ReviewThe effects of Tai Chi on fall prevention, fear of falling and balance in older people: A meta-analysis
Introduction
Each year approximately 30% of community-living persons aged 65 years and older experiences a fall. Of these falls, 55–70% result in physical injury of which 20% require medical attention (Gillespie et al., 2009, Nevitt et al., 1991, Rubenstein, 2006). Estimated costs of falls (for the year 2000) range from almost one billion pounds in the UK to 19.2 billion dollars in the USA (Scuffham et al., 2003, Stevens et al., 2006). Given the individual burden of falls and the societal costs, prevention of falls is desirable.
Until now, the merits of Tai Chi (TC) as a fall prevention intervention are promising but remain inconclusive (Chang et al., 2004, Gillespie et al., 2009, Harmer and Li, 2008, Hong and Li, 2007, Komagata and Newton, 2003, Li et al., 2004b, Li et al., 2005b, Low et al., 2009, Sherrington et al., 2008, Sjosten et al., 2008, Verhagen et al., 2004, Voukelatos et al., 2007, Wayne et al., 2004, Wu, 2002).
The integrated physical and cognitive components in TC could represent the additional value of TC compared with other exercise programs which mainly focus on physical aspects only. Besides the improvement of balance, TC might increase ‘self-awareness of balance’ and thereby decrease the fear of falling (Chan and Barlett, 2000, Howe et al., 2007, Li et al., 2005a, Zijlstra et al., 2007, Zwick et al., 2000).
Based on the type of TC, exercise dose, intervention duration and the study population, the effects of TC might vary. If TC is to be used as a community-based fall prevention intervention, insight is needed into the effectiveness of TC with regard to different populations, optimal exercise dose and effect maintenance.
This meta-analysis assesses the effectiveness of TC as a single intervention on fall rate, fear of falling and balance in healthy older people, to provide insight into the effectiveness of TC regarding setting, intervention dose and duration of follow-up.
Section snippets
Search strategy
A broad literature search on TC interventions was made covering Medline, Cinahl, Psychlit and the Cochrane Database for Systematic Reviews (CDSR) until January 31 2009. For all databases we used the highly sensitive search strategy for randomized clinical trials (RCTs) as suggested in the Cochrane Handbook. References in relevant reviews and identified RCTs were also screened.
Study selection
Studies were included when 1) the design was an RCT, 2) participants were aged 50 years or older, 3) the population
Search strategy
The search strategy resulted in 524 titles of potentially eligible studies. Based on title and abstract we selected 41 references of which full-text articles were obtained. One full-text article could not be retrieved (Zhao et al., 2007). Finally, 21 papers were included in this systematic review, representing 15 trials (Audette et al., 2006, Choi et al., 2005, Frye et al., 2007, Li et al., 2004a, Li et al., 2004b, Li et al., 2005a, Li et al., 2005b, Li et al., 2008, Logghe et al., 2009, Nnodim
Discussion
Until now no pooled estimates are available for the effects of TC alone on fall reduction. In the present study we found a non-significant overall fall reduction of 21% for TC compared to non-exercise controls. The amount of fall reduction is in line with earlier meta-analyses of exercise interventions on fall reduction, in which a significant 17% reduction in fall was found (Province et al., 1995, Sherrington et al., 2008). We also found a larger effect in a community setting and in exercise
Conclusions
Currently, there is insufficient evidence to conclude whether TC is effective in fall prevention, decreasing fear of falling and improving balance in people over age 50 years. However, the presence of a positive dose–effect relation in TC is highly likely. Future research should focus on the role of patient characteristics (e.g. living setting, activity level), intervention dose and effect maintenance on the measured outcomes.
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Sponsors role
None.
Acknowledgments
The authors thank Yvonne van Leeuwen and Pim Luijsterburg (Dept. of General Practice) who performed the methodology assessment of one article, and Sten Willemsen (Dept. of General Practice) for his valuable assistance with the statistical analyses. We also thank the authors that we contacted for supplying us with additional information about the trials they had conducted.
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Chapter 9: Analysing data and undertaking meta-analyses