timestamp":1747128408000},"page":"768","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Relationship Between Driving Performance and Lower Limb Motor Function After Total Knee Arthroplasty Using a Driving Simulator: A Pilot Study on Elucidating Factors Influencing Accelerator and Brake Operations"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9781-7559","authenticated-orcid":false,"given":"Kazuya","family":"Okazawa","sequence":"first","affiliation":[{"name":"Department of Rehabilitation, Kyushu University Hospital, Fukuoka 812-8582, Japan"},{"name":"Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata 990-2212, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6302-2539","authenticated-orcid":false,"given":"Satoshi","family":"Hamai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6715-4886","authenticated-orcid":false,"given":"Tsutomu","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Kyushu University Hospital, Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Nasu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Kyushu University Hospital, Fukuoka 812-8582, Japan"},{"name":"Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata 990-2212, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9229-6205","authenticated-orcid":false,"given":"Shinya","family":"Kawahara","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuharu","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitoshi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata 990-2212, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0155-3873","authenticated-orcid":false,"given":"Hiromi","family":"Fujii","sequence":"additional","affiliation":[{"name":"Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata 990-2212, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9983-474X","authenticated-orcid":false,"given":"Hiroshi","family":"Katoh","sequence":"additional","affiliation":[{"name":"Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata 990-2212, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"295","DOI":"10.2188\/jea.JE20230217","article-title":"Revisiting Older Drivers\u2019 Risks of At-fault Motor Vehicle Collisions in Japan","volume":"34","author":"Ichikawa","year":"2024","journal-title":"J. Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1016\/j.apmr.2014.03.009","article-title":"Influence of left- and right-side total hip arthroplasty on the ability to perform an emergency stop while driving a car","volume":"95","author":"Jordan","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3213","DOI":"10.1007\/s00167-020-06105-2","article-title":"Reaction time and brake pedal force after total knee replacement: Timeframe for return to car driving","volume":"29","author":"Kirschbaum","year":"2021","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1111\/ggi.13915","article-title":"Brake time is correlated with lower extremity strength, dynamic balance and low-contrast sensitivity in unpredictable driving situations in elderly drivers compared with young drivers: A cross-sectional study","volume":"20","author":"Park","year":"2020","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.exger.2016.09.006","article-title":"Muscle strength, postural balance, and cognition are associated with braking time during driving in older adults","volume":"85","author":"Alonso","year":"2016","journal-title":"Exp. Gerontol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.arth.2017.08.012","article-title":"Braking Time Following Total Knee Arthroplasty: A Systematic Review","volume":"33","author":"Hartman","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.joca.2007.12.013","article-title":"OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines","volume":"16","author":"Zhang","year":"2008","journal-title":"Osteoarthr. Cartil."},{"key":"ref_8","unstructured":"Uchio, Y., Ishijima, M., Ikeuchi, M., Ikegawa, S., Ishibashi, Y., Omori, G., Shiba, N., Takeuchi, R., Tanaka, S., and Tsumura, H. (2023). Japanese Orthopaedic Association (JOA) Clinical Practice Guidelines on the Management of Osteoarthritis of the Knee, Nankodo."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.knee.2021.03.013","article-title":"Doctor when can I drive? Braking response after knee arthroplasty: A systematic review & meta-analysis of brake reaction time","volume":"30","author":"Giannoudis","year":"2021","journal-title":"Knee"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Huang, H.T., Liang, J.M., Hung, W.T., Chen, Y.Y., Guo, L.Y., and Wu, W.L. (2014). Timeframe for return to driving for patients with minimally invasive knee arthroplasty is associated with knee performance on functional tests. Bmc Musculoskelet. Disord., 15.","DOI":"10.1186\/1471-2474-15-198"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/S0749-8063(00)90028-8","article-title":"Measurement of Brake Response Time After Right Anterior Cruciate Ligament Reconstruction","volume":"16","author":"Gotlin","year":"2000","journal-title":"Arthrosc. J. Arthrosc. Relat. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s001670050192","article-title":"Driving reaction time after right knee arthroscopy","volume":"8","author":"Hau","year":"2000","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"696","DOI":"10.5435\/JAAOS-21-11-696","article-title":"Driving after orthopaedic surgery","volume":"21","author":"Marecek","year":"2013","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1097\/PHM.0000000000000342","article-title":"Brake response time is significantly impaired after total knee arthroplasty: Investigation of performing an emergency stop while driving a car","volume":"94","author":"Jordan","year":"2015","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.apmr.2007.10.025","article-title":"The effects of task complexity on brake response time before and after primary right total knee arthroplasty","volume":"89","author":"Marques","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1302\/0301-620X.76B5.8083265","article-title":"Driver reaction times after total knee replacement","volume":"76","author":"Spalding","year":"1994","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1080\/10749357.2023.2235797","article-title":"Evaluation of driving fitness using driving simulators in patients with right-hemisphere damage: An unmatched case-control study","volume":"31","author":"Sotokawa","year":"2024","journal-title":"Top. Stroke Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/15389588.2025.2468272","article-title":"A study on brake-accelerator reaction times in elderly patients after artificial knee joint and hip joint replacement surgery","volume":"26","author":"Kagino","year":"2025","journal-title":"Traffic Inj. Prev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.knee.2008.02.008","article-title":"Does the brake response time of the right leg change after left total knee arthroplasty? A prospective study","volume":"15","author":"Marques","year":"2008","journal-title":"Knee"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1177\/1120700020936635","article-title":"Effect of total hip arthroplasty on brake reaction time and braking force","volume":"32","author":"Backer","year":"2022","journal-title":"Hip Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1007\/s00221-022-06330-w","article-title":"Sex differences in cognitive-motor components of braking in older adults","volume":"240","author":"Patel","year":"2022","journal-title":"Exp. Brain Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lodha, N., Patel, P., Casamento-Moran, A., and Christou, E.A. (2022). Motor Training After Stroke: A Novel Approach for Driving Rehabilitation. