Effects of Telerehabilitation-Based Dual-Task Exercises on Balance, Fall Risk, Cognitive Function, and Sleep Quality in Geriatric Individuals

The Effects of Dual-Task Exercises Performed Through Telerehabilitation on Balance, Falls, Cognitive Function, and Sleep Quality in Geriatric Individuals: A Randomised Control Trial

The purpose of this study is to investigate the effects of dual-task exercises-which simultaneously target cognitive and motor functions-delivered via telerehabilitation on fall risk, balance, cognitive functions, and sleep quality in geriatric individuals.Aging is often associated with balance disorders, increased fall risk, cognitive decline, and impaired sleep quality, all of which significantly impact the quality of life in the elderly. Dual-task interventions require individuals to perform physical and cognitive tasks concurrently, aiming to improve sensorimotor control and enhance balance strategies under cognitive load.This study utilizes telerehabilitation as a cost-effective and sustainable solution to facilitate access to healthcare services, providing a remote alternative to face-to-face rehabilitation. The research aims to demonstrate that dual-task exercises performed through telerehabilitation can contribute to functional recovery, reduce the fear of falling, and increase the safe mobility capacity of geriatric individuals.

Study Overview

• Status: Recruiting
• Conditions: Aging; Balance Control in Elderly; Sleep Disorder (Disorder)
• Intervention / Treatment: Other: Telerehabilitation Based Dual-Task Exercises; Other: Educational Brochure and Phone Follow-Up

Detailed Description

Aging is associated with various physiological and functional changes that can negatively affect independence and quality of life in older adults. Among the most common problems observed in geriatric individuals are balance impairments, increased risk of falls, decline in cognitive functions, and deterioration in sleep quality. These conditions not only reduce functional independence but also increase morbidity and healthcare utilization in older populations. Therefore, effective and accessible rehabilitation strategies are needed to address these multidimensional problems.

In recent years, technological approaches have increasingly been integrated into rehabilitation programs. One of the most prominent approaches is telerehabilitation, which enables healthcare professionals to deliver rehabilitation interventions remotely using digital communication technologies. Telerehabilitation facilitates access to rehabilitation services for older individuals who may have limited mobility or difficulty accessing healthcare facilities. Previous studies have demonstrated that telerehabilitation can provide outcomes comparable to conventional face-to-face rehabilitation, particularly in terms of pain reduction, functional improvement, and quality of life enhancement in musculoskeletal conditions. These findings suggest that telerehabilitation may serve as a safe, effective, and sustainable rehabilitation model for older adults.

Dual-task training has emerged as an important intervention approach aimed at improving both cognitive and motor functions simultaneously. Dual-task exercises require individuals to perform a motor task while concurrently completing a cognitive task, thereby stimulating the interaction between motor and cognitive systems. This approach reflects real-life situations in which individuals frequently perform multiple tasks at the same time during daily activities. Research has shown that dual-task training can improve postural stability, enhance cognitive performance, and reduce fall risk in older adults by strengthening sensorimotor control and motor-cognitive integration.

Functional mobility and dynamic balance are important determinants of independence in older adults. The interaction between cognitive load and motor performance plays a critical role in maintaining postural control and preventing falls in this population. In addition, cognitive status in older individuals is frequently evaluated using standardized tools that assess attention, memory, executive functions, and orientation, as these cognitive processes are closely related to balance performance and functional mobility.

Sleep quality is another important factor affecting the health and functional capacity of older adults. Poor sleep quality has been associated with decreased cognitive performance, impaired balance, and increased risk of falls. Previous studies have reported that combined physical and cognitive training interventions, such as dual-task exercise programs, may improve not only physical performance but also cognitive functioning and sleep quality in older adults.

Considering these findings, dual-task exercise programs delivered through telerehabilitation platforms may provide an effective and accessible intervention strategy for geriatric individuals. Such programs allow participants to perform exercises in their home environment under remote supervision, thereby improving accessibility and adherence while reducing barriers related to transportation and mobility.

The aim of this study is to investigate the effects of telerehabilitation-based dual-task exercises on balance, fall risk, cognitive functions, and sleep quality in geriatric individuals.

This experimental study is planned to be conducted with geriatric patients presenting to Zonguldak Atatürk State Hospital between February 2, 2026 and June 2, 2026. The findings of the study are expected to contribute to the growing body of evidence regarding the role of telerehabilitation and dual-task exercise approaches in improving functional and cognitive outcomes in older adults.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Kozlu
    • Zonguldak, Kozlu, Turkey (Türkiye), 67600
      • Recruiting
      • Zonguldak Bülent Ecevit University
      • Contact: Sanem ŞENER, PhD; Phone Number: +90 553 591 83 96; Email: sanemsener@yahoo.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Participants aged 65 to 74 years.

Berg Balance Scale (BBS) score between 41 and 56.

Tinetti Performance Oriented Mobility Assessment (POMA) score between 19 and 23.

Mini-Mental State Examination (MMSE) score between 18 and 30.

Independent in activities of daily living.

Able to walk without assistive devices.

Capable of using video call applications for telerehabilitation sessions.

Exclusion Criteria:

Participants younger than 65 years.

Individuals with cardiovascular diseases.

Amputees.

Individuals with severe cognitive impairment.

Individuals with significant visual or hearing impairments.

Individuals without internet access.

