Effectiveness of dual-task training on balance and gait in people with multiple sclerosis: a systematic review and meta-analysis

BACKGROUND: Multiple sclerosis (MS) is a chronic neurodegenerative disease frequently associated with balance impairments, gait disturbances, and cognitive deficits. Dual-task training (DTT), integrating simultaneous motor and cognitive tasks, has been proposed as a rehabilitation strategy to improve functional performance. This systematic review with meta-analysis aimed to evaluate the effectiveness of DTT on postural balance and gait speed in people with MS (PwMS). METHODS: A systematic review with meta-analysis was conducted following PRISMA 2020 guidelines and the Cochrane Handbook recommendations. Randomized controlled trials assessing DTT effects on balance and gait in PwMS were included. Databases searched included PubMed/MEDLINE, Scopus, Web of Science, CINAHL Complete, and ScienceDirect. Risk of bias was assessed using the Cochrane Risk of Bias tool, and methodological quality was evaluated with the PEDro scale. Pooled effects were calculated using standardized mean differences (SMD) with 95% confidence intervals (CI) under a random-effects model. RESULTS: Seventeen randomized controlled trials including 649 participants were analyzed. Improvement was defined as score increases for BBS and gait speed, and decreases for TUG and posturography. DTT significantly improved functional balance (SMD=0.96; 95% CI 0.32-1.60), dynamic balance (SMD=-0.28; 95% CI -0.50 to -0.06), and static balance with eyes open (SMD=-0.33; 95% CI -0.62 to -0.04). Gait speed also showed significant improvement (SMD=0.26; 95% CI 0.09-0.44). Evidence quality ranged from low to moderate. CONCLUSIONS: Dual-task training may represent a promising intervention to improve balance and gait speed in PwMS. However, methodological heterogeneity and risk of bias warrant cautious interpretation. Future large-scale trials with standardized protocols and long-term follow-up are needed.