Abstract P428: Effects of Tai Chi on Physical Function and Quality of Life in Chronic Stroke

Abstract

Background: Poor physical function and quality of life are ubiquitous post-stroke. Effective interventions to improve physical function and quality of life for stroke survivors are critically needed. Objective: Examine the effect of a Tai Chi (TC) intervention on physical function and quality of life. Methods: In a single-blind randomized clinical trial community-dwelling stroke survivors, aged ≥ 50 years and ≥ 3 months post-stroke, were assigned to: Yang style 24-posture TC (n=53), SilverSneakers® (SS, n=44) strength and range of movement exercise, or Usual Care (UC, n=48) for 12 weeks. TC and SS attended a 1-hour class 3 times/week, while UC had weekly phone calls. Standardized measures for Physical Function were the Short Physical Performance Battery (SPPB), Fall Rates and 2-Minute StepTest; and for Quality of Life were the Medical Outcomes Study SF-36, Center for Epidemiological Studies Depression and Pittsburgh Sleep Quality Index. Results: A total of 145 stroke survivors (47% women, mean age=70 years, time post-stroke=3 years, ischemic stroke=66%, hemiparesis=73%) enrolled. During the intervention, TC participants had 2/3 fewer falls (n=5 falls), than the SS (n=14 falls) and UC (n=15 falls) groups (χ2=5.60, p=0.06). All groups had improvements in the SPPB score (F 1,142 =85.29, p<0.01), after the 12-week intervention. Post-hoc tests following a significant interaction for the 2-Minute StepTest (F 2,142 =4.69, p<0.01) indicated TC (t 53 =2.45, p=0.02) and SS (t 44 =4.63, p<0.01) groups had significantly better aerobic endurance over time, though the UC group did not (t 48 =1.58, p=0.12). All groups reported better perceived physical (SF-36 PCS, F 1,142 =4.15, p=0.04) and mental health (SF-36 MCS, F 1,142 =15.60, p<0.01), after the intervention. There were no significant within group changes in perceived physical health (p>0.05), while significant improvements in perceived mental health (p < 0.05) were observed within all groups. No significant changes in depressive symptoms or sleep quality were observed (p>0.05). Attrition was 10% (n=14), and intervention adherence rates were 85%. Conclusions: Goals of stroke rehabilitation are to prevent disability, improve physical function and quality of life. TC and SS led to improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration. Our data suggest that a 12-week TC intervention may be more effective in reducing fall rates than SS or UC. Future studies examining the effectiveness of TC to reduce fall rates; and improve physical function and quality of life for community-dwelling stroke survivors are recommended.

Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials

“…Through a meta-analysis of other fall or balance ability tests, it was found that Tai Chi can effectively lengthen SLB test times (including with eyes open and closed) (MD [95% CI]: 9.63 [5.87, 13.40], p < 0.001) (25,26,30,33,34), increase BBS scores (MD [95% CI]: 1.80 [0.09, 3.51], p = 0.04) (21,26,29,32), and improve gait speed (MD [95% CI]: 9.26 [1.00, 17.52], p = 0.03) (8,25,26,34). In addition, Tai Chi did not have a significant effect on overall SPPB scores (27,35,37) or FES scores (24, 29, 34) (MD [95% CI]: −0.07 [−1.07, 0.93], 0.17 [−0.49, 0.83]; p = 0.89, 0.61; respectively) (Table 3).…”

“…Among the 24 articles, 6 reported participants with a history of falls (7,24,27,29,30,36), and 5 reported patients with a history of neurological diseases such as stroke or Parkinson's disease (8,21,35,37,38). The Tai Chi styles used in the interventions were mainly Sun-style (19, 25,33,34,36,39) or Yang-style (7,21,23,24,26,32,35,37,40), with one article using Chen-style (30) and others not specifying. Exercise frequency ranged from one to three times a week, with one article reporting five times a week (23).…”