Meta-analysis And Applied Research On The Effect Of Dual-task Training On Gait And Balance In The Elderly

Objective: To explore the effect of dual-task training on gait and balance performance in the elderly by using the Meta-analysis method,to develop a dual-task training program based on the evidence of systematic review,and to explore the effect of its application in the elderly in nursing home.Section one:Methods: Medline,Embase,Web of Science,PubMed,Ovid,CINAHL(Ebsco)and China National Knowledge Internet were searched until 11 th May 2018.MeSH terms and keywords were combined in the searching strategy.Two researchers independently searched and screened the title/abstract and the full text(if necessary)to determine the eligibility of the articles.The library Endnote X7 was used for the screening.The third researcher would join the discussion if any disagreement existed.We scanned the references of the articles included.We also searched Open Gray,Clinical Trails and International Clinical Trails Registry Platform for the gray articles.Results: Twenty-six studies with a population of 1341 were reviewed and pooled for meta-analysis.Dual-task training was superior to non-treatment control group in improving gait speed [SMD=0.31,95%CI(0.05,0.57),P=0.02],dual-task gait speed [SMD=0.33,95%CI(0.44,0.62),P=0.02] and step length [SMD=0.43,95%CI(0.17,0.69),P=0.001],dual-task step length [SMD=0.39,95%CI(0.06,0.72),P=0.02] and TUG [MD=-1.31,95%CI(-1.76,-0.86),P<0.00001].There was no significant difference for step width [MD=-0.59,95%CI(-2.09,0.90),P=0.44] and dual-task step width [MD=-0.08,95%CI(-1.37,1.20),P=0.44] between dual-task and nontreatment control group.Dual-task training was superior to single-task training in improving gait speed [SMD=0.34,95%CI(0.03,0.65),P=0.03],dual-task gait speed [MD=0.08,95%CI(0.04,0.13),P=0.0005] and step length [MD=7.02,95%CI(3.41,10.63),P=0.0001].The effects of dual-task and single-task training groups were equal in the improvement of fast gait speed [SMD=0.15,95%CI(-0.30,0.60),P=0.52],step width [SMD=-0.03,95%CI(-0.47,0.40),P=0.89] and dual-task step width [SMD=-0.25,95%CI(-0.69,0.19),P=0.27],time of TUG [MD=-0.01,95%CI(-0.47,0.45),P=0.96] and time of dual-task TUG [MD=0.00,95%CI(-1.22,1.22),P=1.00].The use of fixed or variable task priority had no impact on the improvement of BBS [MD=-0.92,95%CI(-3.97,2.14),P=0.56] and ABC scale [MD=5.13,95%CI(-7.34,17.61),P=0.42].Conclusion: Compared with single-task training and non-treatment control group,dual-task training can better improve the gait speed and step length of the elderly.The use of different task priorities has no significant impact on gait speed,balance,and fear of falling.Section two:Methods: Develop a dual-task training program based on the evidence of systematic review and the recommendation of experts.A total of 32 healthy older adults were recruited from a nursing home and volunteered to participate.Participants were randomly assigned to either experiment group(n=16)or control group(n=16).A 1:1 computer-generated random number sequence was used for randomization.Participants from the experiment group carried out dual-task training which was provided 5 times per week for 6 weeks.Each session lasted about 30 minutes.Participants from the control group lived as usual.The Trail walking test,Timed up and go test,Berg balance scale and Activity-associated balance confidence scale was assessed before and after the training.After collection,data was input into Excel software and was analyzed use SPSS version 21.0 for windows.The training effects on the TWT,Gait parameters,TUG,BBS and ABC were determined using dependent t tests or two dependent samples Nonparametric test were conducted to examine changes across time.The training effects on the parameters were determined using independent t tests or two independent samples Nonparametric test were conducted to examine changes between groups.Results: The two groups were comparable on baseline characteristics.After six weeks of intervention,the gait speed,step length,dual-task step length and BBS scale in the experimental group were significantly higher than those in the control group(P<0.05).The time for Timed up and go and dual-task Timed up and go test in the experimental group were significantly lower than those in the control group(P<0.05).There was no significant difference in dual-task gait speed and Activities associated balance scale between the two groups(P>0.05).Conclusion: The dual-task training program based on comprehensive evidence improved the gait parameters of the elderly in nursing home,including gait speed and step length both in single-task and dual-task conditions as well as the balance performance.