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Kim H, Cho J, Cho S, Shin JH. Ankle stiffness asymmetry is associated with balance function in individuals with chronic stroke. Sci Rep 2023; 13:15721. [PMID: 37735600 PMCID: PMC10514256 DOI: 10.1038/s41598-023-41815-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
Ankle joint is one of important contributors on balance in stroke survivors. This study aimed to investigate the relationships of ankle stiffness symmetry ratios along the talocrural and subtalar axes with clinical balance measures and weight distribution during quiet standing in ambulatory chronic post-stroke survivors. The clinical trials involved 15 ambulatory elderly with chronic post-stroke hemiparesis and 15 healthy controls. Ankle stiffness was evaluated during non-weight-bearing isokinetic passive biaxial ankle movements, and ankle stiffness symmetry ratios between paretic and non-paretic ankle stiffness (SR: Inversion/Eversion SRIE & Dorsi-/Plantarflexion SRDP) were measured. A certified physiotherapist evaluated the Berg Balance Scale (BBS) and weight-distribution ratio (WDR) on bilateral force plates during quiet standing. Correlation coefficients, the factor analysis, and Pearson linear multiple regression were assessed with measured parameters. Correlation coefficients showed significances in-betweens; BBS and SRDP (r = -0.543, p = 0.022), WDR and SRIE (r = -0.667, p = 0.004), SRIE and SRDP (r = -0.604, p = 0.011). The exploratory factor analysis suggested four extracted factors; (1) Balance & Gait, (2) Stroke, (3) Symmetry and (4) Dimension. The first and second factors include general and pathological characteristics in stoke participants respectively. The third factor is associated with symmetrical characteristics explaining up to 99.9% of the variance. Multiple regression analysis showed ankle stiffness ratios predict BBS up to 60% of variance. The biaxial ankle stiffness ratio is a useful clinical variable that assesses balance function, in ambulatory chronic stroke survivors.
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Affiliation(s)
- Hogene Kim
- Department of Clinical Rehabilitation Research, National Rehabilitation Center, Ministry of Health & Welfare, 58 Samgaksan-ro, Gangbuk-gu, Seoul, 01022, South Korea.
| | - Jieun Cho
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Center, Ministry of Health & Welfare, 58 Samgaksan-ro, Gangbuk-gu, Seoul, 01022, South Korea
| | - Sangwoo Cho
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Center, Ministry of Health & Welfare, 58 Samgaksan-ro, Gangbuk-gu, Seoul, 01022, South Korea
| | - Joon-Ho Shin
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health & Welfare, 58 Samgaksan-ro, Gangbuk-gu, Seoul, 01022, South Korea
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Lai MH, Xu HC, Huang MC, Lu Y, Yang K, Jiang LM, Yu XM. Transcranial direct current stimulation combined with bodyweight support-tai chi footwork for motor function of stroke survivors: a study protocol of randomised controlled trial. BMJ Open 2023; 13:e065338. [PMID: 36882241 PMCID: PMC10008177 DOI: 10.1136/bmjopen-2022-065338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Our previous studies have proposed the bodyweight support-t'ai chi (BWS-TC) footwork training for stroke survivors with severe motor dysfunction and fear of falling, and have proven its positive effects for motor function. Transcranial direct current stimulation (tDCS) provides a non-invasive and safe way to modulate neuronal activity and provoke neuroplastic changes and to improve the motor function of stroke survivors. However, it is unclear whether the integration of BWS-TC and tDCS has synergistic effects on improving motor function of the stroke survivors. METHODS AND ANALYSIS This study will be an assessor-blinded randomised controlled trial involving 12-week intervention and 6-month follow-up. One hundred and thirty-five individuals with stroke will be randomly divided in a ratio of 1:1:1 into three groups. Control group A, control group B and intervention group C will receive tDCS and conventional rehabilitation programmes (CRPs), BWS-TC and CRP, tDCS-BWS-TC and CRP for 12 weeks, respectively. The primary outcome measures will include the efficacy (Fugl-Meyer Assessment), acceptability and safety of these interventions. The secondary outcome measures will include balance ability (ie, limits of stability and modified clinical test of sensory integration), walking function, brain structure and function, risk of falling, Barthel Index and 36-Item Short Form Survey. All outcomes will be assessed at baseline, 6 and 12 weeks during intervention, and 1, 3 and 6 months during the follow-up period. Two-way analysis of variance with repeated measures will be applied to examine the main effects of the group and the time factor and group-time interaction effects for all outcome measures. ETHICS AND DISSEMINATION Ethics approval was obtained from the ethics committee of the Shanghai Seventh People's Hospital (2021-7th-HIRB-017). The results of the study will be published in a peer-reviewed journal and presented at scientific conferences. TRIAL REGISTRATION NUMBER ChiCTR2200059329.
