Impact of dual-tasking and balance confidence on turns and transitions: a cross-sectional study in Parkinson’s disease

Abstract

Abstract Background Mobility, cognitive processing, and balance confidence impairments can negatively affect functional mobility in people with Parkinson’s disease (PD). This study aimed to examine the effects of a cognitive dual-task on functional mobility during Timed Up and Go (TUG) sub-phases involving transitions and turns. A secondary aim was to explore whether balance confidence was associated with dual-task interference (DTI) on TUG total duration and sub-phases. Methods A cross-sectional design was employed. Participants completed TUG and TUG-COG (serial three subtractions) and inertial sensors recorded spatiotemporal data on transitions and turns. Paired samples t-tests and corresponding effect sizes (Cohen’s d) were used to compare TUG conditions. Multivariate linear regression assessed the association between balance confidence and DTI on total duration and sub-phases, controlling for gait speed and executive function. Results People with mild-to-moderate PD (N = 94, mean age: 68.7 years) completed TUG-COG 2.7 s slower than TUG (p < 0.001, d = 0.5, DTI = 22.9%). The cognitive task led to reduced performance across TUG sub-phases, with generally stronger effects observed in turning outcomes (d = 0.25–0.45) and comparatively smaller effects observed in postural transitions ( d = 0.02–0.38 ). Balance confidence explained variance in DTI for sit-to-stand duration (B = -−3.560, 95% CI [−5.499, −1.622], p < 0.001), whereas no effect was observed for other sub-phases. Conclusion Dual-tasking impaired nearly all components of the TUG, prolonging total duration and altering spatiotemporal characteristics of transitions and turns. Turning was more strongly impacted by dual-tasking than postural transitions, which has relevance for fall-prevention strategies. Together, the results of this study indicate that clinicians should prioritize turning during dual-task gait training and incorporate assessment of balance confidence to better capture functional capacity in transitional movements such as sit-to-stand.