Cognitive-motor dual-task training on gait and balance in stroke patients: meta-analytic report and trial sequential analysis of randomized clinical trials.
Lu Zhang, Jiangping Ma, Xiaoqing Liu and 3 others
PMID 39716165WHAT IT FOUND
Adding cognitive tasks to stroke gait or balance rehab did not clearly improve Time Up and Go or walking speed.
Berg Balance Scale scores may rise, but the evidence is too small to confirm it.
Key findings
01Berg Balance Scale scores improved by 4.26 points on average versus conventional training, but the pooled sample did not reach the required information size and the authors said this may be a false-positive result.
02Time Up and Go did not show a clear improvement: the random-effects result was not significant, and the authors called the evidence inconclusive.
03Single-task walking speed did not show a clear improvement, and the authors called the evidence inconclusive.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review included only 17 randomized trials and 751 patients, and several key outcomes used small subsets, such as 4 studies for single-task walking speed. Trial sequential analysis did not reach the required information size for Berg Balance Scale, Time Up and Go, single-task walking speed, or Fugl-Meyer Assessment, so the authors called the evidence inconclusive or a possible false positive. Several included trials had unclear allocation concealment, one had unclear randomization, blinding was often incomplete, one had high attrition without intention-to-treat analysis, and 11 studies had unclear reporting bias because protocols or registries were unavailable. GRADE rated the evidence low or very low because of risk of bias, inconsistency, and imprecision. Interventions were heterogeneous: cognitive tasks varied, motor tasks varied, duration and frequency varied, and fixed-effect and random-effect results differed for Time Up and Go, walking speed, activities of daily living, and Fugl-Meyer Assessment. Only English and Chinese randomized trials were included, and the article states there were differences from the registered protocol.
Declared interests
Funding was provided by Shanghai Shenkang Nursing Critical Care Key Technology Training Base and the Special Project for Medical and Health Research of Shanghai Changning District Science and Technology Committee. The supplied text does not state any competing interests.
The easy way to misread this
Do not read the Berg Balance Scale improvement as proven benefit. The authors' trial sequential analysis did not reach the needed sample size and said the result may be a false-positive finding.