Effectiveness of Tai- Chi Intervention

Running head: EFFECTIVENESS OF TAI- CHI INTERVENTION
Effectiveness of Tai- Chi Intervention
Name of the Student
Name of the University
Author Note

1EFFECTIVENESS OF TAI- CHI INTERVENTION
Introduction
Every year around the world a huge amount of fall related cases are reported and in
most of the cases, it is observed that the people under the age group of 65 years or more are
mostly affected by this fall related cases in different countries of the world. As per the data
of the UK government, it was observed that in each and every year, one out of 3 older adults
under the age group of 65 years or more face fall related injury and it was reported that fall is
one of the major reason of injury among the older adults in United Kingdom (UK) (Plummer
and Bradley 2017). Moreover, the study findings of the Plummer and Bradley (2017) also
stated that the fall related problem among the older adults is also responsible for high rate of
hospitalization, disability and death and it causes almost 2 billion pounds in every year for the
management of those conditions in UK. . In this context, it can be stated that the loss of gait
balance among the older people are quite common during the older age and thereby the
chances of fall risks are also enhanced (Taylor et al. 2012). In this context, the application of
the Tai Chi intervention programs can be introduced by the physiotherapists and health care
professionals. Tai chi intervention were used over any other intervention because Tai Chi has
severe impact on the cognitive functions such as visuospatial skills, semantic memory,
learning memory, and self-perception of memory unlike any other intervention that failed to
involve all cognitive domain. The dementia patients usually have impairment in one to two
cognitive domains. Consequently, cognitive impairment is considered as one of the most
crucial risk factors that subject patients into sudden fall and associated injury. Hence, this is
context, unlike any other group of the patient, tai chi intervention is most suitable for the
patients who are suffering from dementia to improve cognitive function of the patients. In
this context, the outcome measures for effectiveness of the intervention will be OCAIRS,
COPM that will provide the idea of effectiveness in each part of the section. In this essay, the
effectiveness of the Tai Chi intervention for reducing the fall risks among the older people is

2EFFECTIVENESS OF TAI- CHI INTERVENTION
discussed and along with this a brief description of this intervention process is also described.
This paper will incorporate Theory of Occupational Reconstructions in occupational therapy
theory and Allen's Cognitive Disabilities Model (CDM) in the models to demonstrate the
effectiveness of the intervention. This paper will provide in depth analysis of the tai chi
intervention, suitable group, occupational therapy model and outcome measures in following
paragraphs.
Methodology:
In the methodology section, for preparing the literature review, secondary research
was conducted where relevant and recent data was collected from a range of sources such as
peer reviewed journals and government documents. For collecting relevant data, the
electronic databases were used such as CINAHL, PubMed and Google scholar where
inclusion criteria was used to obtain relevant data. The peer reviewed journal focused on the
tai chi intervention and research collected based on the publication date from 2010 onwards
which will be assessed based on the relevancy of the articles. The keywords that were used
for obtaining article include, “occupational therapist use of Tai Chi”, “effectiveness of the tai
chi intervention” and “ tai chi intervention in dementia patients”.
Review of Literature
Description of the Intervention:
As per the data, it is reported that Tai Chi is a conventional and traditional Chinese
martial art comprised of slow and beautiful movements. Along with this, the traditional
martial arts also provides special emphasis on the combination of mind and body of the
individuals and as a result various physiological system of the body are also engaged. In the
Tai Chi interventions, the individuals have to practice rotation of the organs, transferring of

