Exploring Tai Chi as an Early Intervention to Improve Balance and Reduce Falls Among Stroke Survivors – A Randomized Feasibility Study

Stroke is a major cause of disability worldwide, with many stroke survivors being at high risk of falling. Falling leads to an increasing amount of hospital admissions, placing substantial economic burden on health services. It has previously been shown that exercise programmes improve balance and reduce falls in older people. Tai Chi has been shown to reduce falls in older people. Therefore, it may show similar benefits early in stroke rehabilitation.

The aim of this randomised controlled feasibility study is to explore the acceptability and adherence of a bespoke Tai Chi programme for stroke survivors. Additionally, the suitability of the outcome measures has also been examined, along with the implementation, demand and practicalities of the programme.

Twenty-three potential participants completed the study and were identified and recruited at the point of discharge at a local hospital on a stroke unit. Participants were randomised into two groups: Tai Chi with usual care (experimental) (n=14) or usual care (control) (n=9). The experimental group attended one-hour Tai Chi classes twice a week and participated in home practice for 12 weeks.

Primary outcome measures were fall rates and the Berg Balance Scale [BBS] to measure falls risk and balance ability. Secondary outcome measures included the Geriatric Depression Scale [GDS] to measure depression levels, the Tinetti Falls Efficacy Scale [FES] to measure fear of falling, and the SF 12 to measure Quality of Life [QoL]. Semi-structured interviews were conducted with the experimental group to gain participants’ perspectives of the programme.

This study found Tai Chi is feasible for stroke survivors as an adjunct to their rehabilitation. Further, Tai Chi may empower them to take control over their own recovery at home. Recommended outcome measures include the number of fallers with the BBS, GDS and FES as secondary outcome measures. Future larger RCTs may consider a 24-week intervention and more advanced professional home practice materials. Adopting a wait-list design and including hospital-based introductory classes are recommended to improve recruitment. Mid-intervention assessment and long-term follow-ups of six and twelve months or longer are also recommended in a future trial.