Does dual-task training improve spatiotemporal gait parameters in Parkinson's disease?

Introduction: The DUALITY trial recently showed that both integrated and consecutive dual-task training improve dual-task gait velocity, without increasing fall risks in patients with Parkinson's disease (PD). Gait velocity was the primary outcome; not reported, however, were important gait measures related to the risk of falling such as gait variability. In this secondary analysis, we compared the efficacy of the two training programs with respect to spatiotemporal outcome parameters. Methods: 121 PD patients (Hoehn and Yahr stage II-III while ON medication) were randomly assigned to either a consecutive group (n = 65) in which cognitive and gait tasks were trained separately, or an integrated group (n = 56) in which cognitive and gait tasks were trained simultaneously. Both groups received 24 in-home physiotherapy sessions for six consecutive weeks. Two baseline measurements were performed during a six-week control period prior to the interventions. Gait was evaluated under three different (and untrained) dual-task conditions immediately after the treatment period and at 12-week follow-up. Results: Both training modalities had a comparable effect on spatiotemporal gait parameters. A significant post-training increase in stride length (P <.001) and cadence (P <.001) was found under both the single and the dual-task conditions. These improvements were maintained at follow-up, although the effect was slightly reduced. No significant changes were found for gait variability under single and dual-task conditions. Conclusion: We found both integrated and consecutive dual-task training to be safe and effective in improving several spatiotemporal gait parameters under trained and untrained dual-task conditions.