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Determinants of Dual-Task Training Effect Size in Parkinson Disease

Who Will Benefit Most?

Strouwen, Carolien, PhD; Molenaar, Esther A. L. M., MSc; Münks, Liesbeth, MSc; Broeder, Sanne, MSc; Ginis, Pieter, PhD; Bloem, Bastiaan R., PhD; Nieuwboer, Alice, PhD; Heremans, Elke, PhD

Journal of Neurologic Physical Therapy: January 2019 - Volume 43 - Issue 1 - p 3–11
doi: 10.1097/NPT.0000000000000247
Research Articles

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 Parkinson's 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, R2 = 0.23, P < 0.001, for digit; β[gait] = −0.52, β[ScopaCog] = 0.29, R2 = 0.26, P < 0.001, for Stroop; and β[gait] = −0.40, β[ScopaCog] = 0.30, R2 = 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 at:

Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium (C.S., L.M., S.B., P.G., A.N., E.H.); and Department of Neurology, Nijmegen Centre for Evidence Based Practice (E.A.M.) and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (B.R.B.), Radboud University Medical Center, Nijmegen, the Netherlands.

Correspondence: Elke Heremans, PhD, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 bus 1501, 3001 Leuven, Belgium (

This work was funded by the Jacques and Gloria Gossweiler Foundation and the Malou-Malou funds of the King Baudouin foundation. Elke Heremans is a postdoctoral researcher and Sanne Broeder a PhD researcher of the Research Foundation Flanders. The funding sources were not involved in study design or execution.

This study presents results from 121 participants included in the DUALITY trial conducted in 2 clinical centers in Belgium and the Netherlands, registered on as NTC01375413.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 Academy of Neurologic Physical Therapy, APTA