Physical therapy approach to dual-task training in the treatment of Parkinson's disease: a systematic review

Given the rapid population aging and the increased morbidity associated with Parkinson's Disease (PD), rehabilitation strategies that preserve autonomy have become imperative. PD compromises motor automaticity, which is exacerbated in dual-task (DT) conditions, substantially elevating the risk of falls. This study aimed to analyze the efficacy and magnitude of the effect of dual-task training (motor-cognitive) on gait, balance, and the attenuation of motor signs' severity in individuals with PD. A Systematic Review with Meta-analysis was conducted following the PRISMA guidelines. Randomized Controlled Trials (RCTs) comparing DT training with single-task or usual care were included. Methodological quality was assessed using the PEDro scale, and the certainty of evidence was evaluated by the GRADE system. The quantitative synthesis of 17 RCTs (n=826) indicated good to excellent methodological quality (PEDro mean 6.59 to 8.75). DT training demonstrated significant statistical superiority in gait speed (Standardized Mean Difference [SMD] 0.42; 95% CI 0.23–0.60), stride length (SMD 0.69; 95% CI 0.23–1.15), and cadence (SMD 0.41; 95% CI 0.19–0.63) compared to control groups. Subgroup analysis revealed a 0.11 m/s increase in gait speed, a value that exceeds the minimal clinically important difference (MCID) for the Parkinsonian population. A large effect size was observed for functional balance (SMD 1.15) and a reduction in the UPDRS-III scale (SMD -0.86). Dual-task training presents robust evidence for improving spatiotemporal gait parameters and functional balance in PD, maintaining short-term gains, thereby consolidating DT training as an essential, rather than merely complementary, component in the neurofunctional rehabilitation of PD.