Objective: To examine the concurrent validity of manual dual-task and cognitive dual-task versions of a recently validated L-Test [1] in individuals with mild-moderate Parkinson’s Disease (PD). A secondary objective was to establish the predictive ability of the single-task and dual-task versions of the L-Test in identifying those at risk of falling.

Background: Falls are twice as common in PD as in healthy older people [2]. Dual-tasking in PD can exacerbate gait impairments [3] and over half of falls are thought to occur during dual-task activities [4]. Emerging evidence suggests benefits of dual-task training (DTT) on motor skill retention [5-7] and the European Physiotherapy Guidelines for PD recommend its implementation in clinical practice [8]. Robust dual-task mobility measures are therefore necessary to evaluate the effects of DTT programs in PD.

Method: 25 participants (19 male), mean age 65.64 years (SD±9.40) in H&Y stage I-III were categorized into faller (n=7) or non-faller groups (n=18). Participants attended one testing session in which they completed the L-Test and Timed Up-and Go (TUG) single-task, manual and cognitive dual-task conditions [1, 5]. Correlations between each of the L-Test and TUG conditions were determined using Spearman’s Rank Order Correlation Coefficients (rho) for non-parametric data. Predictive ability for each of the test conditions in identifying fallers was determined using univariable regression analysis.

Results: Significant positive correlations were found between the L-Test manual dual-task and cognitive dual-task conditions and the corresponding TUG conditions (rho=0.94, p<0.001, 95% CI=0.87-0.97 and rho=0.92, p<0.001, 95% CI=0.84-0.97 respectively). However, none of the test conditions had the ability to distinguish between fallers and non-fallers (p≤0.05).

Conclusion: The L-Test is a valid measure for the assessment of dual-task walking ability in people with mild-moderate PD and is easily implemented in clinical practice. However, none of the L-Test or TUG conditions could distinguish between fallers and non-fallers and study findings concur with recommendations from other studies that dual-task mobility assessments should only be used as part of a multi-factorial falls risk assessment. Future larger-scale studies using prospective falls evaluation are necessary to establish predictive ability of the dual-task L-Test in identifying fallers.

References: [1] Haas B, Clarke E, Elver L, Gowman E, Mortimer E, Byrd E. The reliability and validity of the L-test in people with Parkinson’s Disease. Physiotherapy 2019;105:84-89. [2] Chivers Seymour K, Pickering R, Rochester L, Roberts HC, Ballinger C, Hulbert S, Kunkel D, Marian IR, Fitton C, McIntosh E, Goodwin VA, Nieuwboer A, Lamb SE, Ashburn A. Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s. J Neurol Neurosurg Psychiatry 2019;90(7):774-782. [3] Heinzel S, Maechtel M, Hasmann SE, Hobert MA, Heger T, Berg D, Maetzler W. Motor dual-tasking deficits predict falls in Parkinson’s disease: A prospective study. Parkinsonism Relat Disord 2016;26:73-77. [4] Bloem BR, Grimbergen YA, van Dijk JG, Munneke M. The “posture second” strategy: a review of wrong priorities in Parkinson’s Disease. J Neurol Sci 2006;248(1-2):196-204. [5] Chomiak T, Watts A, Meyer N, Pereira FV, Hu B. A training approach to improve stepping automaticity while dual-tasking in Parkinson’s disease: a prospective pilot study. Medicine 2017;96(5):1-6. [6] Brauer SG, Morris ME. Can people with Parkinson’s disease improve dual tasking when walking? Gait Posture 2010;31:229-233. [7] Strouwen C, Molenaar EALM, Munks L, Keus SHJ, Zijlmans JCM, Vandenberghe W, Bloem BR, Nieuwboer A. Training Dual Tasks Together or Apart in Parkinson’s Disease: Results From the DUALITY Trial. Mov Disord 2017;0(0):1-10. [8] Keus SHJ, Munneke M, Graziano M, Paltamaa J, Pelosin E, Domingos J, Bruhlmann S, Ramaswamy B, Prins J, Struiksma C, Rochester L, Nieubower A, Bloem B. European Physiotherapy Guideline for Parkinson’s Disease. 2014;KNGF/ParkinsonNet, the Netherlands.

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