Motor-cognitive interactions in older adults: reliability and comparison of Trail Walking and Stepping Trail Making Tests

PURPOSE: Integrated motor-cognitive assessments, such as the Stepping Trail Making Test (S-TMT) and Trail Walking Test (TWT), have shown promise in predicting fall risk and assessing cognitive function. However, their reliability and validity need clarification in European populations.

METHODS: This intra-rater test-retest reliability study involved community-dwelling older adults aged 65+. Participants completed both the S-TMT and the TWT across two sessions, 1 week apart, to assess reliability and correlation. The S-TMT required participants to step on numbered squares in sequence on a 1 × 1 meter mat, while the TWT involved walking through a randomized sequence of 15 numbered flags within a 5 × 5 meter area. Test-retest reliability was evaluated using intraclass correlation coefficients (ICC), and correlations were assessed using Pearson correlation.

RESULTS: We included 34 participants (mean age 74.9, 23 female). Both tests demonstrated good-to-excellent reliability: the S-TMT showed an ICC of 0.81 to 0.93, while the TWT showed an ICC of 0.83 to 0.97 based on number of trials. The S-TMT exhibited significant learning effects between sessions, whereas the TWT showed minimal learning effects. A moderate correlation (r = 0.48) was found between the tests, indicating they assess different aspects of motor-cognitive function.

CONCLUSION: The S-TMT and TWT are reliable and complimentary tools for assessing motor-cognitive interactions in older adults. The S-TMT is suitable for single assessment as learning effects limits short-time re-testing, whereas the TWT seems more appropriate for repeated testing. Further studies should validate these results across diverse populations and explore their predictive value for long-term outcomes.