Efficacy and safety of Tai Chi for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background and objective: In Parkinson's disease (PD), wearing off and side effects of long-term medication and complications pose challenges for neurologists. Although Tai Chi is beneficial for many illnesses, its efficacy for PD remains uncertain. The purpose of this review was to evaluate the efficacy and safety of Tai Chi for PD.

Methods: Randomized controlled trials (RCTs) of Tai Chi for PD were electronically searched by the end of December 2013 and identified by two independent reviewers. The tool from the Cochrane Handbook 5.1 was used to assess the risk of bias. A standard meta-analysis was performed using RevMan 5.2 software.

Results: Ten trials with PD of mild-to-moderate severity were included in the review, and nine trials (n = 409) were included in the meta-analysis. The risk of bias was generally high in the blinding of participants and personnel. Improvements in the Unified Parkinson's Disease Rating Scale Part III (mean difference (MD) -4.34, 95% confidence interval (CI) -6.67--2.01), Berg Balance Scale (MD: 4.25, 95% CI: 2.83-5.66), functional reach test (MD: 3.89, 95% CI: 1.73-6.04), Timed Up and Go test (MD: -0.75, 95% CI: -1.30--0.21), stride length (standardized MD: 0.56, 95% CI: 0.03-1.09), health-related quality of life (standardized MD: -1.10, 95% CI: -1.81--0.39) and reduction of falls were greater after interventions with Tai Chi plus medication. Satisfaction and safety were high. Intervention with Tai Chi alone was more effective for only a few balance and mobility outcomes.

Conclusions: Tai Chi performed with medication resulted in promising gains in mobility and balance, and it was safe and popular among PD patients at an early stage of the disease. This provides a new evidence for PD management. More RCTs with larger sample size that carefully address blinding and prudently select outcomes are needed. PROSPERO registration number CRD42013004989.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow diagram of study selection and identification.

The total number of articles and studies differs because one article reported two independent trials and two articles reported different outcomes for the same trial.

Figure 2. Risk of bias summary.

The article reported two independent trials that are labeled as project 1 and 2. Blank entries mean that the outcome was not reported. CRO, clinician-reported outcome; sPRO, subjective patient-reported outcome; oPRO, objective patient-reported outcome.

Figure 3. The effect of Tai Chi on UPDRS III score.

Subgroup analysis was performed according to whether or not medications were included in the intervention. A random model was used to address the high heterogeneity. UPDRS III, Unified Parkinson's Disease Rating Scale Part III.

Figure 4. The effect of Tai Chi on BBS score.

Subgroup analysis was performed according to whether or not medications were included in the intervention. A random model was used to address the high heterogeneity. BBS, Berg Balance Scale.

Figure 5. The effect of Tai Chi on FRT.

Subgroup analysis was performed according to whether or not medications were included in the intervention. A random model was used to address the high heterogeneity. FRT, functional reach test.

Figure 6. The effect of Tai Chi on TUG.

Subgroup analysis was performed according to whether or not medications were included in the intervention. A random model was used to address the high heterogeneity. TUG, Timed Up and Go test.

Figure 7. The effect of Tai Chi on HRQOL.

Subgroup analysis was performed according to whether or not medications were included in the intervention. Standardized mean difference was calculated for PDQ-39 (short and long versions) and PDQ-39SI scores. HRQOL, health-related quality of life; PDQ-39, Parkinson's Disease Questionairre-39; PDQ-39SI, PDQ-39 Summary Index.

Figure 8. The effect of Tai Chi on gait velocity.

Subgroup analysis was performed according to whether or not medications were included in the intervention. Standardized mean difference was used for different units of velocity.

Figure 9. The effect of Tai Chi on stride length.

Subgroup analysis was performed according to whether or not medications were included in the intervention. Standardized mean difference was used for different units of stride length.