How Reliable and Valid are Dual-Task Cost Metrics? A Meta-Analysis of Locomotor-Cognitive Dual-Task Paradigms

Published:August 05, 2022DOI:



      To assess the retest reliability, predictive validity, and concurrent validity of locomotor and cognitive dual-task cost (DTC) metrics derived from locomotor-cognitive dual-task paradigms.

      Data Sources

      A literature search of electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, and Scopus) was conducted on 29th May 2021 without time restriction.

      Study Selection

      For 1559 search results, titles and abstracts were screened by a single reviewer and full-text of potentially eligible papers was considered by two independent reviewers. 25 studies that evaluated retest reliability, predictive validity, and concurrent validity of locomotor-cognitive DTC in healthy and clinical groups met inclusion criteria.

      Data Extraction

      Study quality was assessed using the COSMIN checklist. Data relating to the retest reliability, predictive validity, and concurrent validity of DTC were extracted.

      Data Synthesis

      Meta-analysis showed that locomotor DTC metrics (ICC=0.61, 95%CI [0.53,0.70]) had better retest reliability than cognitive DTC metrics (ICC=0.27, 95%CI [0.17,0.36]). Larger retest reliability estimates were found for temporal gait outcomes (ICC=0.67-0.72) compared with spatial (ICC=0.34-0.53). Motor DTC metrics showed weak predictive validity for the incidence of future falls (r=0.14, 95%CI [-0.03,0.31]). Motor DTC metrics had weak concurrent validity with other clinical and performance assessments (r=0.11, 95%CI [0.07,0.16]), as did cognitive DTC metrics (r=0.19, 95%CI [0.08,0.30]).


      Gait-related temporal DTC metrics achieve adequate retest reliability, while predictive and concurrent validity of DTC needs to be improved before being used widely in clinical practice and other applied settings. Future research should ensure the reliability and validity of DTC outcomes before being used to assess dual-task interference.


      List of abbreviations:

      DTI (dual-task interference), DTC (dual-task cost), ICC (Intraclass Correlation Coefficient), MS (Multiple Sclerosis), EDSS (Expanded Disability Status Scale), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), KCC (Kendal's Coefficient of Concordance), OR (Odds Ratios), TUG (Timed Up and Go), COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments)
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