Determinants of Dual-Task Training Effect Size in Parkinson Disease: Who Will Benefit Most?

BACKGROUND AND PURPOSE:Dual-task interventions show positive effects in people with Parkinson disease (PD), but it remains unclear which factors determine the size of these benefits. As a secondary analysis of the DUALITY trial, the aim of this study was to assess the determinants of the effect size...

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Bibliographic Details
Published in:Journal of neurologic physical therapy 2019-01, Vol.43 (1), p.3-11
Main Authors: Strouwen, Carolien, Molenaar, Esther A. L M, Münks, Liesbeth, Broeder, Sanne, Ginis, Pieter, Bloem, Bastiaan R, Nieuwboer, Alice, Heremans, Elke
Format: Article
Language:English
Subjects:
Aged
Cognitive Remediation - methods
Executive Function - physiology
Exercise Therapy - methods
Female
Humans
Intervention
Male
Middle Aged
Outcome Assessment, Health Care
Parkinson Disease - physiopathology
Parkinson Disease - therapy
Parkinson's disease
Psychomotor Performance - physiology
Size
Training
Walking - physiology
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Summary:BACKGROUND AND PURPOSE:Dual-task interventions show positive effects in people with Parkinson disease (PD), but it remains unclear which factors determine the size of these benefits. As a secondary analysis of the DUALITY trial, the aim of this study was to assess the determinants of the effect size after 2 types of dual-task practice. METHODS:We randomly allocated 121 participants with PD to receive either integrated or consecutive dual-task training. Dual-task walking performance was assessed during (i) a backward digit span task (digit), (ii) an auditory Stroop task (Stroop), and (iii) a functional mobile phone task. Baseline descriptive, motor, and cognitive variables were correlated with the change in dual-task gait velocity after the intervention. Factors correlated with the change in dual-task gait velocity postintervention (P < 0.20) were entered into a stepwise forward multiple linear regression model. RESULTS:Lower dual-task gait velocity and higher cognitive capacity (Scales for Outcomes in Parkinsonʼs Disease-Cognition [ScopaCog]) at baseline were related to larger improvements in dual-task gait velocity after both integrated and consecutive dual-task training for all 3 tasks (β[gait] = −0.45, β[ScopaCog] = 0.34, R = 0.23, P < 0.001, for digit; β[gait] = −0.52, β[ScopaCog] = 0.29, R = 0.26, P < 0.001, for Stroop; and β[gait] = −0.40, β[ScopaCog] = 0.30, R = 0.18, P < 0.001, for mobile phone task). DISCUSSION AND CONCLUSIONS:Participants with PD who showed a slow dual-task gait velocity and good cognitive functioning at baseline benefited most from the dual-task training, irrespective of the type of training and type of dual-task outcome.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available athttp://links.lww.com/JNPT/A242).
ISSN:1557-0576
1557-0584
DOI:10.1097/NPT.0000000000000247