Effects of Dual-Task Balance and Gait Training on Fear of Falling and Functional Independence in Older Adults: A Randomised Controlled Trial

Abstract

Background: Fear of falling and gait difficulties are major contributors to physical and psychological decline in older adults. These issues restrict mobility, reduce confidence, and increase the risk of dependence and social withdrawal. Objective: To investigate the effects of dual-task balance and gait training on fear of falling and functional independence in older adults. Methodology: This controlled trial was conducted from April to September 2024 at Hayatabad Medical Complex, Peshawar. Participants were community-dwelling older adults ≥60 years who could walk independently and had experienced at least one fall or reported fear of falling in the past year. Exclusion criteria were advanced osteoarthritis, recent fractures, stroke, neurological disorders, uncorrected vestibular/visual impairments, cardiovascular disease, or recent surgery. Randomisation through a lottery method assigned participants to either the dual-task or conventional balance training group (36 each). A mini-mental state examination score ≥24 ensured adequate cognition. Primary outcomes were fear of falling, measured with the Falls Efficacy Scale-International, and functional independence, assessed by the Barthel Index. Secondary outcomes included gait parameters, Timed Up and Go, and the 10-meter walk test. Data were expressed as mean±SD or frequencies/percentages. Normality was tested with the Shapiro-Wilk test; between-group comparisons used two-way repeated measures ANOVA with Bonferroni correction, and within-group changes were tested using paired t-tests or Wilcoxon signed-rank tests. Results: The intervention group showed significantly greater improvements in FES-I (p<0.00), BI (p=0.00), gait velocity (p<0.00), stride length (p=0.01), and dual-task TUG (p<0.00). Fear of falling declined by 28% in the dual-task group compared to 12% in controls, while functional independence improved by 20% versus 9%. Conclusion: Dual-task training is more effective than single-task balance training for reducing fear of falling and improving independence.