Author: Vergara-Diaz G1, Osypiuk K2, Hausdorff JM3,4,5,6,7, Bonato P1, Gow BJ2, Miranda JG1, Sudarsky LR8, Tarsy D9, Fox MD9,10, Gardiner P11, Thomas CA12, Macklin EA10, Wayne PM2
Affiliation:
1Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.
2Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
3Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.
4Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
5Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel.
6Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.
7Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
8Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts.
9Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
10Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
11Department of Family Medicine. Boston University School of Medicine, Boston, MA.
12Department of Neurology, Boston University Medical Campus, Boston, MA.
Conference/Journal: Glob Adv Health Med.
Date published: 2018 May 17
Other:
Volume ID: 7 , Pages: 2164956118775385 , Special Notes: doi: 10.1177/2164956118775385. eCollection 2018. , Word Count: 302
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
PMID: 29796338 PMCID: PMC5960860 DOI: 10.1177/2164956118775385