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Affiliation(s)
- Ming-Hui Lai
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hai-Chen Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Meng-Cui Huang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Lu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kun Yang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Li-Ming Jiang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Ming Yu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
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García-Muñoz C, González-García P, Casuso-Holgado MJ, Martínez-Calderón J, Heredia-Rizo AM. Are movement-based mindful exercises (QIGONG, TAI CHI, AND YOGA) beneficial for stroke and Parkinson's disease? A scoping review. Complement Ther Med 2023; 72:102912. [PMID: 36565791 DOI: 10.1016/j.ctim.2022.102912] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To synthesize evidence from systematic reviews on the effects of qigong, tai chi, and yoga in people with neurological diseases. METHODS A systematic search was conducted in PubMed, PsycINFO, Embase, CINAHL and Cochrane Library until September 2022. Methodological quality was assessed using the AMSTAR 2 tool. A qualitative synthesis of included reviews and meta-analyses was performed. Citation matrices and the corrected covered area were used to explore the overlap of randomized controlled trials among reviews. RESULTS Nineteen systematic reviews (containing 74 trials and 80 meta-analyses) in people with Parkinson's disease (PD) or stroke were included. The critical domains of the AMSTAR 2 were not satisfied in more than half of the reviews, and only 4 evaluated the certainty of the evidence. The overlap was very high (21.7%) and high (11%) for tai chi studies in PD and stroke, respectively. In people with PD, qigong, yoga, and tai chi can improve balance, with tai chi being beneficial to increase functional mobility. For stroke patients, tai chi was better than controls to enhance motor function and independence, but not for health-related quality of life and quality of sleep. Findings on balance, walking ability and depression were inconclusive in stroke population. CONCLUSIONS Qigong, tai chi, and yoga appear to be effective to improve balance performance in people with PD. Tai chi practice enhances motor function and independency in stroke patients.
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Affiliation(s)
- Cristina García-Muñoz
- Departamento de Enfermería y Fisioterapia, Facultad de Enfermería y Fisioterapia, Universidad de Cádiz, Avda. Ana de Viya 52, 11009 Cádiz, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Paula González-García
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain..
| | - María Jesús Casuso-Holgado
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Javier Martínez-Calderón
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Alberto Marcos Heredia-Rizo
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
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Park M, Song R, Ju K, Seo J, Fan X, Ryu A, Li Y, Jang T. Effects of Tai Chi and Qigong on the mobility of stroke survivors: A systematic review and meta-analysis of randomized trials. PLoS One 2022; 17:e0277541. [PMID: 36395145 PMCID: PMC9671349 DOI: 10.1371/journal.pone.0277541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke survivors often experience impaired mobility and physical functions. Tai Chi and Qigong have been shown to have physical and psychological benefits for stroke patients. PURPOSE To summarize the evidence on Tai Chi and Qigong for improving mobility in stroke survivors, specifically the ability to walk, dynamic balance, and activities of daily living (ADL). METHODS Independent searches of 16 electronic databases in English, Korean, and Chinese from their inception until December 2021 were conducted by two research teams. Methodological quality was assessed using Cochrane's risk of bias tool 2.0. Comprehensive Meta-Analysis 3.0 software was used to calculate effect sizes with subgroup analysis and to assess heterogeneity and publication bias. RESULTS The meta-analysis included 27 randomized trials (18 with Tai Chi and 9 with Qigong) on stroke survivors (N = 1,919). None of the studies were considered at high risk of bias, about 70% had some concerns, and 30% were considered low risk. Meta-analysis of 27 randomized controlled trials with random-effects models indicated that Tai Chi and Qigong effectively improved mobility, specifically on the ability to walk (Hedges'g = 0.81), dynamic balance (Hedges'g = 1.04), and ADL (Hedges'g = 0.43). The effects of Tai Chi and Qigong were significant for short-term and long-term programs (Hedges'g 0.91 vs. 0.75), and when compared with active controls and no treatment group (Hedges'g 0.81 vs. 0.73). CONCLUSION Tai Chi and Qigong performed for 12 weeks or less were effective in improving the mobility of stroke survivors. Further studies are warranted to assess whether Tai Chi and Qigong work best as an adjunct to rehabilitation, an effective alternative to rehabilitation or as a maintenance strategy, and whether the results could be further optimized by assessing different schools of Tai Chi and Qigong, different types of stroke patients, and different points in the post-stroke recovery process. PROSPERO REGISTRATION NUMBER This study has been registered on the UK National Institute for Health Research (http://www.crd.york.ac.uk/PROSPERO) PROSPERO registration number: CRD42020220277.
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Affiliation(s)
- Moonkyoung Park
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Rhayun Song
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
- * E-mail:
| | - Kyoungok Ju
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Jisu Seo
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Xing Fan
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Ahyun Ryu
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - YueLin Li
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Taejeong Jang
- Department of Nursing, Woosuk University, Wanju, Republic of Korea
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A Comprehensive Appraisal of Meta-Analyses of Exercise-Based Stroke Rehabilitation with Trial Sequential Analysis. Healthcare (Basel) 2022; 10:healthcare10101984. [PMID: 36292431 PMCID: PMC9602124 DOI: 10.3390/healthcare10101984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022] Open
Abstract
Meta-analysis is a common technique used to synthesise the results of multiple studies through the combination of effect size estimates and testing statistics. Numerous meta-analyses have investigated the efficacy of exercise programmes for stroke rehabilitation. However, meta-analyses may also report false-positive results because of insufficient information or random errors. Trial sequential analysis (TSA) is an advanced technique for calculating the required information size (RIS) and more restrictive statistical significance levels for the precise assessment of any specific treatment. This study used TSA to examine whether published meta-analyses in the field of stroke rehabilitation reached the RIS and whether their overall effect sizes were sufficient. A comprehensive search of six electronic databases for articles published before May 2022 was conducted. The intervention methods were divided into four primary groups, namely aerobic or resistance exercise, machine-assisted exercise, task-oriented exercise, and theory-based exercise. The primary outcome measure was gait speed and the secondary outcome measure was balance function. The data were obtained either from the meta-analyses or as raw data from the original cited texts. All data analysis was performed in TSA software. In total, 38 articles with 46 analysable results were included in the TSA. Only 17 results (37.0%) reached the RIS. In conclusion, meta-analysis interpretation is challenging. Clinicians must consider the RIS of meta-analyses before applying the results in real-world situations. TSA can provide accurate evaluations of treatment effects, which is crucial to the development of evidence-based medicine.
