Implementing Tai Chi: Moving for Better Balance in local Nebraska communities Ericka Welsh, PhD Nebraska Injury Prevention, Control and Surveillance Program Safe States/SAVIR Joint Annual Meeting April 6-8, 2011
Overview Review Tai Chi as intervention to prevent older adult falls Describe process for implementing Tai Chi intervention in local Nebraska communities Present preliminary results from intervention, lessons learned, and next steps
Background From 2004 to 2008, unintentional falls were the leading cause of hospitalizations and emergency department (ED) visits due to injury among Nebraskans, and the third leading cause of injury death.
Tai Chi RCT (Li, Harmer, et al, 2005): 3x/week, 6-month Tai Chi program found effective in decreasing #/risk/fear of falls and improving functional balance in community-dwelling adults aged 70+ yrs Yang style emphasizes multidirectional weight shifting, awareness of body alignment, multisegmental (arms, legs, trunk) movement coordination, and synchronized breathing
Tai Chi: Moving for Better Balance Li, Harmer, et al. (2008): TCMBB translated from RCT into 2x/week 1 hour classes, 12-week sessions in community Results indicated good reach, adoption, program fidelity, and maintenance 25% drop out rate Avg. session attendance ~80% Avg. cost per participant ~$108 (or $4.50 per class) TCMBB Nebraska trainings provided summer 2009 ~80 individuals trained Lacked infrastructure to coordinate implementation beyond training Training raised awareness/interest
Requests for Application Proposals from 20 local public health departments (LHD) were solicited in April 2010 Four (4) applications were submitted in May 2010 In June 2010, a total of 3 LHDs were funded at $10K each for 1 year Grant oversight provided by Nebraska Injury Prevention, Control and Surveillance Program Funding support provided by PHHS Block Grant
Grant requirements Work plans must reflect the evidence-based guidelines for implementation of TCMBB LHDs must: use instructors who have already been trained in TCMBB send their Tai Chi instructors to a training update in summer 2010 assign a lead person to manage TCMBB activities (>=0.10 FTE) participate in a minimum of two contractor site visits and quarterly group conference calls incorporate evaluation components as outlined in the program
Evaluation components Class attendance sheets Pre/post participant surveys Pre/post clinical assessments Contractor site visit reports / fidelity checklist LHD interim progress reports
Funded health departments Elkhorn Logan Valley Public Health Department Four Corners Health Department South Heartland District Health Department
Preliminary results Demographics 128 participants (93 females, 19 males, 16 missing) enrolled across 6 classes Median age=75 years (range: 35-94 years) 29% self-reported health status as very good or excellent at baseline 54% enrolled in the class for exercise; 10% had done Tai Chi before
Preliminary results cont. Attendance
Preliminary results cont. Falls At baseline, 26 participants (23%) reported falling in the past 6 months Of these, 7 resulted in injury At follow-up, 12 participants (17%) reported falling in the past 12 weeks Of these, 4 resulted in injury
Preliminary results cont.
Participant testimony I think it has really helped me with my balance. I really have noticed the difference. -Female, age 75 It has improved my balance and being able to get up out of a chair more easily. -Male, age 80 I feel more secure on the dance floor, able to keep my balance better. -Male, age 85 When I started I had to be close to a counter so I could hang on whenever necessary. Towards the middle I noticed I could do it without hanging onto anything. I have two knee replacements and a back operation so I notice how much easier I can walk. -Female, age 78
Lessons learned Strengths: Participant interest Site visits helpful Positive social experience Effective partnership with local Area Agency on Aging Challenges: Number and quality of instructors Timing/location of classes Attendance Pre/post assessments (participants in wheelchairs, new students, participants who didn t attend last session)
Next steps Grant funding ends June 2011 Complete evaluation and produce summary report Fall 2011 Planning for next RFA currently underway! Program is using evaluation results to improve next round of funding Role of local health departments: train-the-trainer, partnering with other agencies How to ensure quality of data collection Strategies to improve enrollment/attendance/ completion
Acknowledgements Peg Ogea-Ginsburg Nebraska Injury Prevention, Control and Surveillance Program Coordinator Holly Warth, R.N. Site visit contractor Suman Barkhus TCMBB master trainer Participating LHD staff and trainers
Questions?