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A randomized controlled trial of patient‐reported outcomes with tai chi exercise in Parkinson's disease
Author(s) -
Li Fuzhong,
Harmer Peter,
Liu Yu,
Eckstrom Elizabeth,
Fitzgerald Kathleen,
Stock Ronald,
Chou LiShan
Publication year - 2014
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.25787
Subject(s) - physical therapy , medicine , randomized controlled trial , parkinson's disease , rating scale , psychological intervention , clinical trial , physical medicine and rehabilitation , disease , psychology , psychiatry , developmental psychology
A previous randomized, controlled trial of tai chi showed improvements in objectively measured balance and other motor‐related outcomes in patients with Parkinson's disease. This study evaluated whether patient‐reported outcomes could be improved through exercise interventions and whether improvements were associated with clinical outcomes and exercise adherence. In a secondary analysis of the tai chi trial, patient‐reported and clinical outcomes and exercise adherence measures were compared between tai chi and resistance training and between tai chi and stretching exercise. Patient‐reported outcome measures were perceptions of health‐related benefits resulting from participation, assessed by the Parkinson's Disease Questionnaire (PDQ‐8) and Vitality Plus Scale (VPS). Clinical outcome measures included motor symptoms, assessed by a modified Unified Parkinson's Disease Rating Scale–Motor Examination (UPDRS‐ME) and a 50‐foot speed walk. Information on continuing exercise after the structured interventions were terminated was obtained at a 3‐month postintervention follow‐up. Tai chi participants reported significantly better improvement in the PDQ‐8 (−5.77 points, P = 0.014) than did resistance training participants and in PDQ‐8 (−9.56 points, P < 0.001) and VPS (2.80 points, P = 0.003) than did stretching participants. For tai chi, patient‐reported improvement in the PDQ‐8 and VPS was significantly correlated with their clinical outcomes of UPDRS‐ME and a 50‐foot walk, but these correlations were not statistically different from those shown for resistance training or stretching. However, patient‐reported outcomes from tai chi training were associated with greater probability of continued exercise behavior than were either clinical outcomes or patient‐reported outcomes from resistance training or stretching. Tai chi improved patient‐reported perceptions of health‐related benefits, which were found to be associated with a greater probability of exercise adherence. The findings indicate the potential of patient perceptions to drive exercise behavior after structured exercise programs are completed and the value of strengthening such perceptions in any behavioral intervention.