Motor Cognitive Dual-Task Testing to Predict Future Falls in Multiple Sclerosis: A Systematic Review

Abstract

Background Mobility and cognitive impairments are often associated with increased fall risk among people with multiple sclerosis (PwMS). However, evidence on the concurrent assessment of gait or balance and cognitive tasks (dual-task) to predict falls appears to be inconsistent. Objective To summarize the ability of gait or balance dual-task testing to predict future falls among PwMS. Methods Seven databases including PubMed, Embase, Web of Science, Scopus, CINHAL, SPORTDiscuss, and PsycINFO were searched from inception to May 2022. Two independent reviewers identified studies that performed a dual-task testing among adults with multiple sclerosis and monitored falls prospectively for at least 3 months. Both reviewers also evaluated the quality assessment of the included studies. Results Eight studies with 484 participants were included in the review. Most studies (75%) indicated that dual-task testing and dual-task cost did not discriminate prospective fallers (⩾1 fall) and non-fallers (0 fall) and were not found as predictors of future falls. However, dual-task cost of walking velocity (OR = 1.23, 95% CI 0.98-4.45, P = .05) and dual-task of correct response rate of serial 7 subtraction (OR = 1.34, 95% CI 1.04-3.74, P = .02) were significantly associated with increased risk of recurrent falls (≥2 falls). Pattern of cognitive-motor interference was also associated with an increased risk of falling. All studies presented with strong quality. Conclusion The scarce evidence indicates that dual-task testing is not able to predict future falls among PwMS. Further research with more complex motor and cognitive tasks and longer-term fall monitoring is required before dual-task testing can be recommended as a predictor of future falls in this population.

Dual-task assessments for predicting future falls in neurologic conditions: A systematic review

“…Studies that performed dual-task assessments in people with multiple sclerosis were excluded analysis because a recent systematic review examined the utility of dual-task assessments for fall prediction in this population. 18…”

“…15 In older adults, who may also experience declines in frontoparietal networks due to aging, 16 dual-task costs show viability in predicting fall risk 17 ; however, dual-task assessments have not clearly shown to predict prospective fall risk in people with NDs. 18 In ambulatory people with moderate cognitive impairment (MCI) and SCI, research shows that dual-task costs can be predictive of future fall risk. 19,20 In contrast, in people with AD and PD, dual-task tests do not seem to be effective in predicting fall risk.…”

“…18,27,28 Specifically, Abou et al found that most studies examining dual task in people with MS were unable to utilize dual-task tests to predict future falls or discriminate future fallers from nonfallers. 18 Researchers believed that dual-task tests in their current format were too simple and fall monitoring required greater robustness (i.e., longer-term fall monitoring). 18 To the authors' knowledge, no systematic review has extended the examination of the ability of dual-task assessments to predict prospective falls in other ND populations such as AD, SCI, PD, HD, stroke, traumatic brain injury, and cerebral palsy.…”

“…18 Researchers believed that dual-task tests in their current format were too simple and fall monitoring required greater robustness (i.e., longer-term fall monitoring). 18 To the authors' knowledge, no systematic review has extended the examination of the ability of dual-task assessments to predict prospective falls in other ND populations such as AD, SCI, PD, HD, stroke, traumatic brain injury, and cerebral palsy. While research has revealed dual-task testing to be inconclusive in predictive retrospective falling in people with ND, 29 retrospective falling has shown inconsistencies in determining fall risk in people with ND and may not be ecologically valid for predicting future fall risk for this population.…”

Postural Control of Patients with Low Back Pain Under Dual-Task Conditions

“…Dual task (DT) is a combination of multiple different types of tasks, which generally include cognitive and motor tasks. 14 , 15 It is widespread for people to perform dual task in their daily life (such as talking while walking, talking to people while carrying a water cup upstairs, etc.). Dual-task training (DTT) is based on the dual-task examination and evaluation of the subjects to determine the specific dysfunction and then adopt targeted training treatment methods.…”