To analyze the effectiveness of tai chi for falls prevention.
Systematic review and meta-analysis.
Pubmed, Scopus, CINHAL, and Physiotherapy Evidence Database (PEDro) were searched to May 26, 2016.
Older adult population and at-risk adults.
Randomized controlled trials analyzing the effect of tai chi versus other treatments on risk of falls.
The incidence rate ratio (IRR) for falls incidence and hazard ratio (HR) for time to first fall.
The search strategy identified 891 potentially eligible studies, of which 10 met the inclusion criteria. There was high-quality evidence of a medium protective effect for fall incidence over the short term (IRR = 0.57; 95% CI = 0.46, 0.70) and a small protective effect over the long term (IRR = 0.87; 95% CI = 0.77, 0.98). Regarding injurious falls, we found very low-quality evidence of a medium protective effect over the short term (IRR = 0.50; 95% CI = 0.33, 0.74) and a small effect over the long term (IRR = 0.72; 95% CI = 0.54, 0.95). There was no effect on time to first fall, with moderate quality of evidence (HR = 0.98; 95% CI = 0.69, 1.37).
In at-risk adults and older adults, tai chi practice may reduce the rate of falls and injury-related falls over the short term (<12 months) by approximately 43% and 50%, respectively. Tai chi practice may not influence time to first fall in these populations. Due to the low quality of evidence, more studies investigating the effects of tai chi on injurious falls and time to first fall are required.
|jgs15008-sup-0001-FigS1-S4.docxWord document, 513.1 KB||
Figure S1. PRISMA flow diagram of the review process.
Figure S2. Funnel plot for falls incidence for the short-term.
Figure S3. Funnel plot for falls incidence for the long-term.
Figure S4. Funnel plot for time to first fall.
|jgs15008-sup-0002-TableS1-S2.docxWord document, 29 KB||
Table S1. Characteristics of the studies included in this review.
Table S2. The assessment of risk of bias in the individual studies.
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
- 1, . Protocol for disseminating an evidence-based fall prevention program in community senior centers: Evaluation of translatability and public health impact via a single group pre-post study. Implement Sci 2014; 9: 63.
- 2, , , et al. Epidemiology of falls in the non-institutionalized Spanish elderly population, systematic review 2014. Rev Enferm 2015; 38: 40–45.
- 3, , , et al. Epidemiology of falls in older adults in Texas. South Med J 2015; 108: 119–124.
- 4 Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). [Internet] 2017. Available at www.cdc.gov/ncipc/wisqars Accessed January 15, 2017.
- 5, , , et al. The epidemiologic data on falls, 1998–2010: More older Americans report falling. JAMA Intern Med 2015; 175: 443–445.
- 6, , . The direct costs of fatal and non-fatal falls among older adults—United States. J Safety Res 2016; 58: 99–103.
- 7 World Health Organization. WHO Global Report on Falls Prevention in Older Age. Geneva: World Health Organization, 2007.
- 8, , . Falls and Fractures: A systematic approach to screening and prevention. Maturitas 2015; 82: 85–93.
- 9, , , et al. Predictive value of stabilometry and fear of falling on falls in postmenopausal women. Climacteric 2013; 16: 584–589.
- 10, , , et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; 9: Cd007146.
- 11, . Impact of Tai Chi Chu'an practice on balance and mobility in older adults: An integrative review of 20 years of research. J Geriatr Phys Ther 2014; 37: 127–135.
- 12, . Improvement of balance control ability and flexibility in the elderly Tai Chi Chuan (TCC) practitioners: A systematic review and meta-analysis. Arch Gerontol Geriatr 2015; 60: 233–238.
- 13, , . The effect of tai chi on reducing the risk of falling: A systematic review and meta-analysis. Am J Chin Med 2016; 44: 895–906.
- 14, , , et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol 2009; 62: 1006–1012.
- 15, . Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011. Available at http://www.handbook.cochrane.org Accessed June 15, 2016.
- 16, , , et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Br Med J 2011; 343: d5928.