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Chen J, Xue X, Xu J, Zeng J, Xu F. Emerging Trends and Hotspots in Tai Chi Fall Prevention: Analysis and Visualization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148326. [PMID: 35886172 PMCID: PMC9320470 DOI: 10.3390/ijerph19148326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023]
Abstract
Recently, substantial studies have increased around the topic of the tai chi fall-prevention field. Few studies, however, have revealed the current progress and hotspots under a bibliometric analysis. Therefore, the present study aimed to conduct Citespace, a significant application for bibliometric analysis, to carry out the situation and trend in this field. This study has identified the core countries are the United States, China, Australia, and England, which are also the origins of the core institutions. Besides this, we also have found two large research groups led by Li and Sherrington. Moreover, the result has revealed that J Aging Phys Act and J Am Geriatr Soc are the primary journals. Geriatrics and gerontology, sport sciences, rehabilitation, and gerontology are the leading categories. Furthermore, one of the more important findings to come out in this study are that “elderly”, “Parkinson’s disease”, “vestibular rehabilitation”, “frail patient”, and “community fall prevention” are the research hotspots. “Women”, “proprioception”, “cognitive impairment”, “dementia”, “osteoarthritis”, and “stroke” are the potential research trend in the future. These findings suggest that the tai chi fall-prevention field has a broad research prospect. Although several questions remain uncertain currently, it is worthy for scholars to do further study.
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Affiliation(s)
- Jiesi Chen
- School of Physical Education, Hangzhou Normal University, Hangzhou 311121, China; (J.C.); (X.X.); (J.Z.)
| | - Xin Xue
- School of Physical Education, Hangzhou Normal University, Hangzhou 311121, China; (J.C.); (X.X.); (J.Z.)
| | - Jing Xu
- School of Physical Education, Nanjing Xiaozhuang University, Nanjing 211171, China;
| | - Jinshu Zeng
- School of Physical Education, Hangzhou Normal University, Hangzhou 311121, China; (J.C.); (X.X.); (J.Z.)
| | - Fei Xu
- School of Physical Education, Hangzhou Normal University, Hangzhou 311121, China; (J.C.); (X.X.); (J.Z.)
- Correspondence:
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Dong Y, Weng L, Hu Y, Mao Y, Zhang Y, Lu Z, Shi T, Du R, Wang W, Wang J, Wang X. Exercise for Stroke Rehabilitation: A Bibliometric Analysis of Global Research From 2001 to 2021. Front Aging Neurosci 2022; 14:876954. [PMID: 35783146 PMCID: PMC9247282 DOI: 10.3389/fnagi.2022.876954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo make a bibliometric analysis of global trends in research into exercise interventions for stroke between 2001 and 2021.MethodThis study did the systematic literature from 2001 to 2021 in Web of Science Core Collection. CiteSpace software was used to analyze the relationship of publications with countries, journals, authors, references, and keywords.ResultsA total of 3,484 publications were obtained in the bibliometric analysis. The number of publications increased gradually over the period. The United States have the most number of publications. The journal stroke had the most citations per paper (106.95) and the highest impact factor (IF 2020, 7.194). The most high frequency keywords are “stroke,” “rehabilitation,” and “recovery,” the top of burst key words are “health,” “speed,” and “aerobic exercise”.ConclusionThese findings provide the trends of exercise for stroke s and provided the potential research frontiers in the past 20 years. It will be a useful basis for further research into focus issues, cooperators, development trends.
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Affiliation(s)
- Yulin Dong
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Linman Weng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yinhu Hu
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Yuxing Mao
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Yajuan Zhang
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Zefeng Lu
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Tingting Shi
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Renren Du
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Wu Wang
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Jinyan Wang
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
- *Correspondence: Jinyan Wang,
| | - Xueqiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
- *Correspondence: Jinyan Wang,
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Effects of Tai Chi Exercise on Balance Function in Stroke Patients: An Overview of Systematic Review. Neural Plast 2022; 2022:3895514. [PMID: 35309256 PMCID: PMC8926482 DOI: 10.1155/2022/3895514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background Tai chi (TC) has received increased attention in stroke rehabilitation, yet services are greatly underutilized. An increasing number of systematic reviews and meta-analyses (SRs/MAs) have begun to investigate the effects of TC on balance function in stroke patients. The aim of this current study was to systematically collate, appraise, and synthesize the results of these SRs/MAs using a systematic overview. Methods Eight databases were searched: PubMed, Cochrane Library, Embase, Web of Science, CNKI, SinoMed, Chongqing VIP, and Wanfang Data. SRs/MAs of TC on balance function in stroke patients were included. Literature selection, data extraction, and assessment of the review quality were performed by two independent reviewers. Methodological quality was assessed by the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), reporting quality by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and evidence quality by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results Nine SRs/MAs were included in this study. For methodological quality, what resulted in unsatisfactory methodological quality was noncompliance with critical item 4 (using a comprehensive literature search strategy) and critical item 7 (providing the list of excluded research literature). For reporting quality, what resulted in unsatisfactory reporting quality was inadequate reporting of Q1 (protocol and registration), Q8 (search), Q15 (risk of bias across studies), Q16 (additional analyses), Q22 (risk of bias across studies), Q23 (additional analysis), and Q27 (funding). For GRADE, the evidence quality was high in 0, moderate in 3, low in 11, and very low in 6. Risk of bias was the most common factor leading to downgrading of evidence, followed by inconsistency, imprecision, publication bias, and indirectness. Conclusions TC may have beneficial effects on balance function in stroke survivors; however, this finding is limited by the generally low methodology, reporting quality, and evidence quality for published SRs/MAs.
