Psychometric properties of dual-task balance assessments for older adults: a systematic review

Background: The ability to maintain balance while simultaneously performing a cognitive task is essential for daily living and has been implicated as a risk factor of falls in older adults.

Aims: To evaluate the evidence related to the psychometric properties of dual-task balance assessments in older adults.

Methods: An extensive literature search of electronic databases was conducted. Articles were included if they evaluated the psychometric properties of dual-task balance assessment tools in older adults. The data were extracted by two independent researchers and confirmed with the principal investigator. The methodology quality of each study was rated by using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist.

Results: Twenty-six articles were included in this systematic review. For dual-task static standing balance assessments, the center of pressure-related parameters (displacement, velocity) and reaction time measurements were reliable but not useful for prediction of falls. For walking balance assessments, the gait outcomes derived generally demonstrated good to excellent reliability (intraclass correlation coefficient >0.75), but their ability to predict falls varied. Outcomes derived from the cognitive tasks and the dual-task cost (dual-task performance minus single-task performance) mostly demonstrated low to fair reliability. The methodological quality of majority of studies was poor to fair, mainly due to small sample size.

Conclusions: Among the dual-task balance assessments examined, the reliability and validity varied. The findings of this review should be useful in guiding the selection of dual-task balance measures in future research.