一项随机对照试验，比较太极拳联合常规护理与单纯常规护理对社区居住的痴呆症患者姿势平衡的效果：TACIT 试验（太极拳治疗痴呆症）方案。
A randomised controlled trial comparing the effectiveness of tai chi alongside usual care with usual care alone on the postural balance of community-dwelling people with dementia: protocol for the TACIT trial (TAi ChI for people with demenTia).
机构信息
Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science & Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset, BH12 5BB, UK.
Peninsula Clinical Trials Unit, Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK.
出版信息
BMC Geriatr. 2018 Nov 3;18(1):263. doi: 10.1186/s12877-018-0935-8.
BACKGROUND
Falls are a public health issue for the older adult population and more so for people with dementia (PWD). Compared with their cognitively intact peers, PWD are at higher risk of falls and injurious falls. This randomised controlled trial aims to test the clinical and cost effectiveness of Tai Chi to improve postural balance among community-dwelling PWD and to assess the feasibility of conducting a larger definitive trial to reduce the incidence of falls among PWD.
METHODS
A 3-centre parallel group randomised controlled trial with embedded process evaluation. One hundred and fifty community-dwelling dyads of a person with dementia and their informal carer will be recruited and assessed at baseline and at six-month follow-up. Dyads will be randomised in a 1:1 ratio to either usual care or usual care plus a Tai Chi intervention for 20 weeks. The Tai Chi intervention will consist of weekly classes (45 min' Tai Chi plus up to 45 min for informal discussion, with up to 10 dyads per class) and home-based exercises (20 min per day to be facilitated by the carer). Home practice of Tai Chi will be supported by the use of behaviour change techniques with the Tai Chi instructor at a home visit in week 3-4 of the intervention (action planning, coping planning, self-monitoring, and alarm clock reminder) and at the end of each class (feedback on home practice). The primary outcome is dynamic balance measured using the Timed Up and Go test, coinciding with the end of the 20-week intervention phase for participants in the Tai Chi arm. Secondary outcomes for PWD include functional balance, static balance, fear of falling, global cognitive functioning, visual-spatial cognitive functioning, quality of life, and falls. Secondary outcomes for carers include dynamic balance, static balance, quality of life, costs, and carer burden.
DISCUSSION
This trial is the first in the UK to test the effectiveness of Tai Chi to improve balance among PWD. The trial will inform a future study that will be the first in the world to use Tai Chi in a trial to prevent falls among PWD.
TRIAL REGISTRATION
NCT02864056 .
背景
跌倒对老年人群体来说是一个公共健康问题，而对痴呆症患者（PWD）来说更是如此。与认知正常的同龄人相比，PWD 跌倒和受伤跌倒的风险更高。这项随机对照试验旨在测试太极拳对改善社区居住的 PWD 姿势平衡的临床和成本效益，并评估进行更大规模的确定性试验以降低 PWD 跌倒发生率的可行性。
方法
一项 3 中心平行组随机对照试验，嵌入了过程评估。将招募并评估 150 对社区居住的痴呆症患者及其非专业照顾者对，在基线和 6 个月随访时进行评估。将对 1:1 的比例随机分配到常规护理或常规护理加 20 周的太极拳干预组。太极拳干预将包括每周课程（45 分钟太极拳加最多 45 分钟的非正式讨论，每个班最多 10 对）和家庭锻炼（每天 20 分钟，由照顾者协助）。通过行为改变技术，在干预的第 3-4 周（行动计划、应对计划、自我监测和闹钟提醒）和每节课结束时（家庭练习反馈），由太极拳教练在家访中为家庭练习提供支持。主要结果是使用计时起立和行走测试测量的动态平衡，这与太极拳组参与者 20 周干预阶段结束时相吻合。PWD 的次要结果包括功能性平衡、静态平衡、跌倒恐惧、整体认知功能、视觉空间认知功能、生活质量和跌倒。照顾者的次要结果包括动态平衡、静态平衡、生活质量、成本和照顾者负担。
讨论
这项试验是英国首次测试太极拳改善 PWD 平衡的有效性。该试验将为未来的研究提供信息，这将是世界上首次在预防 PWD 跌倒的试验中使用太极拳。
试验注册
NCT02864056。
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