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Faisal MAA, Chowdhury MEH, Khandakar A, Hossain MS, Alhatou M, Mahmud S, Ara I, Sheikh SI, Ahmed MU. An investigation to study the effects of Tai Chi on human gait dynamics using classical machine learning. Comput Biol Med 2022; 142:105184. [PMID: 35016098 DOI: 10.1016/j.compbiomed.2021.105184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/16/2021] [Accepted: 12/26/2021] [Indexed: 11/03/2022]
Abstract
Tai Chi has been proven effective in preventing falls in older adults, improving the joint function of knee osteoarthritis patients, and improving the balance of stroke survivors. However, the effect of Tai Chi on human gait dynamics is still less understood. Studies conducted in this domain only relied on statistical and clinical measurements on the time-series gait data. In recent years machine learning has proven its ability in recognizing complex patterns from time-series data. In this research work, we have evaluated the performance of several machine learning algorithms in classifying the walking gait of Tai Chi masters (people expert on Tai Chi) from the normal subjects. The study is designed in a longitudinal manner where the Tai Chi naive subjects received 6 months of Tai Chi training and the data was recorded during the initial and follow-up sessions. A total of 57 subjects participated in the experiment among which 27 were Tai Chi masters. We have introduced a gender, BMI-based scaling of the features to mitigate their effects from the gait parameters. A hybrid feature ranking technique has also been proposed for selecting the best features for classification. The research reports 88.17% accuracy and 93.10% ROC AUC values from subject-wise 5-fold cross-validation for the Tai Chi masters' vs normal subjects' walking gait classification for the "Single-task" walking scenarios. We have also got fairly good accuracy for the "Dual-task" walking scenarios (82.62% accuracy and 84.11% ROC AUC values). The results indicate that Tai Chi clearly has an effect on the walking gait dynamics. The findings and methodology of this study could provide preliminary guidance for applying machine learning-based approaches to similar gait kinematics analyses.
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Affiliation(s)
- Md Ahasan Atick Faisal
- Department of Electrical and Electronic Engineering, University of Dhaka, Dhaka, 1000, Bangladesh
| | | | - Amith Khandakar
- Department of Electrical Engineering, Qatar University, Doha, 2713, Qatar
| | - Md Shafayet Hossain
- Department of Electrical, Electronics and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi, Selangor, 43600, Malaysia
| | - Mohammed Alhatou
- Neuromuscular Division, Hamad General Hospital and Department of Neurology, Alkhor Hospital, Doha, 3050, Qatar
| | - Sakib Mahmud
- Department of Electrical Engineering, Qatar University, Doha, 2713, Qatar
| | - Iffat Ara
- Department of Electrical Engineering, Qatar University, Doha, 2713, Qatar
| | - Shah Imran Sheikh
- Department of Electrical Engineering, Qatar University, Doha, 2713, Qatar
| | - Mosabber Uddin Ahmed
- Department of Electrical and Electronic Engineering, University of Dhaka, Dhaka, 1000, Bangladesh.
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Han D, Cheng J, Qu J, Wen X, Liu X, Chen Y, Wen Y, Liu Z, Liu H, Huang Y. Effectiveness of Taijiquan in treating insomnia: A systematic review and meta-analysis of randomized controlled studies. Front Psychiatry 2022; 13:892453. [PMID: 36238941 PMCID: PMC9551091 DOI: 10.3389/fpsyt.2022.892453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sleep efficiency of <80% based on actigraphy was defined as insomnia as self-reported difficulty falling asleep or waking up at night three to four times per week. It is known that adequate sleep is very important for human wellbeing, affecting people's work and life, insomnia will seriously damage our daily life. There is no recognized non-drug treatment. Studies have found that Taijiquan has a positive effect on insomnia patients. This systematic review and meta-analysis will evaluate the effect of Taijiquan on insomnia. METHODS To find all randomized controlled trials exploring the effects of Taijiquan on insomnia patients in Chinese and English, eight databases (Pubmed, Embase, Cochrane library, Web of Science, CNKI, CBM, VIP, and Wanfang Data) were searched. The retrieval time is from database construction to October 2021. Searches were conducted in both English and Chinese language. A meta-analysis by mean difference (MD) and 95% confidence interval (CI) was performed with RevMan 5.3. The risk of bias for each study was accounted for according to the Cochrane Handbook. Our primary outcome was Pittsburg Sleep Quality Index. We explored sources of heterogeneity by comparing effect sizes across different types of etiology, country, control group, and intervention type. The protocol was pre-registered with PROSPERO, CRD42021284511. RESULTS Twenty-one RCTs published between 2004 and 2021 with 2,022 participants were included in this study. Twenty-one randomized controlled studies showed that Tai Chi significantly improved PSQI scores in patients with cancer, muscle fibrosis, and sub-health insomnia [MD = -1.16, 95% CI (-1.62, -0.71), P < 0.01]; There is insufficient evidence of improvement in patients with cerebrovascular disease [MD = -0.54, 95% CI (-1.58, 0.51), P = 0.31]; 8-form, 10-form or 24-form Yang's Taijiquan had the same effect in improving PSQI [MD = -1.33, 95% CI (-1.85, -0.81), P < 0.01]. When there is no treatment, exercise, exercise and health education as the control, taijiquan has a significant effect on insomnia treatment, and there is no difference in efficacy compared with cognitive behavioral therapy and health education (usual care) alone. CONCLUSIONS The results of the study showed that Taijiquan significantly improved sleep quality in healthy adults and patients with chronic diseases, which suggests that Taijiquan may be considered as an alternative behavioral therapy in the treatment of insomnia. In the future, more high-quality, well-controlled randomized trials are needed to better inform clinical decisions.
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Affiliation(s)
- Dongmiao Han
- School of Rehabilitation, Gannan Medical University, Ganzhou, China
| | - Jinling Cheng
- School of Rehabilitation, Gannan Medical University, Ganzhou, China
| | - Jiayang Qu
- School of Rehabilitation, Gannan Medical University, Ganzhou, China
| | - Xin Wen
- School of Rehabilitation, Gannan Medical University, Ganzhou, China.,Department of Rehabilitation Medicine, YueBei People's Hospital, Shaoguan, China
| | - Xuejin Liu
- School of Rehabilitation, Gannan Medical University, Ganzhou, China.,Department of Rehabilitation Medicine, YueBei People's Hospital, Shaoguan, China
| | - Yanfeng Chen
- School of Rehabilitation, Gannan Medical University, Ganzhou, China
| | - Youliang Wen
- School of Rehabilitation, Gannan Medical University, Ganzhou, China
| | - Zicai Liu
- School of Rehabilitation, Gannan Medical University, Ganzhou, China.,Department of Rehabilitation Medicine, YueBei People's Hospital, Shaoguan, China
| | - Huiyu Liu
- Department of Rehabilitation Medicine, YueBei People's Hospital, Shaoguan, China
| | - Ying Huang
- School of Rehabilitation, Gannan Medical University, Ganzhou, China
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Stroke Survivors' Personal Efficacy Beliefs and Outcome Expectations of Tai Chi Exercise: A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413001. [PMID: 34948610 PMCID: PMC8701141 DOI: 10.3390/ijerph182413001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
Prior qualitative research conducted among stroke survivors to explore the potential benefits and challenges of participating in tai chi exercise during stroke recovery is limited to those without depression. A qualitative descriptive approach was used. Social Cognitive Theory and Complex Systems Biology provided the theoretical framework, with focus group interview data collected from stroke survivors after participation in a tai chi intervention. Due to COVID-19, the focus group interview was conducted via online video conferencing. Content analysis of the de-identified transcript was conducted with a-priori codes based on the theoretical framework and inductive codes that were added during the analysis process. Lincoln and Guba's criteria were followed to ensure trustworthiness of the data. Community-dwelling stroke survivors (n = 7) participating in the focus group interviews were on average 68 years old, mainly retired (71%, n = 5), married women (57%, n = 4) with >13 years education (86%, n = 6). The three major themes were: personal efficacy beliefs, tai chi intervention active ingredients, and outcome expectations. Social Cognitive Theory underscored stroke survivors' personal efficacy beliefs, behavior, and outcome expectations, while Complex Systems Biology highlighted the active ingredients of the tai chi intervention they experienced. Participation in the 8-week tai chi intervention led to perceived physical, mental, and social benefits post stroke.
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12
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Wang LC, Ye MZ, Xiong J, Wang XQ, Wu JW, Zheng GH. Optimal exercise parameters of tai chi for balance performance in older adults: A meta-analysis. J Am Geriatr Soc 2021; 69:2000-2010. [PMID: 33769556 DOI: 10.1111/jgs.17094] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tai chi is considered a safe and low-cost treatment for improving balance ability among an older population. However, there is no existing evidence on the optimal exercise parameters of tai chi for improving balance in older adults. OBJECTIVES To investigate the optimal parameters of a tai chi intervention to improve balance performance of older adults. DESIGN Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING PubMed, Embase, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure, Wanfang, Chinese Science and Technology Periodical and China Biology Medicine were searched from inception until November 30, 2020. PARTICIPANTS Adults aged 60 years and over. MEASUREMENTS Two reviewers independently extracted the data and assessed the quality of the included studies according to the Physiotherapy Evidence Database (PEDro) scale. Subgroup analyses and meta-regressions were conducted to elucidate the impact of tai chi training programs on balance measures. RESULTS Twenty-six eligible RCTs were included in the meta-analysis. Pooled results showed that tai chi has moderate effects for improving proactive balance (weighted mean standardized mean differences [SMDwm ] = 0.61, 95% CI 0.33-0.89) and static steady-state balance (SMDwm = 0.62, 95% CI 0.30-0.95) and small effects for improving dynamic steady-state balance (SMDwm = 0.38, 95% CI 0.03-0.73) and balance test batteries (SMDwm = 0.47, 95% CI 0.13-0.81) in adults over 60 years of age. The practice frequency could predict the effects of tai chi on static steady-state balance, and the 24-form simplified Yang style tai chi (45-60 min/session, more than four sessions per week and at least 8 weeks) was the most optimal. CONCLUSIONS Tai chi is effective at improving the balance ability of adults over 60 years of age. A medium duration and high frequency of 24-form tai chi may be the optimal program for improving balance, but this evidence should be recommended with caution due to limitations of the methodology and small sample sizes.
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Affiliation(s)
- Le-Cong Wang
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ming-Zhu Ye
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian Xiong
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Qian Wang
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Wei Wu
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guo-Hua Zheng
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, China.,College of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai, China
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Phuphanich ME, Droessler J, Altman L, Eapen BC. Movement-Based Therapies in Rehabilitation. Phys Med Rehabil Clin N Am 2020; 31:577-591. [PMID: 32981580 PMCID: PMC7476461 DOI: 10.1016/j.pmr.2020.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Movement therapy refers to a broad range of Eastern and Western mindful movement-based practices used to treat the mind, body, and spirit concurrently. Forms of movement practice are universal across human culture and exist in ancient history. Research demonstrates forms of movement therapy, such as dance, existed in the common ancestor shared by humans and chimpanzees, approximately 6 million years ago. Movement-based therapies innately promote health and wellness by encouraging proactive participation in one's own health, creating community support and accountability, and so building a foundation for successful, permanent, positive change.
