Effect of Dual-Task Training on Falls and Fall-Related Outcomes After Stroke: A Systematic Review of Randomized Controlled Trials
Dual-Task Training and Falls After Stroke
Keywords:
Accidental Falls, Cognition, Exercise, Postural Balance, StrokeAbstract
Background: Stroke survivors fall often, and many of these falls occur when walking competes with another attentional demand. Dual-task training rehearses precisely this situation, yet its value for fall prevention remains uncertain. This review synthesized the evidence on whether dual-task training reduces falls and improves fall-related outcomes after stroke.
Methods: Five databases (PubMed/MEDLINE, Cochrane CENTRAL, Scopus, Web of Science, PEDro) were searched up to September 2026 and supplemented by trial registers and citation tracking. Eligible studies were randomized trials in adult stroke survivors in which dual-task practice was tested against single-task practice, usual rehabilitation or any other control, with falls, fall-related self-efficacy or a laboratory fall-risk measure as an outcome. Screening, data extraction and RoB 2 appraisal were each performed independently by two reviewers. Findings were synthesized narratively, and the certainty of evidence was rated using GRADE.
Results: Of 1,100 records, six trials (269 participants) were included. Two trials recorded falls. In chronic stroke, 12.0% of the dual-task group fell over six months versus 37.0% of an upper-limb control group, although a matched single-task group fell at a similar rate (15.4%). In subacute stroke, higher-intensity trunk training with dual tasks reduced the proportion of fallers by 19.1% at six months compared with moderate-intensity trunk training alone. Of five trials assessing balance confidence or fall efficacy, the two smallest favored dual-task training, while the remaining three showed no between-group difference. Risk of bias raised some concerns in four trials and was high in two. Certainty was low for falls and injurious falls, and very low for other outcomes.
Conclusion: Dual-task training may lower the number of people who fall after stroke. However, this finding rests on only two trials, and neither demonstrates that the added task confers greater protection than balance practice alone. Its effect on balance confidence remains very uncertain.
DOI: https://doi.org/10.59564/amrj/04.04/012
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