Cost and effectiveness of Dual-task training on balance and fall risk in individuals with cerebellar ataxia: A randomized controlled trial

Purpose: To evaluate the immediate and long-term effects of 4 weeks of intensive Cognitive-coupled Intensive Balance Training (CIBT) on dual-tasking, dynamic balance, disease severity, quality of life and cost among individuals with cerebellar ataxia.
Methods: An assessor and statistician blinded two-arm parallel group, RCT comparing dual-task (CIBT) to single-task (conventional balance, coordination and cognitive) training was conducted among 32 participants with cerebellar ataxia. Participants were randomised to receive either the experimental CIBT intervention, Group A (n=16) or control single-task training, Group B (n=16). Dual-task cost was assessed using the dual-task timed up and go test (D-TUG), the dynamic balance was assessed using the Berg Balance Scale (BBS), Scale for the Assessment and Rating of Ataxia (SARA) balance component (SARAbal), Sensory Organization Test (SOT), and Limits of Stability (LOS) test. Disease severity was assessed using the SARA and health-related quality of life using the Euroqol 5 dimension 5 level (EQ-5D-5L). The healthcare cost during the study period was documented using a self-reported questionnaire. Assessments were completed at baseline 1 (Week 0: T1), baseline 2 (week 6: T2), post-intervention (Week 10: T3), and at the end of the 24-week (Week 34: T4) follow-up period. Group A participants received 60 minutes of integrated cognitive and balance exercises 3 times a week for 4 weeks while group B received the cognitive and balance exercises as a single intervention without combing for the same duration. Participants of both groups were asked to complete an unsupervised home exercise programme during the 24-week follow-up period.
Results: Some immediate within-group beneficial effects were observed in group A in the dual-task cost of physical task (mean difference [MD]: -9%, confidence interval [CI]: 3.47 to 58.82), p=0.04) and cognitive tasks (MD: -84%, CI, 56.11 to 131.38, p=0.03) assessed using the dual-TUG and disease severity reduced following both immediate (MD:-4.11, CI, 2.41 to 19.23, p=0.05) and follow-up assessments (MD:-5.34, CI, 1.85 to 19.43, p=0.02). Compared with group B, group A demonstrated beneficial effects on dynamic balance assessed using TUG (MD: -3.03, CI, 15.86 to 22.85, p=0.01), visual and vestibular scores of SOT, and improvement in reaction time and maximal excursion in the right direction of the LOS. Besides, group A did not have additional beneficial effects compared to group B. The long-term benefits of experimental intervention were limited. Except for SOT-VIS, LOS-F-RT, LOS-F-MXE and LOS-R-RT, the benefits attained at the end of 4 weeks were not sustained during the follow-up assessment after 24 weeks. The total mean cost of the intervention plus the healthcare cost for 28 months was HKD 33,380 for group A and HKD 38,571 for group B.
Conclusion(s): Some evidence supports the immediate beneficial effects of 4 weeks of dual-task training in improving dynamic balance and disease severity among individuals with cerebellar ataxia. Dual-task training did not benefit the quality of life.