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.752880"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jbmt.2020.11.021","article-title":"Smartphone goniometer has excellent reliability between novice and experienced physical therapists in assessing knee range of motion","volume":"25","author":"Mehta","year":"2021","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/j.jelekin.2013.09.004","article-title":"Validity and reliability of isometric, isokinetic and isoinertial modalities for the assessment of quadriceps muscle strength in patients with total knee arthroplasty","volume":"23","author":"Lienhard","year":"2013","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"443","DOI":"10.2114\/jpa2.26.443","article-title":"Potentiation of Knee Extensor Contraction by Antagonist Conditioning Contraction at Several Intensities","volume":"26","author":"Kamimura","year":"2007","journal-title":"J. Physiol. Anthropol."},{"key":"ref_26","first-page":"99","article-title":"Agreement between two walking speeds measured by different walkway lengths: Comparison between 5- and 2.4-m walkways","volume":"9","author":"Kamide","year":"2018","journal-title":"J. Clin. Gerontol. Geriatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"23094990211010522","DOI":"10.1177\/23094990211010522","article-title":"The impact of sagittal imbalance on walking in patients with lumbar spinal canal stenosis","volume":"29","author":"Murata","year":"2021","journal-title":"J. Orthop. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1111\/ggi.13102","article-title":"Fear of falling and gait parameters in older adults with and without fall history","volume":"17","author":"Makino","year":"2017","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.arth.2016.11.045","article-title":"OBTAIN A: Outcome Benefits of Tranexamic Acid in Hip Arthroplasty. A Randomized Double-Blinded Controlled Trial","volume":"32","author":"Fraval","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/00002508-199103000-00053","article-title":"The Tampa Scale: A Measure of Kinisophobia","volume":"7","author":"Miller","year":"1991","journal-title":"Clin. J. Pain"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1037\/0033-2909.112.1.155","article-title":"A power primer","volume":"112","author":"Cohen","year":"1992","journal-title":"Psychol. Bull."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1136\/jisakos-2018-000268","article-title":"Early resumption of driving within 3 weeks following patient-specific instrumented total knee arthroplasty: An evaluation of 160 cases","volume":"4","author":"Nizam","year":"2019","journal-title":"J. Isakos"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1007\/s00167-014-3212-1","article-title":"Recovery in knee range of motion reaches a plateau by 12 months after total knee arthroplasty","volume":"23","author":"Zhou","year":"2015","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1007\/s00402-021-03869-1","article-title":"High range of motion in the first ten postoperative days after TKA does not predict superior outcome in the long run","volume":"142","author":"Koglberger","year":"2022","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1298\/ptr.E9996","article-title":"Importance of knee flexion range of motion during the acute phase after total knee arthroplasty","volume":"23","author":"Oka","year":"2020","journal-title":"Phys. Ther. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"210","DOI":"10.2522\/ptj.20110124","article-title":"Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: A randomized controlled trial","volume":"92","author":"Balter","year":"2012","journal-title":"Phys. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1002\/acr.22825","article-title":"Efficacy of Preoperative Progressive Resistance Training on Postoperative Outcomes in Patients Undergoing Total Knee Arthroplasty","volume":"68","author":"Skoffer","year":"2016","journal-title":"Arthritis Care Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2864","DOI":"10.1007\/s00167-016-3985-5","article-title":"High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: A randomized controlled trial","volume":"25","author":"Calatayud","year":"2017","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.gaitpost.2018.08.030","article-title":"Association of walk ratio during normal gait speed and fall in community-dwelling elderly people","volume":"66","author":"Nakakubo","year":"2018","journal-title":"Gait Posture"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2989","DOI":"10.1007\/s40520-021-01832-z","article-title":"Estimate of gait speed by using persons\u2019 walk ratio or step-frequency in older adults","volume":"33","author":"Lindemann","year":"2021","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/S0966-6362(02)00159-5","article-title":"Acceleration patterns of the head and pelvis when walking on level and irregular surfaces","volume":"18","author":"Menz","year":"2003","journal-title":"Gait Posture"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.knee.2023.06.002","article-title":"A multimodal intraosseous infusion of morphine and ketorolac decreases early postoperative pain and opioid consumption following total knee arthroplasty","volume":"43","author":"McNamara","year":"2023","journal-title":"Knee"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1302\/0301-620X.101B1.BJJ-2018-0672.R1","article-title":"The influence of preoperative psychological distress on pain and function after total knee arthroplasty: A systematic review and meta-analysis","volume":"101-B","author":"Sorel","year":"2019","journal-title":"Bone Jt. J."},{"key":"ref_44","first-page":"241","article-title":"The invariant relationship between step length and step rate during free walking","volume":"30","author":"Sekiya","year":"1996","journal-title":"J. Hum. Mov. Stud."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/0304-3959(94)00279-N","article-title":"Fear of movement\/(re)injury in chronic low back pain and its relation to behavioral performance","volume":"62","author":"Vlaeyen","year":"1995","journal-title":"Pain"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/5\/768\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:30:58Z","timestamp":1760031058000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/5\/768"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,11]]},"references-count":45,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["life15050768"],"URL":"https:\/\/doi.org\/10.3390\/life15050768","relation":{},"ISSN":["2075-1729"],"issn-type":[{"type":"electronic","value":"2075-1729"}],"subject":[],"published":{"date-parts":[[2025,5,11]]}}}