Tai Chi for Risk of Falls. A Meta‐analysis

ArticleinJournal of the American Geriatrics Society 65(9) · July 2017with 117 Reads
Abstract
Objectives: To analyze the effectiveness of tai chi for falls prevention. Design: Systematic review and meta-analysis. Setting: Pubmed, Scopus, CINHAL, and Physiotherapy Evidence Database (PEDro) were searched to May 26, 2016. Participants: Older adult population and at-risk adults. Intervention: Randomized controlled trials analyzing the effect of tai chi versus other treatments on risk of falls. Measurements: The incidence rate ratio (IRR) for falls incidence and hazard ratio (HR) for time to first fall. Results: The search strategy identified 891 potentially eligible studies, of which 10 met the inclusion criteria. There was high-quality evidence of a medium protective effect for fall incidence over the short term (IRR = 0.57; 95% CI = 0.46, 0.70) and a small protective effect over the long term (IRR = 0.87; 95% CI = 0.77, 0.98). Regarding injurious falls, we found very low-quality evidence of a medium protective effect over the short term (IRR = 0.50; 95% CI = 0.33, 0.74) and a small effect over the long term (IRR = 0.72; 95% CI = 0.54, 0.95). There was no effect on time to first fall, with moderate quality of evidence (HR = 0.98; 95% CI = 0.69, 1.37). Conclusion: In at-risk adults and older adults, tai chi practice may reduce the rate of falls and injury-related falls over the short term (<12 months) by approximately 43% and 50%, respectively. Tai chi practice may not influence time to first fall in these populations. Due to the low quality of evidence, more studies investigating the effects of tai chi on injurious falls and time to first fall are required.

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  • ... 9,16 Thus, of the 3 exercise interven- tions, TJQMBB yielded the greatest reduction in number of falls, whereas both TJQMBB and multimodal exercise signifi- cantly improved physical function and global cognitive func- tion compared with the stretching exercise control. The findings from this study are aligned with systematic review and meta-analyses on the effect of exercise on reduc- ing the incidence of falls 7,26 and are commensurate with the results from a meta-analysis 27 and previous controlled tai ji quan studies involving community-dwelling older adults 13,28,29 and persons with Parkinson disease. 30 This clinically ori- ented and functionally driven tai ji quan-based program, 21 how- ever, is shown to be more efficacious in the magnitude of re- duction in the incidence of falls compared with earlier trial or meta-analysis results. ...
    ... 30 This clinically ori- ented and functionally driven tai ji quan-based program, 21 how- ever, is shown to be more efficacious in the magnitude of re- duction in the incidence of falls compared with earlier trial or meta-analysis results. 13,[27][28][29] Our study also extends the current literature by compar- ing, head-to-head, 2 evidence-based interventions, 13,16 with the results showing 31% fewer falls in TJQMBB compared with multimodal exercise, thus adding new clinical knowledge on the effectiveness of a therapeutically tailored tai ji quan in- tervention strategy for preventing falls among older adults. The findings that TJQMBB was more effective than a multimodal exercise program are of considerable practical importance be- cause they suggest the utility of an equipment-free, low-cost, non-space-constrained exercise intervention in addressing the clinical problem of falls and balance deficits in the older popu- lation. ...
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  • ... Some researcher [4,[11][12][13][14] have pointed out that there are effective ways to improve the static and dynamic balance in elderly people to reduce the fear of falls, and that training Tai Chi are proven to be effective than other training methods for preventing falls in at risk populations. Ancient Chinese Tai Chi practice reduces the risk of deadly falls by 43% and 50%, also that there are many factors for falling, and a great percentage of falls of elderly. ...
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  • ... The interventions focused on the realisation of physical activity have shown their effectiveness, and that it is possible to delay and, in many cases, reverse fragility and dependence. The same goes for the practice of Tai-Chi, which can help reduce the risk of suffering a fall in the older adult population [23,24]. However, despite the fact that we carry out preventive interventions and work on the physical condition of the elderly, they will still be subject to the risk of falling and this is where JUA represents a unique intervention, proposing strategies of action to fall safely and securely, to retain mobility on the ground (once the fall has occurred) and to get back to a standing position. ...
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  • ... One meta-analysis examined the effect of Tai-Chi on the incidence of falls and time to first fall in adults aged 56 to 98 years compared to usual care or other interventions in 10 randomised controlled trials 18 . Interventions were typically of 1-hour duration and delivered at a frequency of 1-3 times per week for 12-26 weeks. ...
