Evaluation of Tai Chi Yunshou exercises on community-based stroke patients with balance dysfunction: a study protocol of a cluster randomized controlled trial

Jing Tao, Ting Rao, Lili Lin, Wei Liu, Zhenkai Wu, Guohua Zheng, Yusheng Su, Jia Huang, Zhengkun Lin, Jinsong Wu, Yunhua Fang, Lidian Chen, Jing Tao, Ting Rao, Lili Lin, Wei Liu, Zhenkai Wu, Guohua Zheng, Yusheng Su, Jia Huang, Zhengkun Lin, Jinsong Wu, Yunhua Fang, Lidian Chen

Abstract

Background: Balance dysfunction after stroke limits patients' general function and participation in daily life. Previous researches have suggested that Tai Chi exercise could offer a positive improvement in older individuals' balance function and reduce the risk of falls. But convincing evidence for the effectiveness of enhancing balance function after stroke with Tai Chi exercise is still inadequate. Considering the difficulties for stroke patients to complete the whole exercise, the current trial evaluates the benefit of Tai Chi Yunshou exercise for patients with balance dysfunction after stroke through a cluster randomization, parallel-controlled design.

Methods/design: A single-blind, cluster-randomized, parallel-controlled trial will be conducted. A total of 10 community health centers (5 per arm) will be selected and randomly allocated into Tai Chi Yunshou exercise group or balance rehabilitation training group. Each community health centers will be asked to enroll 25 eligible patients into the trial. 60 minutes per each session, 1 session per day, 5 times per week and the total training round is 12 weeks. Primary and secondary outcomes will be measured at baseline and 4-weeks, 8-weeks, 12-weeks, 6-week follow-up, 12-week follow-up after randomization. Safety and economic evaluation will also be assessed.

Discussion: This protocol aims to evaluate the effectiveness of Tai Chi Yunshou exercise for the balance function of patients after stroke. If the outcome is positive, this project will provide an appropriate and economic balance rehabilitation technology for community-based stroke patients.

Trial registration: Chinese Clinical Trial Registry: ChiCTR-TRC-13003641. Registration date: 22 August, 2013 http://www.chictr.org/usercenter/project/listbycreater.aspx .

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Tai Chi Yunshou exercise.

