Motor-walking dual-task training improved multiple gait and balance outcomes in stroke patients compared to other modalities.

ObjectiveThis study aimed to compare the effects of different dual-task training modalities on walking and balance in stroke patients using network meta-analysis.Data sourcesRandomized controlled trials were searched in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Chinese Biomedical Database from inception to September 2025.Review methodsMethodological quality was assessed using the Cochrane risk-of-bias tool. A frequentist approach was applied for network meta-analysis, and evidence quality was evaluated with confidence in the network meta-analysis framework.ResultsThirty-four trials covering 10 dual-task modalities were included. Network meta-analysis results showed that motor-walking dual-task training was the most effective in improving cadence (mean difference = 7.04, 95%: 1.95 to 12.12), walking speed (standardized mean difference = 0.67, 95%: 0.27 to 1.06), step length (standardized mean difference = 0.56, 95%: 0.20 to 0.92), stride (standardized mean difference = 0.76, 95%: 0.45 to 1.08), 10-Meter Walk Test (standardized mean difference = 0.73, 95%: 0.05 to 1.12) and berg balance scale (mean difference = 5.76, 95%: 1.38 to 10.14). Cognitive-balance dual-task training showed the greatest improvement in Timed Up and Go test (mean difference = -4.73, 95%: -10.24 to -0.78). The certainty of evidence for most outcomes, assessed using the Grading of Recommendations Assessment, Development and Evaluation framework, ranged from very low to high.ConclusionsMotor-walking dual-task training best improved cadence, walking speed, step length, stride, 10-Meter Walk Test, and Berg Balance Scale. Cognitive-balance dual-task training showed the greatest improvement in Timed Up and Go test. These results inform future guidelines and clinical decisions for stroke patients' walking and balance rehabilitation.