Objective: To scope Dual-Task Training (DTT) intervention types, combinations, reported superiority of task type and participants’ perspectives of DTT, along with balance outcome measures that have been used to evaluate effectiveness in the literature to date.

Background: Balance dysfunction is a frequently encountered problem for people with Parkinson’s Disease (PD) with mild to moderate disease severity [1]. This impacts upon many activities of daily life involving a bipedal upright position at both functional and participation levels. Reports suggest that DTT is a physiotherapy approach that can effectively improve balance [2]. To inform the development of physiotherapy guidelines, the availability of evidence regarding DTT parameters and superiority need to be scoped.

Method: A protocol based on the PRISMA Extension for Scoping Reviews [3] fully details the methods [4]. Keywords and index terms were identified in a search of PubMed and CINAHL before conducting a structured search strategy of text words (PubMed, CINAHL, MEDLINE databases, OpenGrey and Google Scholar). At the full-text screen stage, reference lists were searched for additional studies. Three reviewers independently screened the titles and abstracts of articles against inclusion and exclusion criteria and analysed eligible full text articles, two extracted data and conducted narrative charting.

Results: 31 articles (of 189 screened) met the criteria for inclusion in the review; 4 systematic reviews, 12 RCTs, 14 non-powered clinical trials and a qualitative study. There is no standard defined approach for DTT evident in the literature: DTT varies in terms of task types, combinations and progression and interventions involve a range of frequencies, session and course durations. The most frequently cited balance outcome measure is the Mini-BESTest [5] but over 20 different primary measures are reported in clinical trials to date. Only one study explores participants’ perceptions of DTT. Only one study specifically examines the superiority of DTT types relative to balance.

Conclusion: Further qualitative studies are needed to explore participants’ perceptions of DTT. There is a clear need for superiority studies using feasible and acceptable RCT designs to determine optimal effectiveness of DTT protocols to guide evidence-based practice.

References: [1] Hoehn, M. M., & Yahr, M. D. (1967). Parkinsonism: onset, progression and mortality. Neurology, 17(5), 427-442. doi:10.1212/wnl.17.5.427, [2] De Freitas Tb Ms, P. T., Leite, P. B., Dona F PhD, P. T., Pompeu Je PhD, P. T., Swarowsky A PhD, P. T., & Torriani-Pasin C PhD, P. T. (2018). The effects of dual task gait and balance training in Parkinson’s disease: a systematic review. Physiother Theory Pract, 1-9. doi:10.1080/09593985.2018.1551455, [3] Tricco A, Lillie E, Zarin W et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467. doi:10.7326/m18-0850, [4] Cakmak N., Logan A., Freeman J., Carroll C., Bunn L. Dual-task training interventions and outcome measurements for bipedal upright balance rehabilitation in people with mild to moderate Parkinson’s disease: A scoping review of the literature. Center for Open Science website. August 19, 2020. Accessed January 10, 2021. https://osf.io/rbvu2/, [5] Leddy A, Crowner B, Earhart G. Utility of the Mini-BESTest, BESTest, and BESTest Sections for Balance Assessments in Individuals With Parkinson Disease. Journal of Neurologic Physical Therapy. 2011;35(2):90-97. doi:10.1097/npt.0b013e31821a620c.

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