References

    1. Lamb SE, Ferrucci L, Volapto S, Fried LP, Guralnik JM, Gustafson Y. Risk factors for falling in home-dwelling older women with stroke: the women’s health and aging study. Stroke. 2003;34:494–501. doi: 10.1161/01.STR.0000053444.00582.B7.
    1. Belgen B, Beninato M, Sullivan PE, Narielwalla K. The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil. 2006;87:554–61. doi: 10.1016/j.apmr.2005.12.027.
    1. Eng JJ, Pang MY, Ashe MC. Balance, falls, and bone health: role of exercise in reducing fracture risk after stroke. J Rehabil Res Dev. 2008;45:297–313. doi: 10.1682/JRRD.2007.01.0014.
    1. Allison R, Dennett R. Pilot randomized controlled trial to assess the impact of additional supported standing practice on functional ability post stroke. Clin Rehabil. 2007;21:614–9. doi: 10.1177/0269215507077364.
    1. English CK, Hillier SL, Stiller KR, Warden-Flood A. Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial. Arch Phys Med Rehabil. 2007;88:955–63. doi: 10.1016/j.apmr.2007.04.010.
    1. Pyoria O, Talvitie U, Nyrkk H, Kautiainen H, Pohjolainen T, Kasper V. The effect of two physiotherapy approaches on physical and cognitive functions and independent coping at home in stroke rehabilitation. A preliminary follow-up study. Dis Rehabil. 2007;29:503–11. doi: 10.1080/09638280600902497.
    1. Chan DY, Chan CC, Au DK. Motor relearning programme for stroke patients: a randomized controlled trial. Clin Rehabil. 2006;20:191–200. doi: 10.1191/0269215506cr930oa.
    1. Langhammer B, Stanghelle JK, Lindmark B. Exercise and health-related quality of life during the first year following acute stroke: a randomized controlled trial. Brain Inj. 2008;22:135–45. doi: 10.1080/02699050801895423.
    1. Langhammer B, Stanghelle JK, Lindmark B. An evaluation of two different exercise regimes during the first year following stroke: a randomized controlled trial. Physiother Theory Pract. 2009;25:55–68. doi: 10.1080/09593980802686938.
    1. Hidler J, Nichols D, Pelliccio M, Brady K, Campbell DD, Kahn JH, et al. Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair. 2009;23:5–13. doi: 10.1177/1545968308326632.
    1. Lubetzky-Vilnai A, Kartin D. The effect of balance training on balance performance in individuals post stroke: a systematic review. J Neurol Phys Ther. 2010;34:127–37. doi: 10.1097/NPT.0b013e3181ef764d.
    1. Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010;363:743–54. doi: 10.1056/NEJMoa0912611.
    1. Wayne PM, Kaptchuk TJ. Challenges inherent to t’ai chi research: part I — t’ai chi as a complex multicomponent intervention. J Altern Complement Med. 2008;14:95–102. doi: 10.1089/acm.2007.7170A.
    1. Sheng JZ, Gu LX, Fu ZW, Tang H. The Comprehensive Book of Tai Ji Quan. 2. Beijing: People’s Sports Publishing House of China; 2006.
    1. Bonifonte P. T’Ai Chi for seniors: how to gain flexibility, strength, and inner peace. Franklin Lakes, NJ: New Page Book; 2004.
    1. Liao W. Tai Chi Classics. Boston, MA: Shambhala Publications, Inc; 1990.
    1. Wu G, Liu W, Hill J, Millon D. Spatial, temporal and muscle action pattern of Tai Chi gait. J Electromyogr Kinesiol. 2004;14:343–54. doi: 10.1016/j.jelekin.2003.09.002.
    1. Xu D, Hong Y, Li J, Chan K. Effect of Tai Chi exercise on proprioception of ankle and knee joints in old people. Br J Sports Med. 2004;38:50–4. doi: 10.1136/bjsm.2002.003335.
    1. Gatts SK, Woollacott MH. How Tai Chi improves balance: biomechanics of recovery to a walking slip in impaired seniors. Gait Posture. 2007;25:205–14. doi: 10.1016/j.gaitpost.2006.03.011.
    1. Gatts SK, Woollacott MH. Neural mechanisms underlying balance improvement with short-term Tai Chi training. Aging (Milano) 2006;18:7–19.
    1. Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, et al. Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2005;60:187–94. doi: 10.1093/gerona/60.2.187.
    1. Sattin RW, Easley KA, Wolf SL, Chen Y, Kutner MH. Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults. J Am Geriatr Soc. 2005;53:1168–78. doi: 10.1111/j.1532-5415.2005.53375.x.
    1. Tsang WW, Hui-Chan CW. Effect of 4- and 8-week intensive Tai Chi training on balance control in the elderly. Med Sci Sports Exerc. 2004;36:648–57. doi: 10.1249/.
    1. Tsang WW, Hui-Chan CW. Effects of Tai Chi on joint proprioception and stability limits in elderly subjects. Med Sci Sports Exerc. 2003;35:1962–71. doi: 10.1249/01.MSS.0000099110.17311.A2.
    1. Tsang WW, Hui-Chan CW. Comparison of muscle torque, balance, and confidence in older Tai Chi and healthy adults. Med Sci Sports Exerc. 2005;37:280–9. doi: 10.1249/01.MSS.0000152735.06282.58.
    1. Guo J, Jin SG. Sample estimation: Cluster randomization test design. Chin J Health Stat. 2008;25:117–9.
    1. Chinese Medical Association Various types of cerebrovascular disease diagnostic criteria. Zhonghua Shen Jing Ge Za Zhi. 1996;29:379.
    1. Physical activity and cardiovascular health:NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. In proceedings of NIH Consensus Conference. JAMA. 1996; 276:241–6.
    1. Tong YH. Chinese national standard movements of Tai Chi Competition 24. Chengdu: Chengdu erapress; 2009.
    1. Chinese Association of Rehabilitation Medicine . Technical Specification of Common Rehabilitation Therapy. Beijing: People’s Medical Publishing House; 2012.
    1. Blum L, Korner-Bitensky N. Usefulness of the Berg balance scale in stroke rehabilitation: a systematic review. Phys Ther. 2008;88:559–66. doi: 10.2522/ptj.20070205.
    1. Dongmei J, Tiebin Y. Berg balance scale and its clinical application. Chin Rehabil Theory and Pract. 2002;8:155–7.
    1. Stevenson TJ. Detecting change in patients with stroke using the Berg Balance Scale. Aust J Physiother. 2001;47:29–38. doi: 10.1016/S0004-9514(14)60296-8.
    1. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer Assessment of sensorimotor recovery followingcerebrovascular accident. Phys Ther. 1983;63:1606–10.
    1. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002;16:232–40. doi: 10.1177/154596802401105171.
    1. Van Wijck FM, Pandyan AD, Johnson GR, Barnes MP. Assessing motor deficits in neurological rehabilitation: Patterns of instrument usage. Neurorehabil Neural Repair. 2001;15:23–30. doi: 10.1177/154596830101500104.
    1. Leung SO, Chan CC, Shah S. Development of a Chinese version of the Modified Barthel Index– validity and reliability. Clin Rehabil. 2007;21:912–22. doi: 10.1177/0269215507077286.
    1. Ware J, Kosinski M, Keller SD. SF-36 Physical and Mental Health Summary Scales: a user’s manual. Boston: Health Assessment Lab; 1994.
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;12:57–62.
    1. Yanping H, Xueqin L. Test study of the Modified Falls Efficacy Scale among the elderly population in China. Zhonghua Hu Li Za Zhi. 2007;42:19–21.
    1. Kamide N, Shiba Y, Shibata H. Effects on balance, falls, and bone mineral density of a home-based exercise program without home visits in community-dwelling elderly women: a randomized controlled trial. J Physiol Anthropol. 2009;28:115–22. doi: 10.2114/jpa2.28.115.
    1. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8.
    1. Wu G, Keyes L, Callas P, Ren X, Bookchin B. Comparison of telecommunication, community, and homebased Tai Chi exercise programs on compliance and effectiveness in elders at risk for falls. Arch Phys Med Rehabil. 2010;91:849–56. doi: 10.1016/j.apmr.2010.01.024.
    1. Patterson RB, Pinto B, Marcus B, Colucci A, Braun T, Roberts M. Value of a supervised exercise program for the therapy of arterial claudication. J Vasc Surg. 1997;25:312–9. doi: 10.1016/S0741-5214(97)70352-5.

Source: PubMed

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