Randomized controlled trial on the efficacy of hydrotherapy incorporating Tai Chi and Ai Chi

Transcription

1 Randomized controlled trial on the efficacy of hydrotherapy incorporating Tai Chi and Ai Chi (Water Tai Chi) for patients with low back pain: a pilot study (Sept to Aug. 2010) Mr. Anthony LAU & Mr. Rayson LAM Physiotherapy Department Alice Ho Miu Ling Nethersole Hospital

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3 Styles and Elements Yang s 24 movements Ai-Chi Originated by Jun Konno in 1980 s Popularised by Ruth Sova 16 movements

4 Single Leg Lift 左右蹬腿 Balance Static and Dynamic Core Stabilization Strengthening Static and Graded

5 Ai-Chi Balancing Accepting with grace

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7 Workflow & Design Patients with LBP Baseline Assessment Randomization Water Tai Chi + Ai Chi Group x 12 sessions (6-8/52) Normal PT Group x 12 sessions (6-8/52) Control Group: basic back ex. at home & wait x 6-8/52 Re-assessment Intention-to-treat analysis was done for those defaulted cases

8 Methodology Inclusion Criteria: Patients with principal diagnosis of LBP for more than 3 weeks Patients aged between 18 to 72 years

9 Methodology Exclusion Criteria: Patients who are contra-indicated to hydrotherapy Patients whose LBP are due to IOD or on litigation Patients with neurological deficits Patients with severe pathology of low back pain e.g. CA, Infection, systemic disease.

10 Methodology Exclusion Criteria: Patients who cannot walk independently Patients who will have spinal operation within 3 months Patients with active psychiatric illness

11 Methodology Outcome Measures Numeric Pain Rating Scale (NPRS) from 0 to 10 Numeric Global Rate of Change Scale (NGRCS) in % Roland-Morris Disability Questionnaire (RMDQ) 6-minute Walk Test Thickness change of transverse abdominus Single-leg Standing Test (SLS

12 Measuring activation of abdominal muscles (TA)

13 Groups Distribution Group No. of patients participated No. of patients finished No. of patients defaulted Water Tai Ch + Ai Chi Usual PT Control

14 Demographics Water Tai Chi Group n = 27 Usual PT Group n = 27 Control Group n = 26 Age (mean ± SD) 51.2 ± ± ± 10.2 Sex (M:F) 12 : 15 7 : : 14 Onset of LBP in months (Mean ± SD) (p = 0.926) Sessions Attended (Mean ± SD) 64.6 ± ± ± ± ± 4.7 N/A

15 Baseline data comparison ( 3 groups comparison) Outcomes Mean +/- SD p-value Water Tai Chi (n = 27) Usual PT (n = 27) Control (n = 26) (Kruskal Wallis) P<0.05 Pain (-10 to 10) RMDQ (0 to 24) 6-min. walk (meters) Balance (EO) (seconds) Balance (EC) (seconds) TA activation (%) / / / / / / / / / / / / / / / / / /

16 Post-treatment data comparison (3 groups comparison) Outcomes Mean +/- SD p-value Water Tai Chi (n = 27) Usual PT (n = 27) Control (n = 26) (Kruskal Wallis) p<0.05 Pain (-10 to 10) RMDQ (0 to 24) 6-min. walk (meters) Balance (EO) (seconds) Balance (EC) (seconds) TA activation (%) Overall improvement % / / / / / / / / / / / / / / / / / / / / /

17 Post-treatment data comparison (Water Tai Chi vs Control) Outcomes Mean +/- SD p-value Water Tai Chi (n = 27) Control (n = 26) (Mann-Whitney U) P< Pain / / (-10 to 10) RMDQ / / (0 to 24) 6-min. walk / / (meters) Balance (EO) / / (seconds) Balance (EC) / / (seconds) TA activation / / (%) Overall improvement % 50 +/ /

18 Outcomes Mean +/- SD p-value Usual PT (n = 27) Control (n = 26) (Mann-Whitney U) p< Pain (-10 to 10) RMDQ (0 to 24) 6-min. walk (meters) Balance (EO) (seconds) Balance (EC) (seconds) TA activation (%) Overall improvement % Post-treatment data comparison (Usual PT vs Control) 3.2 +/ / / / / / / / / / / / / /

19 Post-treatment data comparison (Water Tai Chi vs Usual PT) Outcomes Mean +/- SD p-value Water Tai Chi (n = 27) Usual PT (n = 27) (Mann-Whitney U) P< Pain / / (-10 to 10) RMDQ / / (0 to 24) 6-min. walk / / (meters) Balance (EO) / / (seconds) Balance (EC) / / (seconds) TA activation / / (%) Overall improvement % 50 +/ /

20 Conclusions Water Tai Chi improves: walking endurance improve balance without vision and the activation of TA for lumbar stabilization. Usual PT improves: walking endurance and improve balance without vision. Both produce significant subjective improvement Water Tai Chi vs. PT usual care : no significant difference

21 Limitations Small sample size A fairly heterogeneous group: include acute/ subacute/ chronic LBP patients High ceiling effect of single-leg standing with vision No long-term follow-up

22 Discussion Fusion of well accepted means of rehabilitation Improving compliance to self-management take home skill Practicability in the community No equipment required Peer support

23 Acknowledgement Dr. Joseph Ng Associate Professor of Department of Rehabilitation Sciences. The Hong Kong Polytechnic University. Mr. Marcus Wong Research Assistant Ms. Rainbow Law Senior Physiotherapist, AHNH

24 THANK YOU

25 References 1. Benjamin Waller, Johan Lambeck & Daniel Daly (2009) Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. Clinical Rehabilitation 23: Geytenbeek J (2002) Evidence for effective hydrotherapy. Physiotherapy, 88(9): Hall J, Swinkels A, Briddon J, & McCabe CS (2008) Does aquatic exercise relieve pain in adults with neurologic or musculoskeletal disease? A systematic review and meta-analysis of randomized controlled trials. Archives of Physical Medicine and Rehabilitation, 89(5): Mcllveen B & Robertson VJ (1998) A randomized controlled study of the outcome of hydrotherapy for subjects with low back pain and leg pain. Physiotherapy, 84(1): Smit T & Harrison R (1991) Hydrotherapy and chronic lower back pain: A pilot study. Australian Journal of Physiotherapy, 36(3): Wang C, Collet JP & Lau J (2004) The effect of Tai Chi on health outcomes in patients with chronic conditions: A systematic review. Archives of Internal Medicine 164: