• Thursday, February 16, 2012RSS Feed

    New in the Literature: Tai Chi in Patients With Parkinson Disease (N Engl J Med 2012; 366:511-519.)

    Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson disease, with additional benefits of improved functional capacity and reduced falls, say authors of an article published this month in NEJM 

    For this trial, researchers randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to 1 of 3 groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson Disease Rating Scale, and number of falls.

    The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline were 5.55 percentage points and 11.98 percentage points, respectively) and in directional control (10.45 percentage points and 11.38 percentage points, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai chi lowered the incidence of falls more than stretching did, but not more than resistance training did. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed.

    APTA member Johnny Galver, PT, coauthored the article.


    Comments

    Would like to know which type/ style of Tai Chi was used? Also, did the participants learn isolated therapeutic type motions, or they did practice a specific part of a specific "form". For instance, many classic "forms" incorporate 100 or more specific motions. Thanks!
    Posted by Gail, PT on 2/17/2012 3:58 PM
    I applaud the study, thank you group. I use Tai Chi principles consistently in my rehab work, with positive response. All of my work is one to one, it's good to see another study w/ numbers. Gail PT - look at Appendix for form sequences.
    Posted by Peter Kay PTA on 2/17/2012 4:44 PM
    Your willingness to devote the time and energy to do research are commendable. However, I do not understand the rationale for comparing Tai Chi to resistance training and stretching as neither are intervention techniques specifically related to improving balance. In other words, it seems the positive results of Tai Chi compared to the other groups for addressing balance and fall risk would be expected by physical therapy professionals. Why research to support what we already know? Research comparing Tai Chi to traditional balance training makes more sense.
    Posted by Laura Miele, PTA on 2/17/2012 5:08 PM
    But Tai Chi was not more effective at reducing fall risks. It would seem that this is would be of primary concern.
    Posted by John Stapleton on 2/19/2012 10:11 PM
    In response to John, Tai Chi did reduce fall risks moreso than stretching but not more than resistance training. The implications are great for supporting active stretching and posture that takes place in Tai Chi versus traditional muscle stretching techniques.
    Posted by Kelly King, PT on 2/23/2012 10:27 AM
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