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Affiliation(s)
- Melissa E Phuphanich
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Health Care System, 11301 Wilshire Boulevard (117) Los Angeles, CA 90073, USA.
| | - Jonathan Droessler
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Health Care System, 11301 Wilshire Boulevard (117) Los Angeles, CA 90073, USA
| | - Lisa Altman
- Healthcare Transformation, VA Greater Los Angeles Health Care System, 11301 Wilshire Boulevard (117) Los Angeles, CA 90073, USA; University of California Los Angeles- UCLA, Los Angeles, CA, USA
| | - Blessen C Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Health Care System, 11301 Wilshire Boulevard (117) Los Angeles, CA 90073, USA; University of California Los Angeles- UCLA, Los Angeles, CA, USA
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14
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Tang YY, Woollacott M. Editorial: The Physiological and Genetic Influences of Meditation and Tai Chi on Mental, Emotional, and Movement Regulation. Front Physiol 2020; 11:581841. [PMID: 33192590 PMCID: PMC7645161 DOI: 10.3389/fphys.2020.581841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yi-Yuan Tang
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
- *Correspondence: Yi-Yuan Tang
| | - Marjorie Woollacott
- Department of Human Physiology, University of Oregon, Eugene, OR, United States
- Marjorie Woollacott
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15
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Abstract
Tai chi is an ancient Chinese internal martial art that has increased in popularity across the United States over the past 2 decades. Tai chi combines gentle physical movement, mental imagery, and natural, relaxed breathing. There is increasing scientific evidence showing the impact of tai chi exercise on multifaceted areas of health and well-being, including positive effects on cognition, depression, anxiety, sleep, cardiovascular health, and fall prevention. A review of the health benefits of tai chi exercise is presented, as well as recommendations for nurses seeking to answer patient questions about tai chi.
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Taylor-Piliae RE, Finley BA. Tai Chi exercise for psychological well-being among adults with cardiovascular disease: A systematic review and meta-analysis. Eur J Cardiovasc Nurs 2020; 19:580-591. [DOI: 10.1177/1474515120926068] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background:
Regular exercise is beneficial for adults with cardiovascular disease to improve psychological well-being. Tai Chi is a mind–body exercise thought to promote psychological well-being.
Aim:
Examine the efficacy of Tai Chi in improving psychological well-being among persons with cardiovascular disease.
Methods:
An electronic literature search of 10 databases (AMED, CINAHL, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted. Clinical trials that examined one or more aspect of psychological well-being, incorporated a Tai Chi intervention among cardiovascular disease participants, and were published in English or German languages were included. Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc.) was used to calculate the effect sizes (i.e. Hedges’ g) and the 95% confidence intervals using random effects models.
Results:
A total of 15 studies met the inclusion criteria, enrolling 1853 participants (mean age = 66 years old, 44% women). Outcomes included: quality of life (QOL), stress, anxiety, depression, and psychological distress. When Tai Chi was compared with controls, significantly better general QOL (Hedges’ g 0.96; p=0.02, I2=94.99%), mental health QOL (Hedges’ g=0.20; p=0.01, I2=15.93) and physical health QOL (Hedges’ g=0.40; p=0.00, I2=0%); with less depression (Hedges’ g=0.69; p=0.00, I2=86.64%) and psychological distress (Hedges’ g=0.58; p=0.00, I2=0%) were found.
Conclusions:
Few Tai Chi studies have been conducted during the past decade examining psychological well-being among older adults with cardiovascular disease. Further research is needed with more rigorous study designs, adequate Tai Chi exercise doses, and carefully chosen outcome measures that assess the mechanisms as well as the effects of Tai Chi.
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Affiliation(s)
| | - Brooke A Finley
- College of Nursing, University of Arizona, Tucson, USA
- The Meadows Behavioral Health, Wickenburg, USA
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Luo XC, Zhou J, Zhang YG, Liu YY, Li JJ, Zheng Z, Tong F, Feng F. Effects of Tai Chi Yunshou on upper limb function and balance in stroke survivors: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e21040. [PMID: 32702844 PMCID: PMC7373622 DOI: 10.1097/md.0000000000021040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Functional disability is the most common disorder that occurs after stroke and seriously affects the quality of life of stroke survivors. Tai Chi Yunshou (TCY), a fundamental form of Tai Chi, is a simple, convenient, and economical exercise therapy from ancient China. Some clinical trials have reported that it improves upper limb function and balance during stroke rehabilitation. Thus, we plan to conduct a systematic review to investigate the effects of TCY in stroke survivors. METHODS This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We will search English and Chinese databases for randomized controlled trials on TCY for stroke survivors from the dates when the databases were established to 1 July 2020. The English databases will include MEDLINE (PubMed), EMBASE (embase.com), and the Cochrane Central Register of Controlled Trials (Cochrane Library). In addition, the Chinese databases will include the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Science and Technology Periodical Database, the Wanfang database, and the Chinese Dissertation Database. The primary outcomes will include upper limb function and balance function, as measured by the Fugl-Meyer assessment and Berg balance scale, respectively. Two reviewers will independently screen the studies on the basis of the inclusion criteria and extract data. Review Manager (v5.3) will be used for data synthesis, and Cochrane Collaboration's tool will be used to assess the risk of bias. A fixed effects model or a random effects model will be selected based on the level of heterogeneity. The grading of recommendations assessment, development, and evaluation system will be used to evaluate the quality of the outcomes. RESULTS This systematic review results will be carried out after the completion of the protocol. CONCLUSIONS This protocol aims to guide a systematic review and meta-analysis investigating the effects of JCY on upper limb function and body balance in stroke survivors, which will provide evidence for post-stroke rehabilitation training. PROSPERO REGISTRATION NUMBER CRD42020169549.
