The Effect of 2 Different Dual-Task Balance Training Methods on Balance and Gait in Older Adults: A Randomized Controlled Trial

What are the hidden shortcomings of balance training research in older adults that prevent its transfer into practice? Scoping review

BACKGROUND

Although a lot of attention is paid to the flaws of balance training research in older adults, the low methodological quality and incomplete reporting of studies still limit the knowledge transfer between research and practice. These known shortcomings are considered also as barriers for creating recommendations for balance training in older adults. Despite the considerable efforts to improve the scientific quality of studies, such recommendations have not yet been formulated to date. Therefore, this scoping review aims (1) to analyze the literature that addresses balance training in older adults, (2) to identify and summarize gaps in the existing literature, and (3) to propose future research on this topic.

METHODS

We focused on studies that evaluated the effect of balance training on balance control in apparently healthy older adults over 60 years of age.

RESULTS

Out of 6910 potentially relevant studies, only 26 met the eligibility criteria. The identified shortcomings were as follows: missing a priori criteria for training session attendance and leisure-time physical activities, insufficiently described exercises and training load, and inappropriately chosen tests.

CONCLUSIONS

Among the shortcomings of the balance training research, the insufficiently described balance training program and inappropriately chosen tests can be considered the most important. For this reason, even with an excellently designed experiment, it is almost impossible for practitioners to apply the results of such studies into practice. Therefore, researchers should pay more attention to possible users of the acquired knowledge, which is more than desirable in the case of exercise programs for older adults.

Effects of nurse-led cognitive-motor dual-task training based on mobile health technology on the older adults with cognitive frailty: A quasi-experimental study

OBJECTIVE

To evaluate the feasibility and effect of nurse-led cognitive-motor dual-task training based on mobile health technology in people with cognitive frailty and investigate its potential for transforming practice in this population.

METHODS

From September 2021 to May 2022, a total of 74 older adults with cognitive frailty were screened at a Cognitive Memory Clinic of a tertiary hospital in Beijing. The control and intervention groups received health education related to cognitive frailty; additionally the intervention group received cognitive-motor dual-task training based on mobile health technology at home for 12 weeks, three times a week. At baseline (T0), post-intervention (T1) and one-year follow-up (T2), Montreal Cognitive Assessment-Peking version (MoCA-P), Fried Frailty phenotype (FP), Short Physical Performance Battery (SPPB), and Modified Fall Efficacy Scale (MFES) were employed to evaluate cognitive function, frailty, physical function, and fear of falling, and to assess the impact of cognitive-motor dual-task training on these measures.

RESULTS

The data collected for 65 out of 74 participants enrolled for the study was completed after 12 weeks intervention, including 34 participants in the control group and 31 participants in the intervention group. During the intervention, the majority (83.8 %) of the participants in the intervention group were able to complete the recommended intervention dose for 12 weeks under the guidance of nurses and the presence of caregivers. At the end of the 12-week intervention, the intervention group showed statistically significant improvements compared to the control in scores of MoCA-P (t=4.017, p<0.001), FP (t=3.739, p<0.001), MFES (t=4.283, p<0.001) and SPPB (t=3.548, p<0.001). At after one-year follow-up, the scores of MoCA-P (t=3.237, p<0.05), FP(t=3.725, p<0.001), and MFES (t=4.473, p<0.001) in the two groups remained statistically significant. Cognition, frailty and fear of falling were significantly affected by intergroup effects (Pgroup<0.05), time effects (Ptime<0.05) and interaction effects (Pgroup*time<0.001).

CONCLUSIONS

The cognitive-motor dual-task training program based on mobile health technology developed by nurses exhibited high feasibility and acceptability in older people with cognitive frailty. The intervention was found to significantly improve cognitive function, frailty, physical function, and fear of falling in older individuals with cognitive frailty, and showed a specific long-term maintenance effect. This study provides evidence for the promotion and application of mobile health technology, and serves as a practical basis for home health intervention for older individuals in the post-pandemic era.

Benefits of a Dual-Task Training on Motor and Cognitive Functions in Community-Dwelling Older Adults: A Controlled Clinical Trial

OBJECTIVE

The aim of the study is to verify the effects of a 3-mo dual-task training on motor and cognitive functions in community-dwelling older adults.

DESIGN

In this prospective, single-blinded, controlled clinical trial, a total of 40 participants were allocated to either the experimental or the control (no-exercise) group. The intervention program consisted of a combination of motor and cognitive exercises conducted twice a week on nonconsecutive days. The main outcome measures were postural stability, mobility, fear of falling, and cognitive functions. Multiple analyses of variance were used to assess the impact of the dual-task training. Effect sizes (η 2 p) were reported. Significance was set at 5%.

