Effectiveness of dual-task training in older adults undergoing total knee arthroplasty: a randomized controlled trial

Motor-cognitive (dual-task) training may enhance functional recovery after total knee arthroplasty (TKA). However, evidence for its integration into telerehabilitation programs is limited.

To investigate the effects of motor-cognitive dual-task training on physical and cognitive performance in older adults undergoing TKA.

A randomized controlled trial was conducted with 28 older adults undergoing TKA. Participants were assigned to a control group (CG; n=14), which received routine physiotherapy via telerehabilitation following one face-to-face session, or an intervention group (IG; n=14), which received the same protocol plus an 8-week motor-cognitive dual-task training program. Pre- and post-intervention assessments included Visual Analogue Scale (VAS), Knee Society Score (KSS), Mini-Mental State Examination, Dual Task Questionnaire, cognitive Timed Up and Go Test (cTUG), Lower Extremity Motor Coordination Test (LEMOCOT), 3-Meter Backward Walk Test (3-MBWT), 10-Meter Walk Test (10-MWT), Walking Impact Scale (WALK-12), and Reaction Time Test.

The IG demonstrated significantly greater improvements in both rest and activity VAS scores (p<0.001). Both groups showed improvement in 3-MBWT performance (p<0.001), with the IG exhibiting superior gains (p=0.019). The IG also demonstrated greater improvement in cTUG (p<0.001) and LEMOCOT scores (p<0.001). No additional benefits of dual-task training were observed for KSS symptom scores, gait parameters (10-MWT, WALK-12), reaction time, or cognitive outcomes.

Integrating dual-task training into telerehabilitation following TKA yields superior improvements in pain, dual-task performance, and somatosensory-motor function in older adults. However, dual-task-specific exercises do not provide additional benefits regarding knee symptoms, gait speed, reaction time, or global cognitive performance compared with standard physiotherapy alone.