  • Chapter
    In diesem Kapitel werden die unterschiedlichen Achtsamkeitsverfahren dargestellt. Generell lässt sich zwischen statischen und dynamischen Verfahren unterscheiden. Zu den statischen Verfahren gehören verschiedene Meditationsformen, wie die kontemplative Meditation oder die Metta-Meditation, die Meditation der liebenden Güte. Auch das „Mindfulness-based stress reduction“-Programm von Jon Kabat-Zinn kann zu diesen Verfahren gezählt werden. Yoga, Tai-Chi und Qigong zählen zu den bewegungsbasierten Achtsamkeitsverfahren. Dabei gibt es zahlreiche Differenzierungen, die gerade auch das Yoga betreffen und im Rahmen dieses Buches nicht alle erwähnt werden können. Ergänzt wird dieses Kapitel noch durch einen Exkurs über die Komponente des Selbstmitgefühls. Sowohl die stillen als auch bewegungsbasierten Achtsamkeitsverfahren können von Kindern und Erwachsenen praktiziert werden. Mittlerweile gibt es zahlreiche Studien, die die Wirksamkeit der Verfahren für unterschiedliche Gruppen und unterschiedliche Settings untersucht und positive Effekte gezeigt haben, wobei in allen Studien der Ruf nach weiteren umfassenderen Studien deutlich wird.
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    Purpose of ReviewTai Chi (TC) is expanding as a holistic intervention. The purpose of this paper is to provide a historical perspective on TC and how its original preventative tenants can be applied today. TC can go far beyond its accepted use for balance and falls prevention and has benefits for a wide variety of physical, mental, and social health conditions common with aging. Recent FindingsUsing current (last 5 years) evidence from PubMed (meta-analyses and systematic reviews), the merits of TC as an integrative intervention and preventative tool are analyzed by key causes of mortality and morbidity found in older adults. SummaryTC is a readily adaptable exercise accessible to a wide variety of ages and skill levels. Traditional free-standing TC can be modified to seated, standing with side support, and or walker support versions. TC can be used in individual or group community-based settings to promote wellness.
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    Tai Chi has frequently been used as a preventive measure against falling in at-risk populations. However, studies have yielded contradictory results, and literature reviews have considered only a small number of trials and have not addressed some key aspects, such as sources of heterogeneity and publication bias. This study includes 13 controlled trials published before June 2015 that analyzed the effectiveness of Tai Chi in fall prevention in populations of frail and at-risk adults. The effect measure used in this meta-analysis was absolute risk reduction (ARR) with a 95% confidence interval (CI). According to our findings, practice of Tai Chi significantly prevents the risk of falling (ARR, [Formula: see text]; 95% CI: [Formula: see text], [Formula: see text]). The heterogeneity of results across the trials was low, with a reduced risk of publication bias, and no significant effect differences were observed between studies comparing Tai Chi with other interventions or non-treatment. We therefore conclude that Tai Chi is more effective than other measures, or no intervention, for fall prevention in at-risk populations. Further research is warranted to analyze the consequences of falls and to study the episodes rather than the cases of falls.
  • Article
    Introduction: This study sought to estimate the incidence, average cost, and total direct medical costs for fatal and non-fatal fall injuries in hospital, ED, and out-patient settings among U.S. adults aged 65 or older in 2012, by sex and age group and to report total direct medical costs for falls inflated to 2015 dollars. Method: Incidence data came from the 2012 National Vital Statistics System, 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 2012 Health Care Utilization Program National Emergency Department Sample, and 2007 Medical Expenditure Panel Survey. Costs for fatal falls were derived from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System; costs for non-fatal falls were based on claims from the 1998/1999 Medicare fee-for-service 5% Standard Analytical Files. Costs were inflated to 2015 estimates using the health care component of the Personal Consumption Expenditure index. Results: In 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries. Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015. Fall incidence as well as total cost increased with age and were higher among women. Conclusion: Medically treated falls among older adults, especially among older women, are associated with substantial economic costs. Practical application: Widely implementing evidence-based interventions for fall prevention is essential to decrease the incidence and healthcare costs associated with these injuries.
  • Article
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    Objective To examine the effects of stepping interventions on fall risk factors and fall incidence in older people. Data source Electronic databases (PubMed, EMBASE, CINAHL, Cochrane, CENTRAL) and reference lists of included articles from inception to March 2015. Study selection Randomised (RCT) or clinical controlled trials (CCT) of volitional and reactive stepping interventions that included older (minimum age 60) people providing data on falls or fall risk factors. Results Meta-analyses of seven RCTs (n=660) showed that the stepping interventions significantly reduced the rate of falls (rate ratio=0.48, 95% CI 0.36 to 0.65, p<0.0001, I2=0%) and the proportion of fallers (risk ratio=0.51, 95% CI 0.38 to 0.68, p<0.0001, I2=0%). Subgroup analyses stratified by reactive and volitional stepping interventions revealed a similar efficacy for rate of falls and proportion of fallers. A meta-analysis of two RCTs (n=62) showed that stepping interventions significantly reduced laboratory-induced falls, and meta-analysis findings of up to five RCTs and CCTs (n=36–416) revealed that stepping interventions significantly improved simple and choice stepping reaction time, single leg stance, timed up and go performance (p<0.05), but not measures of strength. Conclusions The findings indicate that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%. This clinically significant reduction may be due to improvements in reaction time, gait, balance and balance recovery but not in strength. Further high-quality studies aimed at maximising the effectiveness and feasibility of stepping interventions are required. Systematic reviews registration number CRD42015017357.