RESULTS

Compared with the control group, participants who underwent the dual-task training showed positive outcomes in terms of postural stability (η 2 p = 0.298, P = 0.020), mobility (η 2 p = 0.285, P = 0.003), and cognitive functions (η 2 p = 0.536, P = 0.001). No significant differences were observed between the groups in terms of the fear of falling ( P = 0.566).

CONCLUSIONS

Three-month dual-task training was beneficial for postural control, mobility, and cognitive functions in community-dwelling older adults. Based on the present findings, healthcare professionals should consider incorporating dual-task training into clinical practice.

Uncorking the limitation-improving dual tasking using transcranial electrical stimulation and task training in the elderly: a systematic review

Introduction

With aging, dual task (DT) ability declines and is more cognitively demanding than single tasks. Rapidly declining DT performance is regarded as a predictor of neurodegenerative disease. Task training and non-invasive transcranial electrical stimulation (tES) are methods applied to optimize the DT ability of the elderly.

Methods

A systematic search was carried out in the PUBMED, TDCS (transcranial direct current stimulation) databases, as well as Web of Science, and a qualitative analysis was conducted in 56 included studies. Aiming to summarize the results of studies that implemented tES, task training, or the combination for improving DT ability and related performance changes in healthy elderly and geriatric patients. For different approaches, the training procedures, parameters, as well as outcomes were discussed.

Results

Task training, particularly cognitive-motor DT training, has more notable effects on improving DT performance in the elderly when compared to the neuromodulation method.

Discussion

Anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (L-DLPFC), or its combination with task training could be promising tools. However, additional evidence is required from aged healthy people and patients, as well as further exploration of electrode montage.

Trials and tribulations of transparency related to inconsistencies between plan and conduct in peer-reviewed physiotherapy publications: A methodology review

RATIONALE

The physiotherapy profession strives to be a leader in providing quality care and strongly recognizes the value of research to guide clinical practice. Adherence to guidelines for research reporting and conduct is a significant step towards high-quality, transparent and reproducible research.

AIM/OBJECTIVE

Assess integrity between planned and conducted methodology in randomized controlled trials (RCTs) and systematic reviews (SRs) published in physiotherapy journals.

METHODS

Eighteen journals were manually searched for RCTs and SRs published from 1 July 2021 through 31 December 2021. Studies were included if the journal or specific study was indexed in PubMed and published/translated in English. Descriptive statistics determined congruence between preregistration data and publication.

RESULTS

Forty RCTs and 68 SRs were assessed. Forty-three SRs included meta-analysis (MA). Of the 34 registered RCTs, 7 (20.6%) had no discrepancy between the registration and publication. Two trials (5.9%) addressed all discrepancies, 4 (11.8%) addressed some and 21 (61.8%) did not address any discrepancies. Of the 36 registered MAs, 33 (91.7%) had discrepancies between the registration and publication. Two (5.6%) addressed all discrepancies and three (8.3%) had no discrepancies. Eight SRs without MA published information not matching their registration, and none provided justification for the discrepancies.

CONCLUSION

Most RCTs/SRs were registered; the majority had discrepancies between preregistration and publication, potentially influencing the outcomes and interpretations of findings. Journals should require preregistration and compare the submission with the registration information when assessing publication suitability. Readers should be aware of these inconsistencies and their implications when interpreting and translating results into practice.

A Systematic Review Exploring the Theories Underlying the Improvement of Balance and Reduction in Falls Following Dual-Task Training among Older Adults

BACKGROUND

Balance impairment causes frequent falls in older adults, and preventing falls remains challenging. Dual-task (DT) training reduces falls by improving balance, but the precise theory is not fully understood. This review aims to explore the theories underlying the effectiveness of DT in improving balance and reducing falls in older adults.

METHODS

Eleven electronic databases were searched from database inception to June 2022. Two reviewers independently performed study screening and data extraction. The risk of bias (RoB) in the included studies was assessed using the Cochrane Collaboration RoB 2 tool.

RESULTS

The searches yielded 1478 citations, of which 30 studies met the inclusion criteria and were included in the review. Twenty-two of the 30 included studies utilized the motor-cognitive type of DT for training, while six used motor-motor and two utilized cognitive-cognitive DT. The included studies reported 20 different theories to explain the effectiveness of DT for improving balance and reducing falls in older adults. The predominant theory identified in the included studies was attention theory (n = 14). Overall, 26 studies reported improved balance and five studies found a reduction in fall incidence following DT training. Balance and falls improved significantly in 15 motor-cognitive DT intervention studies.

CONCLUSION

Attention shifting between two tasks is reported to occur following DT training. Motor-cognitive DT training improves balance and reduces fall incidence in older adults by shifting attention based on the difficulty and priority of a task from the motor to the cognitive task.