Effectiveness of Tai Chi on Improving Balance in Older Adults: An Evidence-based Review, The

Journal of Geriatric Physical Therapy,  2003  by Komagata, Sachiko,  Newton, Roberta

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Only 4 studies clearly documented the subject's compliance with the intervention. The qualifications of Tai Chi instructors also play a major role in the effectiveness of Tai Chi in balance training. The instructors may affect the participants' levels of motivation,1053 compliance, and accuracy in performing the forms and postures. Observational studies investigating the quality of instruction and movement may provide the opportunity to discover a deeper understanding of Tai Chi's hidden effects on an individual's movement and wellness.

Since the effect of Tai Chi on balance has been tested in elderly subjects who have no history of neurological or musculoskeletal diseases, it may be beneficial to use this type of intervention to a specific disease population, such as stroke, Parkinson disease, or peripheral neuropathy. Physical therapists are skilled in analyzing people's movement patterns based on motor control and biomechanical theories. Therefore, they have the potential to determine through systematic study what specific characteristics of Tai Chi improve balance as compared with traditional physical therapy balance training techniques. The use of a sham-Tai Chi paradigm can be used to examine a placebo effect of Tai Chi.

Furthermore, due to the nationwide managed care trends, neuromusculoskeletal rehabilitation has been evolving to use more innovative formats. This usually entails fewer visits, a shorter length of treatment sessions, or the use of group sessions with more emphasis on education and home exercise programs. Tai Chi and other movement therapies can supplement a rehabilitation program and can be provided by health care professionals and practitioners other than physical therapists. A trend in current physical therapy practice is to offer post rehabilitation maintenance programs. Tai Chi may be an effective group therapy activity for people who undergo formal outpatient physical therapy programs for balance and gait training. When this review article was nearly completed, the authors found Wu's review article on Tai Chi's effectiveness for improving balance and preventing falls in the older population.49 Thus our recommendations for future studies overlap significantly with the study by Wu.

CONCLUSION

The majority of the studies reviewed here support the effectiveness of Tai Chi to improve balance. However, quality of studies requires further improvement in treating confounding factors, addressing compliance, and randomizing the assignments. Systematic review using Ql and d-index is warranted due to the existence of nonrandomized studies. Although the 3 balance outcome measure categories do not show a statistically significant difference in their effect size d-index, the internal balance perturbations category appears most suited to demonstrate Tai Chi's effect on the participants'balance. Demystifying the oriental martial art ofTai Chi through scientific studies and incorporating it in physical therapy practice, particularly aiming for balance improvement and fall prevention, can be justified.