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weights to the multiple organs of the body, practicing of circular movements for making the
body more flexible. Moreover, practicing of Tai Chi interventions also allows the individuals
to control the joints of the human body accurately. Furthermore, the muscle coordination and
balance of the individuals are also improved by practicing this Tai Chi intervention (Hu et al.
2016). As a Chinese traditional martial art practice, it has become a global intervention and it
is observed that a huge number of trainers are present in Korea, Japan, United States and
Europe. According to the study of Zhong et al. (2019), it is stated that practicing Tai Chi
intervention can be used as a way of balance training through the practice of soft and gentle
movements of the different parts of the body. The study also states that Tai Chi is very easy
to practice and it is not limited by venues. The study also identified that in the Tai Chi
intervention process, not only the physical exercises are included, but the mental
coordination, mental exercises are also required. In order to provide mental and physical
peace, in this intervention process muscle relaxation exercise, relaxed breathing exercises are
practiced by the individuals. It is believed that this particular martial art can improve the
balance function of the body and thus practicing this exercise can improve the limb function
of the patients suffering from the problem of dementia. The study also identified that the use
of this Tai Chi intervention can also affect the functionality of the knee joints and thereby
improves the pain in the knee joints of the individuals. However, this intervention also has
proven to be successful among the stroke patients. In another study by Tousignant et al.
(2013), it is stated that Tai Chi is effective in various other ways and it can be mentioned that
Tai Chi not only improves the balance control of the body but also can help in the
enhancement of the cardiovascular fitness of the body as well. However, in recent time, in
spite of having multiple usability of Tai Chi intervention this intervention process is mainly
used to improve the gait balance, muscle flexibility, fall prevention among the older adults.
Hence, occupational therapist must involve patients with dementia in tai chi intervention

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under Mental Capacity Act 2005 for promoting active aging. World Health Organization
estimated that around the world approximately 240 billion US dollar is spent for the
management of the fall related cases in the world and the number of older population faces an
exponential growth around the different countries of the world and it is estimated that by the
end of 2021, there will be an increase in the number of the older people and approximately 2
million of elderly people will rise and contribute to the overall number of elderly population
in UK. According to the study of Mortazavi et al. (2018), it is stated that among the patients
with dementia, the cases of fall related injuries are very common. In this context, tai chi
intervention is most effective intervention that can coordinate the mind and body.
Effectiveness of tai chi:
The main reason of high fall related injury cases among the older adults suffering from
the problem of dementia is associated with the reduced physical activities of the patients,
presence of osteoporosis, lack of balance control, altered gait balance among the elderly
people. In this context, tai chi intervention is effective. According to the study of Giné-
Garriga et al. (2014), it is stated that in the Tai Chi intervention process a slow and sustained
movement of the muscles are practiced along with a rhythmical movements of the limbs and
trunks and during this process the centre of gravity is maintained throughout the process. In
this context, it can be stated that the application of this intervention is quite cost effective in
nature and along with time most of the countries also follow this intervention strategy as a
part of the fall prevention strategy among the older adults. However, the study has a range of
limitations that negatively impacted the quality of the study. One of the potential example is
that great heterogeneity of the study directly hindered the ability to draw comprehensive
conclusion about appropriate design of the exercise program. Moreover, the sample size of
the research and risk of bias of the research negatively impacted the validity of the research.

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Lastly, multicomponent interventions affected diverse indicators of the frailty and required a
comprehensive assessment of the outcome.
In another study Hu et al. (2016) it was reported that falls are one of the major
concerns of public health issue and mainly the older adults are facing the problems of the fall
due to their poor gait balance. The researchers conducted systematic review and meta-
analysis of articles regarding the tai chi exercise on the fall reduction. While research provide
accurate result regarding the tai chi intervention, it also has a range of limitations. The first
limitation is incomplete and inadequate journals for conducting systematic review and meta-
analysis. The second limitation of the study is that data for the outcome measures were self-
reported that increase the selection bias. Lastly, while it would be ideal for including training
variables in the exercise intervention such as sub group, this was not possible to incorporate
due to lack information from a range of literature.
In various other studies, the positive impacts of Tai Chi intervention among the older
adults for preventing the fall cases are reported. In the study of Rogers, Larkey and Keller
(2009), it was reported that practicing various types of physical activities can improve the
functional capacity of the body and in this regard, the authors identified that meditative
movement forms of physical activities such as Tai Chi and Qigong are quite effective in
improving physical functionality among the elderly people. In this regard, it can be stated that
the application of these intervention is successful as in such type of interventions both
physical and mental practices are present and it will enhance the flexibility of the bodily
postures among the older adults. In the present review study, approximately 36 articles were
analysed and it was reported that approximately 71.97 per cent were women among the
whole participants. The study reported that varieties of Tai Chi intervention were used by the
researchers and the practice was adapted from larger to smaller number of bodily movements.
For example, it can be stated that Yang form of Tai Chi has approximately 108 types of

