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

## TL;DR

This study shows that dual-tasking and low balance confidence worsen mobility in Parkinson's patients, especially during turns and transitions.

## Contribution

The study identifies turning as more vulnerable to dual-task interference than postural transitions in Parkinson’s disease.

## Key findings

- Dual-tasking increased TUG total duration by 2.7 seconds and affected all sub-phases.
- Turning was more strongly impacted by dual-tasking than postural transitions.
- Balance confidence significantly influenced sit-to-stand duration during dual-tasking.

## Abstract

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.

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.

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.

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.