Individuals unable to use video call applications for telerehabilitation sessions.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Telerehabilitation Group; Participants will perform supervised telerehabilitation dual-task exercises at home for 4 weeks, 3 days per week, to improve balance, posture, cognitive function, and reduce fall risk. Each session includes warm-up, dual-task exercises (motor + cognitive), and cool-down.	Other: Telerehabilitation Based Dual-Task Exercises; Participants perform 4-week home-based dual-task exercises 3 days/week via video call with a physiotherapist. Each session includes 5 minutes of warm-up, 50 minutes of combined motor and cognitive exercises, and 5 minutes of cool-down. Motor tasks focus on balance and posture (semi-tandem, tandem walking, single-leg stance, directional changes). Cognitive tasks are performed simultaneously, including counting, naming objects/colors/animals, simple arithmetic, memory, and sequencing tasks. Task difficulty is progressively increased weekly, and intensity is adjusted individually. The physiotherapist monitors exercise form and safety visually during each session.
Experimental: Control Group; Participants will receive an educational brochure including guidance on posture, balance, safe activity, sleep, and the dual-task exercises provided to the intervention group. Participation will be monitored weekly by phone.	Other: Educational Brochure and Phone Follow-Up; Participants receive a brochure covering posture, balance, sleep hygiene, safe physical activity, and the dual-task exercises provided to the intervention group. Weekly phone calls are made to monitor adherence, encourage engagement, and answer questions. Participants perform exercises independently at home, following brochure instructions. No structured telerehabilitation sessions are provided.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Balance performance	Berg Balance Scale (BBS) will be used to assess static and dynamic balance in older adults. Participants perform 14 items evaluating daily functional movements, each scored 0-4 points, total score 0-56. Higher scores indicate better balance. Assessments will be conducted at baseline, after 4-week intervention, and at 1-month follow-up.	Baseline, 4 weeks, 1 month
Fall risk and fear of falling	Falls Efficacy Scale - International (FES-I) will be used to evaluate participants' concern about falling during 16 daily activities. Each item is scored 1-4, with higher scores indicating greater fear of falling. Assessments will be conducted at baseline, after 4-week intervention, and at 1-month follow-up.	Baseline, 4 weeks, 1 month
Sleep quality	Pittsburgh Sleep Quality Index (PSQI) will be used to evaluate sleep quality and disturbances over the past month. Total score ranges 0-21; higher scores indicate poorer sleep quality. Assessments will be performed at baseline, after 4-week intervention, and at 1-month follow-up.	Baseline, 4 weeks, 1 month
Balance and gait performance	Tinetti Performance Oriented Mobility Assessment (POMA) will be used to assess both balance (9 items) and gait performance (7 items) in older adults. Each item is scored 0-2 (0 = unable, 1 = partial/unsafe, 2 = safe and correct), with a total score ranging from 0 to 28. Fall risk is classified as high (<19), medium (19-23), or low (≥24). Assessments will be conducted at baseline, after the 4-week intervention, and at 1-month follow-up.	Baseline, 4 weeks, 1 month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Functional mobility	Timed Up and Go (TUG) Test will be performed to evaluate mobility and fall risk. Participants rise from a chair, walk 3 meters, turn, return, and sit; time to complete is measured. Longer times indicate reduced mobility. Measurements will be performed at baseline, after 4-week intervention, and at 1-month follow-up.	Baseline, 4 weeks, 1 month
Mental state	Mini-Mental State Examination (MMSE) will be used to evaluate orientation, attention, memory, language, and calculation skills. Total score ranges 0-30; lower scores indicate cognitive impairment. Assessments will be performed at baseline, after 4-week intervention, and at 1-month follow-up.	Baseline, 4 weeks, 1 month
Cognitive function	Montreal Cognitive Assessment (MoCA) will be used to evaluate attention, executive functions, memory, language, visuospatial skills, abstraction, and orientation. Score ranges 0-30; higher scores indicate better cognitive performance. Assessments will be performed at baseline, after 4-week intervention, and at 1-month follow-up.	Baseline, 4 weeks, 1 month

Collaborators and Investigators

• Sponsor: Bulent Ecevit University

Publications and helpful links

General Publications

• Ghai S, Ghai I, Effenberg AO. Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis. Clin Interv Aging. 2017 Mar 23;12:557-577. doi: 10.2147/CIA.S125201. eCollection 2017.
• Li F, Harmer P. Prevalence of Falls, Physical Performance, and Dual-Task Cost While Walking in Older Adults at High Risk of Falling with and Without Cognitive Impairment. Clin Interv Aging. 2020 Jun 22;15:945-952. doi: 10.2147/CIA.S254764. eCollection 2020.
• Cottrell MA, O'Leary SP, Raymer M, Hill AJ, Comans T, Russell TG. Does telerehabilitation result in inferior clinical outcomes compared with in-person care for the management of chronic musculoskeletal spinal conditions in the tertiary hospital setting? A non-randomised pilot clinical trial. J Telemed Telecare. 2021 Aug;27(7):444-452. doi: 10.1177/1357633X19887265. Epub 2019 Nov 26.

Study record dates

Study Major Dates

• Study Start (Actual): February 2, 2026
• Primary Completion (Estimated): June 2, 2026
• Study Completion (Estimated): July 2, 2026

Study Registration Dates

• First Submitted: March 10, 2026
• First Submitted That Met QC Criteria: March 10, 2026
• First Posted (Actual): March 16, 2026

Study Record Updates

• Last Update Posted (Actual): March 16, 2026
• Last Update Submitted That Met QC Criteria: March 10, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: cognitive function; balance; sleep quality; telerehabilitation; dual-task exercise
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Mental Disorders; Sleep Disorders, Intrinsic; Dyssomnias; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders
• Other Study ID Numbers: GeriatricDualTaskTelerehab2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No