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original movements and from this original movements almost 10 to 24 movement practices
were adapted by the researchers in different studies (Rogers, Larkey and Keller 2009). In
another systematic review study by Huang et al. (2016), it was reported that Tai Chi
intervention is an effective intervention process for the prevention of fall related cases among
the older adults. In this review study only those articles were selected that addressed the
problem of older adults aged 65 years or more. After applying all the inclusion and exclusion
criteria, finally 18 articles were selected for final review and all the articles were chosen by
using random selection method by the authors and in order to reduce the study bias the
authors extracted the data differently. From the study result, it was reported that the chance of
falling was lower among the groups practicing Tai Chi than that of the control groups who
were not engaged any type of exercise for fall reduction. The reduction of fall risk was higher
among the participants of Tai Chi (Yang style Tai Chi) intervention groups (RR 0.61, 95% CI
0.46 to 0.80) than that of the participants of the Sun Style Tai Chi intervention group (RR
0.88, 95% CI 0.80 to 0.98). Tai Chi intervention was capable of reducing the rate of fall
related risks compared to the control group of the study (IRR 0.69, 95% CI 0.60 to 0.80;
heterogeneity: p=0.003, I2=57%). The limitation of the research is generalizability since it
cannot be applied to the community. The research demonstrated effectiveness in the
relatively narrow gender and ethnic groups. The research mostly conducted in the United
States, especially on women in contrast to other countries. Hence, this study will be effective
for supporting the patient of the United States.
Tai chi intervention is effective compared to other interventions:
Nyman et al. (2018), conducted 3 centred groups of the randomized controlled trial
with an integrative process of evaluation which is a gold standard of experimental study. The
researchers focused on the community-dwelling dyads of patients with dementia and their
informal carer and assessed at the baseline as well as at the baseline and the end of the

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follow-up session. Total 45 minutes of tai chi class along with informal discussion was
provided to one arm and home-based exercise was provided to the controlled arm. The home-
based tai chi was supported with behaviour change techniques such as coping planning, self-
monitoring and alarm clock reminder. The primary outcome measures were dynamic balance
and flexibility whereas secondary balance was static balance, fear of falling and global
cognitive functioning, carer burden, visual-spatial and quality of life and falls. The result of
the suggested that individuals with dementia exhibit static balance and flexibility and reduced
fear of falling compared to other normal care or home-based intervention, indicating
compared to other interventions, it is effective intervention to support the individuals with
dementia. The limitation of the study, in this case, is confounding factors and no cross-
sectional sampling was done to eliminate confounding factors. On the other hand, Plummer
and Bradley( 2017), conducted a literature review to compare the tai chi intervention and
conventional physiotherapy to identify the effective intervention for adults with dementia.
The researchers used a range of databases to obtain articles for the intervention. The
researchers suggested that compared to conventional intervention, multidimensional
intervention containing tai chi intervention is effective in reducing the intervention in terms
of improving the balance of the patients and improving the cognitive functioning of the
patients. To support this data, Lim et al. (2019), suggested that patients with dementia usually
have severe impairment in one or two domains that impact the mobility and daily activities of
the patients. Tai chi involves all cognitive domains such as visuospatial skills, semantic
memory, verbal learning/memory, and self-perception of memory, unlike any other
convention intervention. Hence, compared to any other interventions for dementia patients,
tai chi is specifically effective to improve the cognitive functioning of the patients. It will
promote active ageing by involving in the exercise, reducing the stress of the patients and
enable patients to maintain a healthy weight and live a purposeful life. However, Lim et al.

