title: Efficacy and safety of Tai Chi for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  In Parkinson's disease (PD), wearing off and side effects of long-term medication and complications pose challenges for neurologists. Although Tai Chi is beneficial for many illnesses, its efficacy for PD remains uncertain. The purpose of this review was to evaluate the efficacy and safety of Tai Chi for PD.
  
  
  METHODS
  Randomized controlled trials (RCTs) of Tai Chi for PD were electronically searched by the end of December 2013 and identified by two independent reviewers. The tool from the Cochrane Handbook 5.1 was used to assess the risk of bias. A standard meta-analysis was performed using RevMan 5.2 software.
  
  
  RESULTS
  Ten trials with PD of mild-to-moderate severity were included in the review, and nine trials (n = 409) were included in the meta-analysis. The risk of bias was generally high in the blinding of participants and personnel. Improvements in the Unified Parkinson's Disease Rating Scale Part III (mean difference (MD) -4.34, 95% confidence interval (CI) -6.67--2.01), Berg Balance Scale (MD: 4.25, 95% CI: 2.83-5.66), functional reach test (MD: 3.89, 95% CI: 1.73-6.04), Timed Up and Go test (MD: -0.75, 95% CI: -1.30--0.21), stride length (standardized MD: 0.56, 95% CI: 0.03-1.09), health-related quality of life (standardized MD: -1.10, 95% CI: -1.81--0.39) and reduction of falls were greater after interventions with Tai Chi plus medication. Satisfaction and safety were high. Intervention with Tai Chi alone was more effective for only a few balance and mobility outcomes.
  
  
  CONCLUSIONS
  Tai Chi performed with medication resulted in promising gains in mobility and balance, and it was safe and popular among PD patients at an early stage of the disease. This provides a new evidence for PD management. More RCTs with larger sample size that carefully address blinding and prudently select outcomes are needed. PROSPERO registration number CRD42013004989.
authors.affiliation: Research and Development Department of New Drugs, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province, China; The Second College of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
authors.forename: Xiaojia
authors.initials: X
authors.lastname: Ni
authors.affiliation: Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province, China.
authors.forename: Shaonan
authors.initials: S
authors.lastname: Liu
authors.affiliation: The Second College of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
authors.forename: Fuchang
authors.initials: F
authors.lastname: Lu
authors.affiliation: Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province, China.
authors.forename: Xiaogeng
authors.initials: X
authors.lastname: Shi
authors.affiliation: Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province, China.
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Guo
mesh_terms: D026241:Exercise Movement Techniques / Q000379:methods; D005684:Gait; D006801:Humans; D010300:Parkinson Disease / Q000473:pathology / Q000534:rehabilitation*; D004856:Postural Balance; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D026302:Tai Ji / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome