Effectiveness of nonclinic-based dual-task training on physical and cognitive functions and activities of daily living in older adults with cognitive decline: A systematic review and meta-analysis

Older adults with cognitive decline commonly demonstrate deficits in memory, attention, and problem-solving, leading to reduced ability to perform activities of daily living (ADL). Nonclinic-based dual-task training (DTT), delivered at home, in community, or via telerehabilitation, aligns with digital health strategies to improve accessibility and continuity of care for older adults with cognitive decline. This review examined the effects of such intervention on gait, functional mobility, cognitive performance, and ADL, as well as adverse events, feasibility, acceptability, and caregiver burden. Six electronic databases, including PubMed, Embase, CINAHL, CENTRAL, IEEE Xplore, and ProQuest, were systematically searched. Eligible studies were randomized controlled trials (RCTs) investigating the effectiveness of nonclinic-based DTT on variables in older adults with cognitive decline. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2). Data were synthesized using pairwise meta-analysis to compare the DTT with active or passive controls, and network meta-analysis to compare and rank treatment approaches. Twenty-three RCTs involving 1,674 participants were included. The DTT demonstrated significantly greater improvements than the active control in functional mobility (SMD = 0.49; 95% CI, 0.08-0.89; p = 0.019) and global cognition (SMD = 0.32; 95% CI, 0.10-0.55; p = 0.005). Compared with the passive control, the DTT also showed greater gains in gait speed (USMD = 0.05 m/s; 95% CI, 0.02-0.08; p = 0.001) and global cognition (SMD = 0.80; 95% CI, 0.37-1.23; p < 0.001). Only minimal adverse effects were reported, while the mean adherence rate across studies was 80.82%, despite identified barriers including technical difficulties, lack of motivation, and caregiver burden. These findings support its feasibility and effectiveness as a complementary approach to conventional interventions, offering a practical alternative that may reduce the reliance on frequent clinic visits and facilitate greater functional independence.