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(2019), suggested that one of the potential drawbacks of the intervention is that in order to
involve patients, professionals must consider the side effects such as the sudden impact on
any muscles of the body.
Tai chi intervention aligned with occupational therapy theory and model:
An occupational therapist usually use tai chi intervention to provide best possible
care to patients with dementia. Theory of Occupational Reconstructions is one such
occupational therapy theory that incorporates in the tai chi interventions and used by
occupational therapist. Theory of Occupational Reconstructions focused on the mind and
body engagement for dealing with inherently transformational injustice. The theory considers
occupation as a creative and unique engagement that facilitate intrinsic motivation of the
patients (Walder and Molineux 2017). The seven principles of the theory are used by an
occupational therapist to involve patients such as respond to a difficult situation, meaning and
purpose to improve the situation, have a narrative structure, have hopeful experiments to
enable patients to have a purposeful life. In the tai chi intervention, the occupational therapist
uses these principles to engage mind and body so that patients with dementia experience
healthy ageing. Moreover, the occupational therapist uses Allen’s Cognitive Disabilities
Model in the tai chi intervention to support the active ageing of the population. This model
focuses on the integration of the cognitive functional ability which is suitable for patients
with dementia for preventing the fall (Rojo-Mota et al. 2017). Hence, to comply with the
model, the occupational therapist usually considers the cognitive functionality of dementia
patients and consider the needs of the patient before involving in the tai chi intervention. In
this context, Scott et al. (2017), suggested the occupational therapist usually use OCAIRS
assessment scale to capture the experience of the individuals in the occupation participation.
In this case, an occupational therapist can use this initial part of the participation and end of
the intervention, the positive experience of the patients will provide the idea of whether it will

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be effective or not. Similar to this model COMP is another model that can be used by an
occupational therapist to capture the self-perception of the performance in daily living over
the time, especially the prevention of fall (Mao et al. 2018).
In this context, by incorporating this in the tai chi intervention as part of the session
can be effective so that improved self-perception of daily living from the initiation of session
and end of the session will provide the idea regarding the effectiveness of the patients. The
'active ageing' framework 2015 is one such policy is that support the active ageing of the
patients and occupational therapist must comply with the framework to provide interventions
to dementia patients (Djurovic et al. 2017).
Literature gap:
Dementia patients usually have cognitive impairment in one or two cognitive domain
that affect their memory, mobility, learning and understanding. Majority of the researchers
suggested that tai chi intervention is most effective intervention that improves the cognitive
functioning of the patients (Barrado-Martín et al. 2018). However, the majority of the
researchers focused on the effectiveness of tai chi, limited researchers focused on the
negative part of it, especially side effects of the intervention on the patients. On the other
hand, limited researchers explored the perspective of the patients after involving in the
intervention. Majority of the researchers conducted randomizes control trail and systematic
review for underpinning effectiveness for the intervention, especially fear of fall rather than
the perception of active aging after involving patients in the intervention. In this context, in
order to gather the perception, values and attitude of the dementia patients after involving in
the intervention, a semi-structured interview is required to do. Limited research was
conducted on the required skills that occupational therapists must acquire to support. In this
context, extensive semi-structured interview and phenomenological research are required to
conduct for underpinning the perception, attitude and values of the researchers.