- 17, , . The Handbook of Research Synthesis and Meta-analysis. New York, NY: Russell Sage Foundation Publications, 2009.
- 18, , et al. Statistical heterogeneity in systematic reviews of clinical trials: A critical appraisal of guidelines and practice. J Health Serv Res Policy 2002; 7: 51–61.
- 19, . Trim and fill: A simple funnel plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455–463.
- 20, , , et al. Grading quality of evidence and strength of recommendations. BMJ 2004; 328: 1490–1494.
- 21, , , et al. A checklist designed to aid consistency and reproducibility of GRADE assessments: Development and pilot validation. Syst Rev 2014; 3: 82.
- 22, , , et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.
- 23, , , et al. GRADE guidelines: 4. Rating the quality of evidence–study limitations (risk of bias). J Clin Epidemiol 2011; 64: 407–415.
- 24, , , et al. Tai Chi and fall reductions in older adults: A randomized controlled trial. J Gerontol A Biol Sci Med Sci 2005; 60: 187–194.
- 25, , et al. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial. Arch Phys Med Rehabil 2006; 87: 885–896.
- 26, , , et al. Effects of home-based tai chi and lower extremity training and self-practice on falls and functional outcomes in older fallers from the emergency department-a randomized controlled trial. J Am Geriatr Soc 2016; 64: 518–525.
- 27, , et al. Tai chi: Improving functional balance and predicting subsequent falls in older persons. Med Sci Sports Exerc 2004; 36: 2046–2052.
- 28, , , et al. Lack of effect of Tai Chi Chuan in preventing falls in elderly people living at home: A randomized clinical trial. J Am Geriatr Soc 2009; 57: 70–75.
- 29, , , et al. The influence of tai chi and yoga on balance and falls in a residential care setting: A randomised controlled trial. Contemp Nurse 2014; 48: 76–87.
- 30, , , et al. Effectiveness of tai chi as a community-based falls prevention intervention: A randomized controlled trial. J Am Geriatr Soc 2012; 60: 841–848.
- 31, , , et al. Efficacy of supervised Tai Chi exercises versus conventional physical therapy exercises in fall prevention for frail older adults: A randomized controlled trial. Disabil Rehabil 2013; 35: 1429–1435.
- 32, , et al. A randomized, controlled trial of tai chi for the prevention of falls: The Central Sydney tai chi trial. J Am Geriatr Soc 2007; 55: 1185–1191.
- 33, , , et al. Reducing frailty and falls in older persons: An investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 1996; 44: 489–497.
- 34, , et al. A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. Age Ageing 2007; 36: 262–268.
- 35, , . Step training improves reaction time, gait and balance and reduces falls in older people: A systematic review and meta-analysis. Br J Sports Med 2016; 51: 586–593.
- 36, , et al. Interventions based on exercise and physical environment for preventing falls in cognitively impaired older people living in long-term care facilities: A systematic review and meta-analysis. Rev Esp Geriatr Gerontol 2016; 51: 96–111.
- 37, , , et al. Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev 2014; 11: Cd009848.
- 38, , , et al. Modelling the population-level impact of tai-chi on falls and fall-related injury among community-dwelling older people. Inj Prev 2010; 16: 321–326.
- 39, , et al. An economic evaluation of community and residential aged care falls prevention strategies in NSW. N S W Public Health Bull 2011; 22: 60–68.
- 40, , , et al. Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis. Maturitas 2015; 82: 72–84.
- 41, , et al. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ 2013; 347: f6234.
- 42, , , et al. Effects of exercise programs on balance in older women with age-related visual problems: A pilot study. Arch Gerontol Geriatr 2012; 55: 446–452.
- 43, , . Exercise and physical training improve physical function in older adults with visual impairments but their effect on falls is unclear: A systematic review. J Physiother 2014; 60: 130–135.
- 44, , , et al. Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: A community-based randomized controlled trial. J Bone Miner Res 2014; 29: 182–191.
- 45, , , et al. A cost-benefit analysis of three older adult fall prevention interventions. J Safety Res 2015; 52: 65–70.