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Affiliation(s)
- Xiao-Chao Luo
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Jin Zhou
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yong-Gang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University
| | - Yao-Yao Liu
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Jia-Jia Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Zhen Zheng
- Physical Education School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Feng Tong
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Fen Feng
- Hospital of Chengdu University of Traditional Chinese Medicine
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18
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Effectiveness of Hydrotherapy on Balance and Paretic Knee Strength in Patients With Stroke. Am J Phys Med Rehabil 2020; 99:409-419. [DOI: 10.1097/phm.0000000000001357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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19
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Wu B, Ding Y, Zhong B, Jin X, Cao Y, Xu D. Intervention Treatment for Myocardial Infarction With Tai Chi: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 101:2206-2218. [PMID: 32234412 DOI: 10.1016/j.apmr.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the efficacy of Tai Chi (TC) in patients with myocardial infarction and provide up-to-date evidence for its application. DATA SOURCES Three English databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) and 3 Chinese databases (China Knowledge Resource Integrated, Wanfang, Weipu) were screened for the time period between January 1, 1976 and May 31, 2019. STUDY SELECTION Seven randomized and controlled experiments were included. DATA EXTRACTION Two independent researchers under 2 independent advisors extracted and classified the data from all relevant studies based on the prespecified inclusion criteria and rules for data extraction. DATA SYNTHESIS A total of 615 patients were included in this study. The TC group was comprised of 294 patients, and the control group included 261 patients. The results revealed that TC has significant effects on the outcomes of the 6-minute walk (standardized mean difference, 1.30; 95% confidence interval, 0.50-2.11) and left ventricular ejection fraction (standardized mean difference, 1; 95% confidence interval, 0.43-1.57) compared with no or low-density exercise. Also, TC positively affected the quality of life, pro-B type natriuretic peptide, and short form-36. However, TC did not significantly affect activities of daily living (P=.060), sense of coherence-13 (P=.057) and N-terminal-pro-brain natriuretic peptide (P=.081). A moderate to high heterogeneity was observed across all comparisons. CONCLUSIONS Compared with no exercise or other types of low-intensity physical activities, TC improved the outcome of the 6-minute walk, left ventricular ejection fraction, quality of life, and short form-36 scores, but reduced the outcome of pro-B type natriuretic peptide in patients with myocardial infarction. Therefore, TC could be an effective exercise option for cardiac rehabilitation. More research should be done to identify the effects of TC on academic functioning and to determine ways of motivating patients to use preventive TC interventions.
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Affiliation(s)
- Bingxin Wu
- The Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangdon, China
| | - Yining Ding
- The Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangdon, China
| | - Biying Zhong
- The Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangdon, China
| | - Xiao Jin
- The Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangdon, China
| | - Yongtao Cao
- Department of Mathematical and Computer Sciences, Indiana University of Pennsylvania, Indiana, PA.
| | - Danping Xu
- Cardiac Disease Treatment Center, Guangdong Hospital of Traditional Chinese Medicine, Guangdong, China
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20
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Zhong D, Xiao Q, Xiao X, Li Y, Ye J, Xia L, Zhang C, Li J, Zheng H, Jin R. Tai Chi for improving balance and reducing falls: An overview of 14 systematic reviews. Ann Phys Rehabil Med 2020; 63:505-517. [PMID: 31981834 DOI: 10.1016/j.rehab.2019.12.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Falls play a pivotal role in the cause of injury or death and have become a public health problem, especially for older people. Tai Chi may be an effective approach to improving balance and reducing falls. However, the conclusions of systematic reviews (SRs) have been inconsistent and the quality needs to be appraised critically. OBJECTIVE To provide an overview of the methodological quality, risk of bias and reporting quality as well as quality of evidence of SRs of Tai Chi for improving balance and reducing falls. METHODS We conducted a systematic search of English- and Chinese-language SRs in 8 electronic databases, from inception to October 2019. The methodological quality, risk of bias, reporting quality and the quality of evidence were independently assessed by 2 reviewers who used the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Risk of Bias in Systematic reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Grades of Recommendations, Assessment, Development and Evaluation (GRADE). Primary outcomes were fall rate and the Berg Balance Scale score in older people and people with Parkinson disease. Secondary outcomes included these outcomes in stroke, osteoarthritis and heart failure. RESULTS A total of 14 relevant SRs were included: 13 were rated critically low quality and 1 was rated low quality by AMSTAR 2. By the ROBIS, all SRs were rated low risk in Phase 1 (assessing relevance) and Domain 1 of Phase 2 (study eligibility criteria). With regard to Domain 2, assessing the identification and selection of studies, 3 (21.4%) SRs were rated low risk. Eleven (71.4%) were rated low risk in Domain 3 (data collection and study appraisal), 11 (71.4%) were rated low risk in Domain 4 (synthesis and findings), and 9 (64.3%) were rated low risk in Phase 3 (risk of bias in the review). According to PRISMA, the reporting was relatively complete, but there were still some reporting flaws in the topic of protocol and registration (2/14, 14.3%), search strategy (5/14, 35.7%), risk of bias (6/14, 42.9%), additional analyses (6/14, 42.9%) and funding (4/14, 28.6%). Among the 14 SRs, Tai Chi had benefits for improving balance and reducing falls in older people and people with Parkinson disease; however, no definitive conclusions could be drawn for its effectiveness in stroke, osteoarthritis and heart failure. The level of evidence for fall rate was "moderate" to "high" for older people and "low" for those with Parkinson disease. The level of evidence of the Berg Balance Scale was "low" to "moderate" for older people and "low" for those with Parkinson disease. Among the downgraded factors, imprecision was the most common, followed by inconsistency and publication bias. CONCLUSIONS Tai Chi may be beneficial for improving balance and reducing falls in older people and those with Parkinson disease. Because of limitations and inconsistent conclusions, further rigorous, normative and comprehensive SRs are needed to provide robust evidence for definitive conclusions.
