Effectiveness of dual-task training for fall prevention in older adults: a systematic review and meta-analysis with a dose-response analysis

Abstract

Background . Falls affect approximately one in three individuals aged over 65 annually, thus ranking as a leading cause of injury and functional decline. Dual-task training (DTT) is recognized as a promising non-pharmacological method for preventing falls. Although systematic reviews up to 2022 confirmed its benefits, they did not examine the relationship between clinical effect and dosing parameters. Objective : To evaluate DTT in preventing falls and improving postural balance among the elderly (≥60 years) using a systematic review of publications from 2022–2026 with quantitative synthesis of randomized controlled trial (RCT) data, and to conduct an exploratory meta-regression with training protocol parameters as moderators. Material and methods . A systematic review was conducted on publications from the PubMed/MEDLINE, Embase, PEDro, Web of Science, Google Scholar, eLibrary, and CyberLeninka databases from January 1, 2022, to February 28, 2026. The inclusion criteria were as follows: RCTs for quantitative synthesis; systematic reviews and meta-analyses for narrative synthesis on virtual reality in DTT; participants aged ≥60 years; assessment of primary outcomes using the Berg Balance Scale (BBS) and Timed Up and Go (TUG) tests; and availability of data on fall incidence. The PRISMA 2020 methodology was applied. The Cochrane Risk of Bias 2 tool, the DerSimonian–Laird random effects model, and the exploratory meta-regression method were used (k=5). Results . A total of 38 publications included 22 RCTs, 16 systematic reviews and meta-analyses. Five RCTs with complete numerical data (PEDro ≥6/10) were selected for quantitative pooling. The pooled standardized mean difference for BBS was 0.61 (95% confidence interval (CI) 0.46…0.76), I2=0%. The mean difference for TUG was –2.2 s (95% CI –2.8...–1.6), I2=14%. Meta- analysis for the fall rate was not feasible (1 RCT: risk ratio 0.56; 95% CI 0.38…0.82). Meta-regression did not reveal statistically significant effects of dose parameters (k=5, power <40%). Conclusion . DTT improves postural balance, though the effect is moderate. RCTs with complete dose reporting should be conducted to confirm dose-response relationships.