Aileen W.K. Chan

Tai chi Qigong improves lung functions and activity tolerance in COPD clients: A single blind, randomized controlled trial

OBJECTIVEnTo evaluate the effectiveness of a Tai chi Qigong (TCQ) program in enhancing respiratory functions and activity tolerance in clients with chronic obstructive pulmonary disease (COPD).nnnDESIGNnA single-blind, randomized controlled trial.nnnSETTINGnFive general outpatient clinics in Hong Kong.nnnINTERVENTIONnIn total, 206 COPD clients were randomly assigned into one of the three groups, namely, TCQ, exercise, and control group. Subjects in the TCQ group received a TCQ program consisting of two 60-min sessions each week for three months. Subjects in the exercise group were taught to practice breathing techniques combined with walking as an exercise. Subjects in the control group were instructed to maintain their usual activities. Data collection was performed at baseline and at the 6-week and 3-month marks.nnnOUTCOMESnLung functions, 6-min walk test, and COPD exacerbation rate.nnnRESULTSnResults of repeated measures of analysis of covariance demonstrated that there were significant interaction effects between time and group in forced vital capacity (p=.002, η(2)=.06), forced expiratory volume in 1s (p<.001, η(2)=.02), walking distance (p<.001), and exacerbation rate (p=.006, η(2)=.06) at 3 months. Improvements were noted in the TCQ group. No changes were observed in the exercise group, while a decline in lung functions was noticed in the control group.nnnCONCLUSIONnTai chi Qigong was able to improve respiratory functions and activity tolerance level in COPD clients. The breathing and walking exercise helped maintain lung functions and slow down disease progression.

Effectiveness of a Tai chi Qigong program in promoting health-related quality of life and perceived social support in chronic obstructive pulmonary disease clients

PurposeThis paper evaluates the effectiveness of a 3-month Tai chi Qigong (TCQ) program in promoting the psychosocial functional health of clients with chronic obstructive pulmonary disease (COPD) in Hong Kong.MethodsThis study employed a single-blind, randomized controlled trial. Two hundred and six COPD clients were randomly assigned into three groups, namely, TCQ group, exercise group, and control group. Subjects in the TCQ group received a TCQ program, consisting of two 60-min sessions each week for 3xa0months. Subjects in the exercise group were taught to practice breathing techniques combined with walking as an exercise. Subjects in the control group received their usual care. Data collections were performed at baseline, on the sixth week and on the third month. The primary outcomes were health-related quality of life using St. George Respiratory Questionnaire-Hong Kong Chinese version and perceived social support using the Multidimensional Scale of Perceived Social Support-Chinese version.ResultsThe TCQ group showed greater improvements in the symptom (F4, 404xa0=xa03.351, Pxa0=xa00.010) and activity domains (F4, 404xa0=xa02.611, Pxa0=xa00.035). No differences were detected in perceived social support among the three groups.ConclusionsTai chi Qigong promoted health outcomes with respect to clients’ perception of their respiratory symptoms. Moreover, TCQ decreased disturbances to their physical activities.

The sustaining effects of Tai chi Qigong on physiological health for COPD patients: A randomized controlled trial

OBJECTIVESnTo evaluate the sustaining effects of Tai chi Qigong in improving the physiological health for COPD patients at sixth month.nnnDESIGNnA randomized controlled trial. Subjects were in three randomly assigned groups: Tai chi Qigong group, exercise group, and control group.nnnSETTINGnThe 206 subjects were recruited from five general outpatient clinics.nnnINTERVENTIONSnTai chi Qigong group completed a 3-month Tai chi Qigong program. Exercise group practiced breathing and walking as an exercise. Control group received usual care.nnnMAIN OUTCOME MEASURESnPrimary outcomes included six-minute walking distance and lung functions. Secondary outcomes were dyspnea and fatigue levels, number of exacerbations and hospital admissions.nnnRESULTSnTai chi Qigong group showed a steady improvement in exercise capacity (P<.001) from baseline to the sixth month. The mean walking distance increased from 298 to 349 meters (+17%). No significant changes were noted in the other two groups. Tai chi Qigong group also showed improvement in lung functions (P<.001). Mean forced expiratory volume in 1s increased from .89 to .99l (+11%). No significant change was noted in the exercise group. Deterioration was found in the control group, with mean volume decreased from .89 to .84l (-5.67%). Significant decreased in the number of exacerbations was observed in the Tai chi Qigong group. No changes in dyspnea and fatigue levels were noted among the three groups.nnnCONCLUSIONSnTai chi Qigong has sustaining effects in improving the physiological health and is a useful and appropriate exercise for COPD patients.