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Affiliation(s)
- Dongling Zhong
- Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Qiwei Xiao
- Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Xili Xiao
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Yuxi Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Jing Ye
- Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Lina Xia
- Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Chi Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Juan Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, PR China.
| | - Hui Zheng
- Chengdu University of Traditional Chinese Medicine, Chengdu, PR China.
| | - Rongjiang Jin
- Chengdu University of Traditional Chinese Medicine, Chengdu, PR China.
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Li J, Zhong D, Ye J, He M, Liu X, Zheng H, Jin R, Zhang SL. Rehabilitation for balance impairment in patients after stroke: a protocol of a systematic review and network meta-analysis. BMJ Open 2019; 9:e026844. [PMID: 31326927 PMCID: PMC6661695 DOI: 10.1136/bmjopen-2018-026844] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/24/2019] [Accepted: 06/11/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Multiple rehabilitation therapies have been reported to be effective for poststroke balance impairment. However, the comparative effectiveness of these rehabilitation therapies is still unclear. Therefore, the aim of this study is to summarise evidence and identify the most effective rehabilitation therapy for poststroke balance impairment. METHODS AND ANALYSIS The following databases will be searched: China Biology Medicine, China National Knowledge Infrastructure, Wan Fang Data, the Chinese Science and Technology Periodical Database, Medline, Excerpt Medical Database (EMBASE), Web of Science, the Cochrane Library, from inception to June 2019. All randomised controlled trials that have used rehabilitation interventions to treat poststroke balance impairment will be included. The primary outcomes are the Berg Balance Scale, the Fugl-Meyer Assessment (balance), the Postural Assessment Scale for Stroke, as well as the function in sitting test, the Sitting Balance Scale, the Ottawa Sitting Scale, the Activities-specific Balance Confidence Scale, the Overall Balance Index and the Brunel Balance Assessment. The secondary outcomes include the Barthel Index, the Functional Ambulation Category Scale, fall rates, the Timed Up and Go test, the MOS 36-Item Short-Form Health Survey, and adverse events. To ensure that all relevant studies are included without personal bias, study selection, data extraction and quality assessment will be performed independently by two reviewers. Risk of bias will be assessed with the Cochrane risk of bias assessment tool. Review Manager V.5.3 software will be used to make bias risk diagram and pairwise meta-analysis, while network data synthesis will be performed using WinBUGS V.1.4.3 and R software. ETHICS AND DISSEMINATION Ethics approval is not required for systematic review and network meta-analysis. The results will be submitted to a peer review journal or at a conference. TRIAL REGISTRATION NUMBER PROSPERO (CRD 42018107441).
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Affiliation(s)
- Juan Li
- School of Health Cultivation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongling Zhong
- School of Health Cultivation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Ye
- School of Acupuncture-Moxibustion and Tuina/The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingxing He
- School of Health Cultivation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xicen Liu
- School of Health Cultivation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Zheng
- School of Acupuncture-Moxibustion and Tuina/The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rongjiang Jin
- School of Health Cultivation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shao-lan Zhang
- Immunology Teaching and Research Section, Chengdu Medical College, Chengdu, China
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Rehabilitation interventions for improving balance following stroke: An overview of systematic reviews. PLoS One 2019; 14:e0219781. [PMID: 31323068 PMCID: PMC6641159 DOI: 10.1371/journal.pone.0219781] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 07/01/2019] [Indexed: 12/13/2022] Open
Abstract
Background The aim of this study was to synthesize evidence from systematic reviews, to summarise the effects of rehabilitation interventions for improving balance in stroke survivors. Methods We conducted an overview of systematic reviews (SRs). We included Cochrane Systematic Reviews and non-Cochrane Systematic Reviews of randomized-controlled clinical trials and not-randomized clinical trials, in all types of stroke, comparing the effects of interventions, control interventions and no interventions on balance-related outcomes. We conducted a comprehensive search of electronic databases, from inception to December 2017. Data extracted included: number and type of participants, type of intervention, control intervention, method of assessing risk of bias of primary studies, balance outcome measures and results of statistical meta-analyses. Methodological quality of included reviews was assessed using AMSTAR 2. A narrative description of the characteristics of the SRs was provided and results of meta-analyses summarised with reference to their methodological quality. Results 51 SRs (248 primary studies and 10,638 participants) met the inclusion criteria and were included in the overview. All participants were adults with stroke. A wide variety of different balance and postural control outcomes were included. 61% of SRs focussed on the effectiveness of physical therapy, 20% virtual reality, 6% electromechanical devices, 4% Tai-Chi, whole body vibration and circuit training intervention, and 2% cognitive rehabilitation. The methodology of 54% of SRs were judged to be of a “low or critically low” quality, 23% “moderate” quality and 22% “high” quality. Conclusions There are 51 SRs of evidence relating to the effectiveness of interventions to improve balance in people with stroke, but the majority of these are of poor methodological quality, limiting our ability to draw clear implications. Only 22% of these SRs were judged to be of high quality, highlighting the need to address important methodological issues within rehabilitation research.
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