The Effects of Sitting Tai Chi on Upper Limb Function, Balance Control, Depressive Symptoms, Activities of Daily Living, and Quality of Life among Subacute Stroke Survivors: A Randomised Controlled Trial

BackgroundStroke is a leading cause of disability in China and throughout the world. The initiation of a holistic approach to rehabilitation during the early post-stroke period could provide survivors with an approach to recovery that capitalises on the unique early post-stroke physiological conditions and promotes spontaneous recovery. Accordingly, early initiation of interventions to promote recovery in subacute stroke survivors is warranted.AimsTo develop a sitting Tai Chi programme tailored for subacute stroke survivors and to examine its effects among this population.MethodsThe study was conducted in four phases. Phase I involved a systematic review to determine the effects of sitting Tai Chi on recovery in stroke survivors and identify the corresponding implementation strategies. In Phase II, stroke survivors' (n = 30) perceptions of participating in exercise or sitting Tai Chi were explored through a qualitative study. The findings of these two phases guided the development of the programme. In Phase III, a cross-sectional study with 170 subacute stroke survivors was performed to determine the psychometric properties of the Chinese version of the Trunk Impairment Scale (TIS-C). In Phase IV, a randomised controlled study was conducted to examine the effects of the tailored sitting Tai Chi programme. One hundred sixty subacute stroke survivor-caregiver dyads were recruited and randomly assigned to either the intervention or control group. The intervention group participated in a 12-week (three sessions/week, 40minutes/session) sitting Tai Chi programme. The control group received attention control. The outcomes were measured at baseline (T0) and one (T1), eight (T2), 12 (T3), and 16 weeks (T4) after commencement of the intervention. A generalised estimating equation (GEE) model was used to compare between-group differences over time.ResultsIn Phase I, the systematic review included five studies, and the potential positive effects of sitting Tai Chi on stroke recovery and some implementation strategies were identified. In Phase II, the stroke survivors' perceived barriers and facilitators to exercise participation were identified, and the proposed sitting Tai Chi programme was generally found to be perceived positively. In Phase III, the TIS-C was determined to be valid and reliable.In Phase IV, the GEE model revealed significant improvements in upper limb function (performance time and functional ability domains of the Wolf Motor Function Test) at T2, T3, and T4, sitting balance control (TIS-C) at T2, T3, and T4, balance control (Berg Balance Scale) at T3 and T4, shoulder extension at T2 and T3, shoulder external and internal rotation at T4, activities of daily living at T2, T3, and T4, and quality of life at T2, T3, and T4 in the intervention group relative to the control group (all p < 0.05). The intervention group also achieved greater reductions in depressive symptoms at T2, T3, and T4 compared with the control (all p < 0.05). No other significant between-group differences were observed.ConclusionsThe study findings support the effectiveness of a tailored sitting Tai Chi programme in improving the recovery outcomes of subacute stroke survivors and provide additional knowledge to support the clinical implementation of such a programme.在第一階段，系統評價納入了五項研究。总结了坐式太極拳對中風康復的潛在積極作用及一些實施策略的效能。第二階段了解了中風患者在亚急性期的參與運動的阻礙和促進因素以及坐式太極拳項目能被普遍接受。第三階段結果表明TIS-C的良好信效度。第四階段，GEE模型顯示，與對照組相比，干預組在上肢功能（沃夫運動功能測試的動作完成時間和功能評分）在T2、T3和T4，平衡控制（伯格平衡量表）在T3和T4、坐位平衡控制（TIS-C）在T2、T3和T4，抑鬱症狀在T2、T3和T4，肩關節後伸在T2和T3，肩關節外旋和內旋在T4，日常活動能力在T2、T3和T4，生活質量在T2、T3和T4取得明顯改善（所有p值少于0.05）。兩組在上肢功能（傅格梅爾上肢功能量表）、握力、肩關節前屈、肩外展和肩痛無顯著差異。結論本研究為创新坐式太極拳項目對改善亞急性中風患者健康結局的有效性提供了證據。為醫護人員在中國醫療體制下將坐式太極拳項目用於中風康復提供了重要的線索和方向。背景中風是全球引致肢体及功能障碍的主要原因之一。利用中風亞急性期的生理自發恢復過程，實施整體康復能促進中風患者康復。因此，有必要採取干預措施來促進亞急性期中風患者的康復。目的為亞急性期中風患者制定一項创新的坐式太極拳項目，並驗證該項目的干預效果。方法本研究分四個階段。第一階段系統評價確定了坐式太極拳對中風患者康復的效果及总结相應的實施策略。第二階段採用質性研究（n = 30）法瞭解中風患者對運動或坐式太極拳的看法。這兩個階段的結果指導了坐式太極拳項目的制定。第三階段是一項橫斷面研究（n = 170），旨在確定中文版軀乾損傷量表（TIS-C）在亞急性期中風患者中應用的信效度。第四階段採用隨機對照試驗評價該坐式太極拳項目的效果。共招募并隨機分配了160對亞急性中風患者及其家庭照顧者到干預組或對照組。干預組進行了12周坐式太極拳訓練。在基線（T0），干預開始後的一周（T1），八周（T2），十二周（T3），十六周（T4）測量了結果。採用了廣義估計方程（GEE）模型比較不同時間点坐式太極拳對中風患者康復結局的影響。結果ZHAO, Jie.Ph.D. Chinese University of Hong Kong 2021.Includes bibliographical references (leaves )Abstracts in English and Chinese.Title from PDF title page (viewed on ...