Health & Rehabilitation

Research Institute

Denise Taylor, Leigh Hale, Philip Schluter, Debra Waters, Elizabeth Binns, Hamish McCracken, Kathryn McPherson, Steven Wolf

THE EFFECTIVENESS AND COST-EFFECTIVENESS OF TAI CHI AS A COMMUNITY BASED FALLS PREVENTION INTERVENTION

THE SIZE OF THE PROBLEM

About 30% of adults over 65 years fall each year

About half of these people experience recurrent falls

Healthcare resource use is high for fallers

Monetary cost is high (2006-7 cost to ACC was $30 million) (Robertson & Campbell 2008)

TAI CHI

Low to moderate form of exercise (low impact & low velocity)

Increasingly available to and accepted by the general public as a form of exercise

TAI CHI TO PREVENT FALLS

Favours intervention Favours controlStretching control group – very low levelWait list controlComputerised balance training – ½ amount of class practice and no home practiceA transitioning to frailty group

The controls are much lower intensity or lower frequency

No comparison including a more active control matched forsetting and matched for dose

(Gillespie et al)

THE QUESTIONS

Does a programme of modified Tai Chi reduce the rate offalls in community dwelling older adults to a greater extent

than an active control (low level exercise programme)?

Is there a dose response of Tai Chi?

Is Tai Chi cost-effective compared to a low level exercise programme?

Do strength and balance change ?

METHOD: DESIGN

Multicentre single-blind randomised control trial

Tai Chi 1x week5 months

Tai Chi 2x week 5 months

Low level exercise 1x week 5 months

Community dwelling older adults

Baseline assessment

Post intervention assessment

6 month follow up assessment

12 month follow up assessment

Monthly calendar17 months

METHOD: PARTICIPANTS

65 years or older (>55 years if Maori or PI)

Had a falls risk factor

Telephone MMSE score >23

Ambulate independently (+/- aid)

Not participating in organised exercise currently

Medical clearance from GP

METHOD: OUTCOMES

Falls rate

Timed up and go

Dynamic balance (step test)

Leg strength (30s chair stand test)

Balance confidence (ABC Scale)

Health status (SF36v2)

Falls related heath care utilisation & costs

RESULTS - PARTICIPANTS

1095 people were screened

684 people were recruited and randomised

233 in the TC1 group

220 in the TC2 group

231 in the LLE group

WhangareiOrewaNorth Shore AucklandWest AucklandTaurangaHamiltonChristchurchDunedinMilton

RESULTS - FALLS

Over the whole trial period there were1060 falls

TC1 group = 412 fallsLLE group = 350 fallsTC2 group = 298 falls

0.00

0.05

0.10

0.15

0.20

Mo

nthl

y fa

lls r

ate

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17Time (month)

LLETC1TC2

FALLS RATES

On average, how many falls did people have over a year?

Falls rate per person years (95% CI)

TC1 - 1.55 (1.23-1.97)

LLE - 1.38 (1.24-1.53)

TC2 - 1.16 (0.92-1.48)

Negative binomial regression

No statistically significant difference in the reduction of falls

STRENGTH AND BALANCE

Timed up and go

Step Test (Right & Left)

30 second Chair Stand

• Significant time effect• No significant group difference at baseline • No time x group interaction

Multi-level mixed-effects model

COST-EFFECTIVENESSThe joint distribution of cost and effect

WHAT WERE THE COSTS OF THE INTERVENTIONS?

Total falls related costs

Medical

Hospital

Ambulance

Transport to treatment

Therapy

Independence

Home help

Dental

Tai Chi x1

Tai Chi x2

Low level exercise x1

NZ$1052

NZ$834

NZ$866

Mean cost per person year

PlusProgramme costs

TC1

TC2

Incremental costs

Incrementaleffects

0.1 0.2 0.3-0.1-0.2-0.3

100

200

300

-300

-200

-100

INCREMENTAL COST EFFECTIVENESS PLANE

SO WHAT…

All groups had reduced falls over time (controlling for drop-out)

There was no statistically significant reduction in falls in the TC1 or TC2 group compared to the LLE group

There was no greater reduction of falls in the TC2 group than the TC1 group

Strength and balance measures improved

Functional mobility did not improve

TC2 was more cost-effective than TC1 based on trial only data

BUT...

ACKNOWLEDGEMENTS

Leigh HaleDebra Waters

Denise TaylorPhilip Schluter

Elizabeth BinnsHamish McCracken,Kathryn McPherson

Steven Wolf

The Accident Compensation Corporation of New Zealand

mynetbizz.com

FRAT

History of any fall in the previous year,

Four or more prescribed medications,

Diagnosis of stroke or Parkinson’s disease,

Reported problems with balance,

Inability to rise from a chair without using arms.