Ni Xiaojia, Liu Shaonan, Lu Fuchang, Shi Xiaogeng, Guo Xinfeng
Research and Development Department of New Drugs, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province, China; The Second College of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province, China.
PLoS One. 2014 Jun 13;9(6):e99377. doi: 10.1371/journal.pone.0099377. eCollection 2014.
In Parkinson's disease (PD), wearing off and side effects of long-term medication and complications pose challenges for neurologists. Although Tai Chi is beneficial for many illnesses, its efficacy for PD remains uncertain. The purpose of this review was to evaluate the efficacy and safety of Tai Chi for PD.
Randomized controlled trials (RCTs) of Tai Chi for PD were electronically searched by the end of December 2013 and identified by two independent reviewers. The tool from the Cochrane Handbook 5.1 was used to assess the risk of bias. A standard meta-analysis was performed using RevMan 5.2 software.
Ten trials with PD of mild-to-moderate severity were included in the review, and nine trials (n = 409) were included in the meta-analysis. The risk of bias was generally high in the blinding of participants and personnel. Improvements in the Unified Parkinson's Disease Rating Scale Part III (mean difference (MD) -4.34, 95% confidence interval (CI) -6.67--2.01), Berg Balance Scale (MD: 4.25, 95% CI: 2.83-5.66), functional reach test (MD: 3.89, 95% CI: 1.73-6.04), Timed Up and Go test (MD: -0.75, 95% CI: -1.30--0.21), stride length (standardized MD: 0.56, 95% CI: 0.03-1.09), health-related quality of life (standardized MD: -1.10, 95% CI: -1.81--0.39) and reduction of falls were greater after interventions with Tai Chi plus medication. Satisfaction and safety were high. Intervention with Tai Chi alone was more effective for only a few balance and mobility outcomes.
Tai Chi performed with medication resulted in promising gains in mobility and balance, and it was safe and popular among PD patients at an early stage of the disease. This provides a new evidence for PD management. More RCTs with larger sample size that carefully address blinding and prudently select outcomes are needed. PROSPERO registration number CRD42013004989.
在帕金森病（PD）中，长期药物治疗的疗效减退、副作用及并发症给神经科医生带来了挑战。尽管太极拳对多种疾病有益，但其对帕金森病的疗效仍不确定。本综述的目的是评估太极拳治疗帕金森病的疗效和安全性。
截至2013年12月底，通过电子检索太极拳治疗帕金森病的随机对照试验（RCT），并由两名独立审阅者进行识别。采用Cochrane手册5.1中的工具评估偏倚风险。使用RevMan 5.2软件进行标准的荟萃分析。
本综述纳入了10项针对轻至中度帕金森病的试验，荟萃分析纳入了9项试验（n = 409）。在参与者和研究人员的盲法方面，偏倚风险普遍较高。与单纯药物治疗相比，太极拳联合药物治疗后，帕金森病统一评分量表第三部分（平均差值（MD）-4.34，95%置信区间（CI）-6.67--2.01）、伯格平衡量表（MD：4.25，95% CI：2.83 - 5.66）、功能性伸展测试（MD：3.89，95% CI：1.73 - 6.04）、计时起立行走测试（MD：-0.75，95% CI：-1.30--0.21）、步幅（标准化MD：0.56，95% CI：0.03 - 1.09）、健康相关生活质量（标准化MD：-1.10，95% CI：-1.81--0.39）以及跌倒次数减少等方面的改善更为显著。满意度和安全性较高。仅在少数平衡和运动能力指标上，单纯太极拳干预更为有效。
太极拳联合药物治疗在改善运动能力和平衡方面取得了有前景的效果，且在帕金森病早期患者中安全且受欢迎。这为帕金森病的管理提供了新的证据。需要更多样本量更大、仔细解决盲法问题并谨慎选择结局指标的随机对照试验。PROSPERO注册号CRD42013004989。
