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Comparison of Ai Chi and Impairment-Based Aquatic Therapy for Older Adults With Balance Problems: A Clinical Study

Covill, Laura G. PT, DPT, OCS1,2; Utley, Cynthia PT, DPT1; Hochstein, Cheryl PT, MSPT2

Journal of Geriatric Physical Therapy: October/December 2017 - Volume 40 - Issue 4 - p 204–213
doi: 10.1519/JPT.0000000000000100
Research Reports

Background and Purpose: Older adults with balance deficits often fear falling and limit their mobility. Poor balance is multifactorial, influenced by medication interactions, musculoskeletal and sensory system changes, and poor neuromuscular response to changes in body positions. Aquatic physical therapy (APT) is an intervention used to improve balance and decrease falls. Ai Chi is a water-based exercise program. It incorporates slow movements of progressive difficulty utilizing the upper and lower extremities and trunk coordinated with deep breathing. It is used for relaxation, strengthening, and balance training. The purpose of this study was to determine whether Ai Chi provides better results than conventional impairment-based aquatic therapy (IBAT) for older adults with balance deficits.

Methods: Thirty-two community-dwelling adults, 65 to 85 years old, were referred to 2 different community pools for APT. Fifteen participants received Ai Chi-based aquatic interventions and 17 participants received an IBAT program. Physical therapists trained in both programs completed interventions and determined discharge. Physical balance measures, which included the Berg Balance Scale (BBS) and Timed Up and Go (TUG), were collected pre- and posttherapy. Self-reported outcome measures, the Activities-Specific Balance Confidence Scale (ABC) and Numerical Pain Rating Scale (NPRS), were collected pre- and posttherapy and 3- and 6-month postdischarge.

Results: A 2-way (group by time) mixed-model analysis of covariance with initial outcome scores as a covariate revealed no difference between groups in any of the outcome measures (BBS, P = .53; TUG, P = .39; ABC, P = .63; NPRS, P = .27). Repeated-measures analysis and dependent t tests showed significant improvements in the BBS (P = .00) and TUG (P = .03) after APT. The ABC and NPRS did not improve significantly (ABC, P = .27; NPRS, P = .77).

Conclusions: There were no significant differences found in balance measures, balance confidence, or pain levels for community-dwelling older adults between the Ai Chi and IBAT programs. Physical outcome measures improved with APT but patient-reported measures did not. Further study is indicated to determine the most effective treatment frequency and duration for this population.

1Des Moines University, Des Moines, Iowa.

2Mercy Physical Therapy Clinics, Des Moines, Iowa.

Address correspondence to: Laura G. Covill, PT, DPT, OCS Associate Professor, Des Moines University, Iowa (Laura.Covill@dmu.edu).

This work was presented in a poster presentation at the Combined Sections meeting of the American Physical Therapy Association, February 2015.

Supported by the Iowa Osteopathic Education Fund and Iowa Physical Therapy Association.

All 3 authors work for Mercy Medical Center–Des Moines, where the research took place and 1 author (Hochstein) performed the intervention of Ai Chi.

Robert Wellmon was the Decision Editor

© 2017 Academy of Geriatric Physical Therapy, APTA
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