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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

The efficacy of Tai Chi Chuan in older adults: a systematic review

AP Verhagen, M Immink, A van der Meulen, and SM Bierma-Zeinstra.

Review published: 2004.

Link to full article: [Journal publisher]

CRD summary

This review found limited evidence that Tai Chi Chuan was effective in reducing falls and blood-pressure in the elderly. Given the origin of the intervention, the possibility of language and publication bias cannot be discounted. However, the review authors usefully identify the methodological limitations of the available evidence and point to the need for further research.

Authors' objectives

To assess the effect of Tai Chi Chuan (TCC) on fall prevention and physical function in elderly people.

Searching

MEDLINE, CINAHL and PsycLIT were searched using keywords (unspecified) to describe the intervention; the search dates were not specified. The references of reviews and identified RCTs were also checked. Only studies published in English, French, German or Dutch were eligible for inclusion.

Study selection

Study designs of evaluations included in the review

Randomised controlled trials (RCTs) and concurrent controlled trials (CCTs) were eligible for inclusion in the review.

Specific interventions included in the review

The studies had to include TCC as an intervention to be eligible. The TCC intervention was frequently a modified Yang style, and between studies the number of forms used varied from 10 to 24. The intensity of the intervention varied from 1 hour weekly for 10 weeks to 1 hour every morning for 1 year. The control groups received no treatment, a walking or jogging programme, balance training, a discussion group, aerobic exercise, or continued with usual activities (unspecified).

Participants included in the review

The study populations needed to be over 50 years of age to be eligible. The participants in the included studies were aged between 53 and 96 years with the majority being healthy individuals.

Outcomes assessed in the review

The studies had to include the primary outcome measure (falls) or one of the secondary outcome measures (balance and cardiorespiratory functions) to be eligible. The majority of studies reported on cardiorespiratory outcomes.

How were decisions on the relevance of primary studies made?

Two reviewers independently evaluated the studies for inclusion in the review.

Assessment of study quality

The studies were evaluated for methodological quality using the Delphi list developed by the Delphi Consensus. The list covers nine items: two on treatment allocation, three on blinding, two on data presentation and analysis, and two on eligibility of the study population and comparability of study groups. Each item was scored 'yes', 'no' or 'don't know'; all yes scores were summed to obtain an overall quality score. High-quality studies were defined as using adequate randomisation methods and blinding (person unspecified), or a quality score of at least 50% of the maximum available score.

Two reviewers scored the included studies independently. Any differences in scores were resolved by discussion with referral to a third reviewer, where necessary, to resolve disagreements. Information pertaining to quality was obtained from all publications of an included trial if multiple publications reported on a single study.

Data extraction

Standardised forms were used to extract data solely relating to the specified outcomes. The authors did not state how many reviewers performed the data extraction.

Methods of synthesis

How were the studies combined?

The studies were considered to be heterogeneous in terms of outcomes, therefore statistical pooling was not performed and the studies were summarised narratively.

How were differences between studies investigated?

Differences between the studies with regard to the study population, types of reference treatments and outcomes were evaluated.

Results of the review

Seven trials (n=505) were included: three RCTs (n=360) and four CCTs (n=145). Three CCTs assigned treatment using patient preference.

The overall quality score varied between 2 and 6 out of a possible 9 (two studies scored 2, two scored 3, two scored 5 and one scored 6). Most studies had at least three 'don't know' items, indicating overall poor reporting and methodological quality. The studies were often limited in sample size and most performed a pre-test post-test analysis instead of a between-group analysis; only one study reported using an intention-to-treat analysis. The drop-out rates were over 20% in four studies, whilst two studies presented no data on drop-outs. Three studies were deemed to be of a high quality.

All studies reported beneficial effects relating to TCC. In the only study to evaluate falls as an outcome, a statistically significant reduction of 47% in fall risk was observed for the TCC groups over the 4-month follow-up period. This study was designated as high quality, as were two further studies which found improvements in blood-pressure and physical activities.

Authors' conclusions

There was limited evidence of the effect of TCC in reducing risk of falls, reducing blood-pressure and improving functional status. Further research to determine the potential benefits of TCC is recommended.

CRD commentary

The review addressed a clear question in terms of the population, intervention, study design and outcomes. The searches covered three databases but the dates and search terms were not reported. No attempts to identify unpublished literature appear to have been made, so the possibility of publication bias cannot be ruled out. Although several languages were eligible for inclusion, language bias may be an issue for this review since articles on TCC may be published in Chinese, a language not covered by the review. Collectively, these issues would indicate that the search was not entirely adequate for a review of this particular intervention. Methods were used to minimise bias at the study selection stage. A quality assessment was conducted, although the use of quality summary scores is problematic as the designation of a study as 'high' can vary according to the scale used.

Adequate details on each of the included studies were presented, and the decision to combine the studies narratively was appropriate. To summarise, the authors have usefully highlighted the methodological limitations of the trials in the Western literature of TCC and their conclusion about the need for further RCTs appears appropriate.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that more RCTs are required to evaluate the effect of TCC in fall prevention and to evaluate other health care benefits.

Bibliographic details

Verhagen A P, Immink M, van der Meulen A, Bierma-Zeinstra S M. The efficacy of Tai Chi Chuan in older adults: a systematic review. Family Practice 2004; 21(1): 107-113. [PubMed: 14760055]

Indexing Status

Subject indexing assigned by NLM

MeSH

Accidental Falls /prevention & control; Aged; Blood Pressure; Chronic Disease /rehabilitation; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Postural Balance; Tai Ji; Treatment Outcome

AccessionNumber

12004006114

Database entry date

28/02/2007

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 14760055