Dual tasking as a predictor of falls in post-stroke: Walking While Talking versus Stops Walking While Talking.

Abstract

Background Falls affect 40-70% within the first year and contributing to increased morbidity and reduced quality of life. Dual-task assessments, such as the Walking While Talking (WWT) and Stops Walking While Talking (SWWT) tests, are potential tools for predicting fall risk, but their comparative effectiveness remains underexplored. Methods This cross-sectional study included 68 stroke survivors who completed WWT-Simple (WWT-S), WWT-Complex (WWT-C), and SWWT assessments, as well as the Berg Balance Scale (BBS) and Falls Efficacy Scale (FES). Spearman correlations assessed relationships between balance, fear of falling, and dual-task performance. Logistic regression identified predictors of fall risk, and Receiver Operating Characteristic (ROC) analysis evaluated predictive accuracy. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Results BBS scores were strongly negatively correlated with WWT-S (r = -0.734, p < 0.0001) and WWT-C (r = -0.737, p < 0.0001), indicating poorer balance with slower dual-task completion. Positive correlations were found between WWT-S and FES (r = 0.668, p < 0.0001) and WWT-C and FES (r = 0.610, p < 0.0001), linking slower completion times with higher fear of falling. SWWT was significantly negatively correlated with BBS (r = -0.625, p < 0.0001). WWT tests had higher sensitivity (97.8%) and specificity (99%) than SWWT (sensitivity = 68.9%; specificity = 91.3%). Logistic regression identified SWWT (Positive) as a significant predictor of fall risk (p = 0.009), and ROC analysis showed an AUC of 0.911, indicating excellent predictive power. Conclusions Findings highlight the superior predictive value of WWT tests over SWWT in assessing fall risk among stroke survivors. Incorporating dual-task measures into clinical practice may enhance fall risk evaluation, supporting targeted stroke rehabilitation.