Effects of Dual-Task Balance and Gait Training on Fear of Falling and Functional Independence in Older Adults: A Randomised Controlled Trial

Background: Fear of falling and gait difficulties are major contributors to physical and psychological decline in older adults. These issues restrict mobility, reduce confidence, and increase the risk of dependence and social withdrawal. Objective: To investigate the effects of dual-task balance and gait training on fear of falling and functional independence in older adults. Methodology: This controlled trial was carried out from April to September 2024 at Hayatabad Medical Complex, Peshawar. Eligible participants were community-dwelling older adults ≥60 years who could walk independently with or without assistive devices and had experienced at least one fall or reported fear of falling in the past year. Exclusion criteria included advanced osteoarthritis, recent fractures, stroke, neurological disorders, uncorrected vestibular/visual impairments, cardiovascular disease, and recent surgery. Randomisation was done through a lottery method, assigning participants to either the dual-task training group or the conventional balance training group (36 in each group). A mini-mental state examination score ≥24 was required to ensure adequate cognitive function. Primary outcomes were fear of falling, measured with the falls efficacy scale-international, and functional independence, assessed by the Barthel Index of Activities of Daily Living. Secondary outcomes included gait parameters, Timed Up and Go, and the 10-meter walk test. Continuous variables were expressed as mean±SD, and categorical variables as frequencies/percentages. Normality was tested with the Shapiro-Wilk test, and between-group comparisons were made using two-way repeated measures ANOVA, with Bonferroni post-hoc correction. Within-group changes were tested using paired t-tests (parametric) or Wilcoxon signed-rank tests (non-parametric). Results: The intervention group showed significantly greater improvements in FES-I (p<0.00), BI (p=0.00), gait velocity (p<0.00), stride length (p=0.01), and dual-task TUG (p<0.00). Fear of falling declined by 28% in the dual-task group compared to 12% in controls, while functional independence improved by 20% versus 9%. Conclusion: Dual-task training is more effective than single-task balance training for reducing fear of falling and improving independence.