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Glob Adv Health Med. 2018 May 17;7:2164956118775385. doi: 10.1177/2164956118775385. eCollection 2018.

Tai Chi for Reducing Dual-task Gait Variability, a Potential Mediator of Fall Risk in Parkinson's Disease: A Pilot Randomized Controlled Trial.

Author information

1
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.
2
Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
3
Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.
4
Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
5
Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel.
6
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.
7
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
8
Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts.
9
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
10
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
11
Department of Family Medicine. Boston University School of Medicine, Boston, MA.
12
Department of Neurology, Boston University Medical Campus, Boston, MA.

Abstract

Objectives:

To assess the feasibility and inform design features of a fully powered randomized controlled trial (RCT) evaluating the effects of Tai Chi (TC) in Parkinson's disease (PD) and to select outcomes most responsive to TC assessed during off-medication states.

Design:

Two-arm, wait-list controlled RCT.

Settings:

Tertiary care hospital.

Subjects:

Thirty-two subjects aged 40-75 diagnosed with idiopathic PD within 10 years.

Interventions:

Six-month TC intervention added to usual care (UC) versus UC alone.

Outcome Measures:

Primary outcomes were feasibility-related (recruitment rate, adherence, and compliance). Change in dual-task (DT) gait stride-time variability (STV) from baseline to 6 months was defined, a priori, as the clinical outcome measure of primary interest. Other outcomes included: PD motor symptom progression (Unified Parkinson's Disease Rating Scale [UPDRS]), PD-related quality of life (PDQ-39), executive function (Trail Making Test), balance confidence (Activity-Specific Balance Confidence Scale, ABC), and Timed Up and Go test (TUG). All clinical assessments were made in the off-state for PD medications.

Results:

Thirty-two subjects were enrolled into 3 sequential cohorts over 417 days at an average rate of 0.08 subjects per day. Seventy-five percent (12/16) in the TC group vs 94% (15/16) in the UC group completed the primary 6-month follow-up assessment. Mean TC exposure hours overall: 52. No AEs occurred during or as a direct result of TC exercise. Statistically nonsignificant improvements were observed in the TC group at 6 months in DT gait STV (TC [20.1%] vs UC [-0.1%] group [effect size 0.49; P = .47]), ABC, TUG, and PDQ-39. UPDRS progression was modest and very similar in TC and UC groups.

Conclusions:

Conducting an RCT of TC for PD is feasible, though measures to improve recruitment and adherence rates are needed. DT gait STV is a sensitive and logical outcome for evaluating the combined cognitive-motor effects of TC in PD.

KEYWORDS:

Parkinson’s disease; Tai Chi; dual-task performance; feasibility; gait analysis; randomized trial

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