Effectiveness of Tai Ji Quan vs Multimodal and Stretching Exercise Interventions for Reducing Injurious Falls in Older Adults at High Risk of Falling Follow-up Analysis of a Randomized Clinical Trial
Effectiveness of Tai Ji Quan vs Multimodal and Stretching Exercise Interventions for Reducing Injurious Falls in Older Adults at High Risk of Falling Follow-up Analysis of a Randomized Clinical Trial
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DOI：
10.1001/jamanetworkopen.2018.8280
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发表时间：
2019-02-01
影响因子：
13.8
通讯作者：
Liu, Yu
中科院分区：
文献类型：
--
作者：
Li, Fuzhong;Harmer, Peter;Liu, Yu
重要性运动已被证明可以减少老年人的伤害性福尔斯。然而，缺乏证据表明，干预的类型是最有效的预防伤害性福尔斯在老年人中的高风险falling.Objective干预治疗太极拳与多模式运动和伸展运动在减少伤害性福尔斯在老年人中的高风险falling.DESIGN，SETTING，和参与者本试验包括一个预先指定的分析与意向治疗分析的数据。随访分析的单盲随机试验进行的社区设置7个城市和郊区城市在俄勒冈州从2015年2月20日至9月15日，2018年，将治疗性太极拳干预与多模式运动和伸展运动进行了比较。符合条件的参与者是年龄至少70岁的社区居民，临床医生认为他们有跌倒的高风险，因为他们在前一年跌倒过，或者他们在定时起身和行走测试中的得分高于13.5秒。参与者被随机分配到3种干预措施中的1种，并在随机分配后每月进行评估，持续12个月，包括6个月的积极干预阶段和6个月的干预后随访阶段。（太极拳：运动以获得更好的平衡[TJQMBB]），多模式运动和伸展运动，每种方法每周实施两次，每次60分钟，持续24周。主要结果和测量主要结果是12个月时中度和严重伤害性福尔斯的发生率，以发生率比（IRR）测量。670名（平均[SD]年龄，77.7 [5.6]岁; 436名女性[65.1%]）被随机分配到3个干预组中的一个：224人参加TJQMBB，223人参加多模式运动，223人参加拉伸运动。在12个月时，TJQMBB中中度损伤性福尔斯的未校正IRR较低（IRR，0.51; 95% CI，0.35-0.74; P
IMPORTANCE Exercise has been shown to reduce injurious falls in older adults. Evidence, however, is lacking regarding the types of intervention that are most effective in preventing injurious falls among older adults at high risk of falling.OBJECTIVE To determine the longer-term effectiveness of therapeutic tai ji quan intervention vs multimodal exercise and stretching exercise in decreasing injurious falls among older adults at high risk of falling.DESIGN, SETTING, AND PARTICIPANTS This trial involves a prespecified analysis with the data analyzed by intent-to-treat. Follow-up analysis of a single-blind randomized trial conducted in community settings of 7 urban and suburban cities in Oregon from February 20, 2015, to September 15, 2018, compared a therapeutic tai ji quan intervention with multimodal exercise and stretching exercise. Eligible participants were community-dwelling adults aged at least 70 years who were considered by a clinician to be at high risk of falling because they had fallen during the preceding year or who had impaired mobility with scores higher than 13.5 seconds on the Timed Up & Go test. Participants were randomized to 1 of the 3 interventions and were assessed monthly after randomization for 12 months, encompassing a 6-month active intervention phase and a 6-month after intervention follow-up phase.INTERVENTIONS The 3 group-based interventions were therapeutic tai ji quan (Tai Ji Quan: Moving for Better Balance [TJQMBB]), multimodal exercise, and stretching exercise, each implemented twice weekly in 60-minute sessions for 24 weeks.MAIN OUTCOMES AND MEASURES Primary outcomes were the incidence of moderate and serious injurious falls at 12 months, measured as incidence rate ratios (IRRs).RESULTS Of the 1147 persons screened, 670 (mean [SD] age, 77.7 [5.6] years; 436 women [65.1%]) were randomly assigned to 1 of 3 intervention groups: 224 persons in TJQMBB, 223 in multimodal exercise, and 223 in stretching exercise. At 12 months, the unadjusted IRR for moderate injurious falls was lower in the TJQMBB (IRR, 0.51; 95% CI, 0.35-0.74; P