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The recommendations:
Active Ageing intended to extend life expectancy as well as the quality of life for all
individuals as they age so that they can gain the purpose of life (Lyu et al. 2018). At this
juncture, the future recommendation for the occupational therapist is to involve tai chi
interventions as part of multidimensional intervention so that patients can experience active
and comfortable ageing. The occupation therapist must involve family members of the
dementia patient in the intervention so that patients feel empowered, compassionate and safe
and experienced reduced fear of fall (Buric et al. 2017). For promoting active ageing and
supporting patients with dementia, the occupational therapist must acquire a range of skills
such as sound knowledge of the tai chi intervention, excellent observation skills, attention to
the details and excellent communication (Liao et al. 2018). To promote the active ageing, the
occupational therapist must ensure that patients are receiving a high quality of care under the
Mental Capacity Act 2005 for promoting active ageing (Donnelly 2016.). Moreover, the
occupational therapist must ensure that patients are receiving a high quality of care
complying the 'active ageing' framework 2015 so that they can experience active ageing.
Hence, to gather experience and perception of the patients, it is crucial that occupational
therapist must use outcome measures to be used such as OCAIRS, COPM so that they can
apply this in the practice for empowering patients and improving their quality of life.
Conclusion:
On a concluding note, it can be said that fall and associated injuries are one of the most
common public health intervention around the globe. In the united kingdom, a huge
amount of fall-related cases are reported and in most of the cases, it is observed that the
people under the age group of 65 years or more are mostly affected by this fall-related cases
in different countries of the world. So, in order to manage the conditions of the elderly people

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suffering from the problem of dementia various management strategy and intervention
programs can be introduced. The main reason of high fall-related injury cases among the
older adults suffering from the problem of dementia is associated with the reduced physical
activities of the patients, presence of osteoporosis, lack of balance control, and altered gait
balance among the elderly people. In this context, the future recommendation is that
occupation therapist must involve family members of the dementia patient in the intervention
so that patients feel empowered, compassionate and safe and experienced reduced fear of fall.
For promoting active ageing and supporting patients with dementia, the occupational
therapist must acquire a range of skills such as sound knowledge of the tai chi intervention,
excellent observation skills, attention to the details and excellent communication so that
patients feel empowered and eliminate the fear of fall.

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References
Barrado-Martín, Y., Heward, M., Polman, R. and Nyman, S.R., 2018. Acceptability of a
dyadic tai chi intervention for older people living with dementia and their informal
carers. Journal of aging and physical activity, 27(2), pp.166-183.
Buric, I., Farias, M., Jong, J., Mee, C. and Brazil, I.A., 2017. What is the molecular signature
of mind–body interventions? A systematic review of gene expression changes induced by
meditation and related practices. Frontiers in Immunology, 8, p.670.
Djurovic, I., Jeremic, V., Bulajic, M. and Dobrota, M., 2017. A two-step multivariate
composite I-distance indicator approach for the evaluation of Active Ageing Index. Journal
of Population Ageing, 10(1), pp.73-86.
Donnelly, M., 2016. Best interests in the Mental Capacity Act: time to say
goodbye?. Medical law review, 24(3), pp.318-332.
Giné-Garriga, M., Roqué-Fíguls, M., Coll-Planas, L., Sitja-Rabert, M. and Salvà, A., 2014.
Physical exercise interventions for improving performance-based measures of physical
function in community-dwelling, frail older adults: a systematic review and meta-
analysis. Archives of physical medicine and rehabilitation, 95(4), pp.753-769.

