Tai Chi for Reducing Dual-task Gait Variability, a Potential Mediator of Fall Risk in Parkinson's Disease: A Pilot Randomized Controlled Trial.


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: <sup>1</sup>Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.

<sup>2</sup>Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.

<sup>3</sup>Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.

<sup>4</sup>Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.

<sup>5</sup>Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel.

<sup>6</sup>Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.

<sup>7</sup>Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.

<sup>8</sup>Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts.

<sup>9</sup>Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

<sup>10</sup>Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

<sup>11</sup>Department of Family Medicine. Boston University School of Medicine, Boston, MA.

<sup>12</sup>Department 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