R Song1, W Grabowska2, M Park3, K Osypiuk4, G P Vergara-Diaz5, P Bonato6, J M Hausdorff7, M Fox8, L R Sudarsky9, E Macklin10, P M Wayne11. 1. College of Nursing, Chungnam National University, South Korea. Electronic address: songry@cnu.ac.kr. 2. Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, USA. Electronic address: wgrabowska@coa.edu. 3. Department of Nursing, Woosong College, South Korea. Electronic address: mkpark@wsi.ac.kr. 4. Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, USA. Electronic address: kosypiuk@partners.org. 5. Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, USA. Electronic address: gvergaradiaz@partners.org. 6. Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, USA. Electronic address: pbonato@partners.org. 7. Sackler Faculty of Medicine, Tel Aviv University, Center for the Study of Movement, Cognition, and Mobility at Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel. Electronic address: Jeff.hausdorff@gmail.com. 8. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA. Electronic address: Mfox3@bidmc.harvard.edu. 9. Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, USA. Electronic address: lsudarsky@partners.org. 10. Harvard Medical School, Massachusetts General Hospital, USA. Electronic address: emacklin@mgh.harvard.org. 11. Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, USA. Electronic address: pwayne@partners.org.
Abstract
PURPOSE: To systematically evaluate and quantify the effects of Tai Chi/Qigong (TCQ) on motor (UPDRS III, balance, falls, Timed-Up-and-Go, and 6-Minute Walk) and non-motor (depression and cognition) function, and quality of life (QOL) in patients with Parkinson's disease (PD). METHODS: A systematic search in 7 electronic databases targeted clinical studies evaluating TCQ for individuals with PD published through August 2016. Meta-analysis was used to estimate effect sizes (Hedges's g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed by two raters. RESULTS: Our search identified 21 studies, 15 of which were RCTs with a total of 735 subjects. For RCTs, comparison groups included no treatment (n = 7, 47%) and active interventions (n = 8, 53%). Duration of TCQ ranged from 2 to 6 months. Methodological bias was low in 6 studies, moderate in 7, and high in 2. Fixed-effect models showed that TCQ was associated with significant improvement on most motor outcomes (UPDRS III [ES = -0.444, p < 0.001], balance [ES = 0.544, p < 0.001], Timed-Up-and-Go [ES = -0.341, p = 0.005], 6 MW [ES = -0.293, p = 0.06], falls [ES = -0.403, p = 0.004], as well as depression [ES = -0.457, p = 0.008] and QOL [ES = -0.393, p < 0.001], but not cognition [ES = -0.225, p = 0.477]). I2 indicated limited heterogeneity. Funnel plots suggested some degree of publication bias. CONCLUSION: Evidence to date supports a potential benefit of TCQ for improving motor function, depression and QOL for individuals with PD, and validates the need for additional large-scale trials.
PURPOSE: To systematically evaluate and quantify the effects of Tai Chi/Qigong (TCQ) on motor (UPDRS III, balance, falls, Timed-Up-and-Go, and 6-Minute Walk) and non-motor (depression and cognition) function, and quality of life (QOL) in patients with Parkinson's disease (PD). METHODS: A systematic search in 7 electronic databases targeted clinical studies evaluating TCQ for individuals with PD published through August 2016. Meta-analysis was used to estimate effect sizes (Hedges's g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed by two raters. RESULTS: Our search identified 21 studies, 15 of which were RCTs with a total of 735 subjects. For RCTs, comparison groups included no treatment (n = 7, 47%) and active interventions (n = 8, 53%). Duration of TCQ ranged from 2 to 6 months. Methodological bias was low in 6 studies, moderate in 7, and high in 2. Fixed-effect models showed that TCQ was associated with significant improvement on most motor outcomes (UPDRS III [ES = -0.444, p < 0.001], balance [ES = 0.544, p < 0.001], Timed-Up-and-Go [ES = -0.341, p = 0.005], 6 MW [ES = -0.293, p = 0.06], falls [ES = -0.403, p = 0.004], as well as depression [ES = -0.457, p = 0.008] and QOL [ES = -0.393, p < 0.001], but not cognition [ES = -0.225, p = 0.477]). I2 indicated limited heterogeneity. Funnel plots suggested some degree of publication bias. CONCLUSION: Evidence to date supports a potential benefit of TCQ for improving motor function, depression and QOL for individuals with PD, and validates the need for additional large-scale trials.
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