SYDNEY, Australia — Training patients with Parkinson's disease (PD) in the ancient art of tai chi is a cost-effective way to cut the risk for falls, new research shows.

In an earlier randomized controlled study, Fuzhong Li, PhD, from the Oregon Research Institute in Eugene and colleagues, found that tai chi reduced balance impairments, improved function, and reduced falls in patients with PD. The findings were published in the New England Journal of Medicine in 2012, as reported by Medscape Medical News.

This week at the Movement Disorder Society (MDS) 17th International Congress of Parkinson's Disease and Movement Disorders, the researchers reported a preliminary cost-effectiveness analysis of the data from the trial.

The data indicate a "significant potential return on investment value" of tai chi in PD, they said in a meeting abstract. "As treatment costs for injury falls continue to rise these results have important implications for reducing overall healthcare costs while protecting patient health and independence."

Significant Return on Investment

There is increasing evidence of the benefits of exercise for PD but, until now, meager information on cost-effectiveness of various exercise-based modalities, the researchers note.

Dr. Li and colleagues calculated all expenditures related to the tai chi intervention used in their earlier trial, including program promotion, patient enrollment, instructor teaching/training fees and travel expenses, classroom rental, training equipment, participant incentives and transportation, and printing of instructional materials.

The trial included 195 patients with PD at Hoehn and Yahr scale stages 1 to 4 who participated in tai chi, resistance training, or stretching. The Hoehn and Yahr scale ranges from 1 to 5, with higher stages indicating more severe disease. Patients attended two 60-minute exercise sessions per week for 24 weeks. 

During the study, the fewest falls were recorded in the tai chi group (n = 62). There were186 falls in the stretching group and 133 in the resistance group.

By their calculations, total implementation cost to prevent 124 falls (stretching vs. tai chi) was $102,872 ($791/patient; $830/fall prevented); to prevent 71 falls (resistance vs tai chi) the total cost was $107,557 ($827/patient; $1515/fall prevented).

To put their findings in perspective, the researchers note that current estimates indicate 20% to 30% of falls in community-dwelling older adults result in injury, with an average healthcare cost of a fall injury being approximately $18,470.

Therefore, for the total of 124 falls prevented, approximately 25 to 37 would have resulted in injury that would cost between $461,750 and $683,390 for medical care. For 71 falls prevented, 14 to 21 would have been injury falls generating $258,580 to $387,870 in treatment costs.

"I think the key take-home message for clinicians is that tai chi exercises not only reduce falls or risk of falling but does so at a lower cost (ie, cost-effective)," Dr. Li told Medscape Medical News.

"With the multiple health outcomes reported in our trial published in the New England Journal of Medicine, we believe it is safe to recommend tai chi to patients with mild-to-moderate level of severity. Unlike drugs which induce significant side-effects, tai chi is safe to perform for patients without introducing any significant adverse events or muscular-skeletal discomfort," Dr. Li said.

An Argument for Greater Use

"One perceivable downside is that it has to be initially taught by an instructor or clinician, suggesting some level of time and practice commitment is needed," Dr. Li added.

But Tao Liu, MD, from Jilin University, Changchun, China, who was not involved in the study, told Medscape Medical News, "it should be noted that class delivery is necessary only for early-stage-tai chi-learners. After this initial stage, tai chi can be self-performed at home at almost no expense, which can make it much more cost-effective."

Dr. Liu also noted that this study used fall reduction as a measure to analyze cost-effectiveness of tai chi. "In addition to motor functions, however, substantial evidence shows that tai chi has positive effects on other health outcomes, such as cognitive performance, sleep quality, etc. If this is taken into account, tai chi will become more cost-effective," Dr. Liu commented.

"While there is evidence supporting its potential efficacy and lack of adverse effects, this study adds to the argument for more extensive use of tai chi for treating PD and other like conditions," Dr. Liu concluded.

The study had no funding. The authors and Dr. Liu have disclosed no relevant financial relationships.

Movement Disorder Society (MDS) 17th International Congress of Parkinson's Disease and Movement Disorders. Abstract 280. Presented June 17, 2013.


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