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Hu, Y.N., Chung, Y.J., Yu, H.K., Chen, Y.C., Tsai, C.T. and Hu, G.C., 2016. Effect of Tai
Chi exercise on fall prevention in older adults: systematic review and meta-analysis of
randomized controlled trials. International Journal of Gerontology, 10(3), pp.131-136.
Huang, Z.G., Feng, Y.H., Li, Y.H. and Lv, C.S., 2017. Systematic review and meta-analysis:
Tai Chi for preventing falls in older adults. BMJ open, 7(2), p.e013661.
Liao, S.J., Tan, M.P., Chong, M.C. and Chua, Y.P., 2018. The impact of combined music and
tai chi on depressive symptoms among community-dwelling older persons: A cluster
randomized controlled trial. Issues in mental health nursing, 39(5), pp.398-402.
Lim, K.H.L., Pysklywec, A., Plante, M. and Demers, L., 2019. The effectiveness of Tai Chi
for short-term cognitive function improvement in the early stages of dementia in the elderly:
a systematic literature review. Clinical interventions in aging, 14, p.827.
Lyu, J., Li, W., Rong, X., Wei, L., Huang, N., Champ, M., Xiong, Q., Chen, X., Li, M. and
Li, F., 2018. Efficacy of practising Tai Chi for older people with mild dementia: protocol for
a randomised controlled study. BMJ open, 8(5), p.e019940.
Mao, S.H., Qian, B.P., Shi, B., Zhu, Z.Z. and Qiu, Y., 2018. Quantitative evaluation of the
relationship between COMP promoter methylation and the susceptibility and curve
progression of adolescent idiopathic scoliosis. European Spine Journal, 27(2), pp.272-277.
Mortazavi, H., Tabatabaeichehr, M., Golestani, A., Armat, M.R. and Yousefi, M.R., 2018.
The effect of tai chi exercise on the risk and fear of falling in older adults: a randomized
clinical trial. Materia socio-medica, 30(1), p.38.
Nyman, S.R., Hayward, C., Ingram, W., Thomas, P., Thomas, S., Vassallo, M., Raftery, J.,
Allen, H. and Barrado-Martin, Y., 2018. A randomised controlled trial comparing the
effectiveness of tai chi alongside usual care with usual care alone on the postural balance of

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community-dwelling people with dementia: protocol for the TACIT trial (TAi ChI for people
with demenTia). BMC geriatrics, 18(1), p.263.
Plummer, M. and Bradley, C., 2017. Tai Chi as a falls prevention strategy in older adults
compared to conventional physiotherapy exercise: A review. International Journal of
Therapy And Rehabilitation, 24(6), pp.239-247.
Rogers, C.E., Larkey, L.K. and Keller, C., 2009. A review of clinical trials of tai chi and
qigong in older adults. Western journal of nursing research, 31(2), pp.245-279.
Rojo-Mota, G., Pedrero-Perez, E.J., Huertas-Hoyas, E., Merritt, B. and MacKenzie, D., 2017.
Allen Cognitive Level Screen for the classification of subjects treated for
addiction. Scandinavian journal of occupational therapy, 24(4), pp.290-298.
Scott, P.J., Cacich, D., Fulk, M., Michel, K. and Whiffen, K., 2017. Establishing concurrent
validity of the Role Checklist version 2 with the OCAIRS in measurement of participation: a
pilot study. Occupational therapy international, 2017.
Taylor, D., Hale, L., Schluter, P., Waters, D.L., Binns, E.E., McCracken, H., McPherson, K.
and Wolf, S.L., 2012. Effectiveness of tai chi as a community‐based falls prevention
intervention: A randomized controlled trial. Journal of the American Geriatrics
Society, 60(5), pp.841-848.
Tousignant, M., Corriveau, H., Roy, P.M., Desrosiers, J., Dubuc, N. and Hebert, R., 2013.
Efficacy of supervised Tai Chi exercises versus conventional physical therapy exercises in
fall prevention for frail older adults: a randomized controlled trial. Disability and
rehabilitation, 35(17), pp.1429-1435.
Walder, K. and Molineux, M., 2017. Occupational adaptation and identity reconstruction: a
grounded theory synthesis of qualitative studies exploring adults’ experiences of adjustment

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to chronic disease, major illness or injury. Journal of Occupational Science, 24(2), pp.225-
243.
Zhong, D., Xiao, Q., He, M., Li, Y., Ye, J., Zheng, H., Xia, L., Zhang, C., Liang, F., Li, J.
and Jin, R., 2019. Tai Chi for improving balance and reducing falls: A protocol of systematic
review and meta-analysis. Medicine, 98(17).

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