Physiother Res Int. 2027 Jan;32(1):e70371. doi: 10.1002/pri.70371.
ABSTRACT
BACKGROUND AND PURPOSE: Children with cerebral palsy (CP) commonly have impairments in balance, functional mobility, and participation. Whether adding backward walking (BW) to dual-task training (DTT) provides additional benefit is unclear; this study compared DTT alone with DTT + BW.
METHODS: Forty-four children aged 6-12 years with spastic diplegic CP (Gross Motor Function Classification System [GMFCS] Levels I-II) were randomly allocated to DTT alone or DTT + BW, four 40-min sessions weekly for four weeks, in a randomized controlled trial with blinded data analysis. BW replaced an equivalent proportion of forward walking, keeping the total training time equal. Outcomes at baseline and immediately post-intervention were the Timed Up and Go test (TUG; primary), Pediatric Balance Scale (PBS), and Pediatric Outcomes Data Collection Instrument (PODCI; secondary). Analyses used mixed repeated-measures ANOVA, with ANCOVA as a sensitivity analysis for PODCI.
RESULTS: BS scores increased from 21.45 ± 3.79 to 28.50 ± 2.96 (DTT) and 22.36 ± 3.96 to 29.00 ± 3.30 (DTT + BW), with no significant Group × Time interaction (p = 0.680). TUG times decreased from 20.82 ± 4.04 to 17.23 ± 4.05 s (DTT) and 21.41 ± 3.22 to 16.86 ± 3.24 s (DTT + BW), with a significant interaction (p = 0.003, partial η2 = 0.190). PODCI scores increased from 163.14 ± 4.84 to 188.36 ± 3.30 (DTT) and 160.05 ± 7.91 to 187.45 ± 5.74 (DTT + BW), with no significant interaction (p = 0.052).
CONCLUSIONS: In ambulatory children with spastic diplegic CP (GMFCS Levels I-II), adding BW to DTT was associated with a small additional improvement in functional mobility over 4 weeks (approximately 1 s on the TUG) of uncertain clinical importance, whereas superiority for balance or participation was not demonstrated; the trial was not powered for these secondary outcomes, so this is not evidence of equivalence. Without a non-DTT comparison group, standalone DTT efficacy cannot be established.
TRIAL REGISTRATION: NCT06407765 (https://clinicaltrials.gov/study/NCT06407765).
PMID:42967331 | DOI:10.1002/pri.70371
