Advancing standardisation of motor-cognitive dual task walking assessments: a scoping review of methodological practices in healthy older adults

Dual task (DT) assessments evaluating walking combined with a cognitive task are valuable tools for testing functional capacity and monitoring age-related decline. Despite this, motor-cognitive DT assessments are underutilised in clinical practice. This has been attributed in part to methodological challenges, including heterogeneity in DT measurement protocols and poor reliability of outcome measures. To address these barriers, this scoping review systematically identified motor-cognitive DT walking assessments used with healthy older adults and examined current practice in reporting and standardisation. The purpose was to inform the refinement of DT assessments to enhance their precision and reproducibility, facilitating their future integration into routine clinical practice. A systematic search of five electronic databases identified studies that investigated motor-cognitive DT walking assessments in community-dwelling, cognitively healthy older adults. The reporting and standardisation of measurement procedures was extracted using the COSMIN framework. The findings were analysed descriptively. The review included 38 studies investigating a walking motor task combined with a variety of cognitive tasks. The most common walking tasks were unidirectional gait, the timed up and go (TUG), or walking and turning tasks. The most prevalent cognitive tasks included serial subtraction, animal naming, and reciting alternate alphabet letters. There was substantial variability in the administration of DT assessments and no studies fully reported the procedures for set up, test performance, and data collection. Of particular concern was the poor reporting of general task instructions, task prioritisation, and practice trials. The review identified a lack of standardisation in DT walking measurement procedures, which likely contributes to measurement variability and limits clinical replication. Given that measurement variability inherent in single task assessments is compounded when motor and cognitive tasks are combined, it is critical to address these sources of inconsistency to ensure DT measures detect and accurately reflect true performance changes. Recommendations are made to improve standardisation of DT measurements with the aim of facilitating their broader adoption and implementation in clinical practice.