Evaluation of the Sustaining Effects of Tai Chi Qigong in the Sixth Month in Promoting Psychosocial Health in COPD Patients: A Single-Blind, Randomized Controlled Trial

Objectives. To evaluate the sustaining effects of Tai Chi Qigong (TCQ) in improving the psychosocial health in chronic obstructive pulmonary disease (COPD) patients in the sixth month. Background. COPD affects both physical and emotional aspects of life. Measures to minimize patients suffering need to be implemented. Methods. 206 COPD patients were randomly assigned into three groups: TCQ group, exercise group, and control group. The TCQ group completed a three-month TCQ program, the exercise group practiced breathing and walking exercise, and the control group received usual care. Results. Significant group-by-time interactions in quality of life (QOL) using St. Georges respiratory questionnaire (P = 0.002) and the perceived social support from friends using multidimensional scale of perceived social support (P = 0.04) were noted. Improvements were observed in the TCQ group only. Conclusions. TCQ has sustaining effects in improving psychosocial health; it is also a useful and appropriate exercise for COPD patients.

Effects of tai chi qigong on psychosocial well-being among hidden elderly, using elderly neighborhood volunteer approach: a pilot randomized controlled trial

Purpose To test the feasibility and preliminary effectiveness of a tai chi qigong program with the assistance of elderly neighborhood volunteers in strengthening social networks and enhancing the psychosocial well-being of hidden elderly. Patients and methods “Hidden elderly” is a term used to describe older adults who are socially isolated and refuse social participation. This pilot randomized controlled trial recruited 48 older adults aged 60 or above who did not engage in any social activity. They were randomized into tai chi qigong (n=24) and standard care control (n=24) groups. The former group underwent a three-month program of two 60-minute sessions each week, with the socially active volunteers paired up with them during practice. Standard care included regular home visits by social workers. Primary outcomes were assessed by means of the Lubben social network and De Jong Gieveld loneliness scales, and by a revised social support questionnaire. Secondary outcomes were covered by a mental health inventory and the Rosenberg self-esteem scale, and quality of life by using the 12-Item Short Form Health Survey. Data was collected at baseline, and at three and six months thereafter. Results The generalized estimating equations model revealed general improvement in outcomes among participants on the tai chi qigong program. In particular, participants reported a significantly greater improvement on the loneliness scale (B=−1.32, 95% confidence interval [CI] −2.54 to −0.11, P=0.033) and the satisfaction component of the social support questionnaire (B=3.43, 95% CI 0.10–6.76, P=0.044) than the control group. Conclusion The pilot study confirmed that tai chi qigong with elderly neighborhood volunteers is a safe and feasible social intervention for hidden elderly. Its potential benefits in improving social and psychological health suggest the need for a full-scale randomized controlled trial to reveal its empirical effects.

Tai chi qigong as a means to improve night-time sleep quality among older adults with cognitive impairment: a pilot randomized controlled trial.

Purpose Age-related cognitivee decline is a growing public health concern worldwide. More than a quarter of adults with cognitive impairment experience sleep disturbance. The objective of this pilot study was to evaluate the preliminary effects of tai chi qigong (TCQ) on improving the night-time sleep quality of older adults with cognitive impairment. Participants Older adults with cognitive impairment who complain of sleep disturbance. Methods A randomized controlled trial with two groups. Fifty-two subjects were recruited from two district elderly community centers and randomly assigned to either the TCQ group (n=27) or the control group (n=25). The intervention group received TCQ training consisting of two 60-minute sessions each week for 2 months. The control group was advised to maintain their usual activities. Sleep quality was measured by the Chinese Pittsburgh Sleep Quality Index. Quality of life was measured by Short-form 12, cognitive functions measured by mini-mental state examination, and subjective memory deficits measured by the memory inventory for Chinese. Results Data were collected at baseline, 2 months, and 6 months. Significant results were noted at 6 months in the Chinese Pittsburgh Sleep Quality Index global score (P=0.004), sleep duration (P=0.003), habitual sleep efficiency (P=0.002), and the Short-form 12 mental health component (P<0.001). The TCQ participants reported better sleep quality and a better (quality of life) mental health component than the control group. Conclusion TCQ can be considered a useful nonpharmacological approach for improving sleep quality in older adults with cognitive impairment. Clinical trial registration CUHK_CCT00448 (https://www2.ccrb.cuhk.edu.hk/registry/public/287).

Promoting Holistic Well-being in Chronic Stroke Patients Through Leisure Art-based Creative Engagement

Purpose: To examine the potential value of a creative art-based activity as a caring modality for promoting holistic well-being among chronic stroke patients, and to explore the feelings and meanings that stroke patients derived from their experience in leisure art-based creative engagement (LACE). Design: Qualitative design. Method: Participants were recruited through purposive and snowball sampling. Individual semi-structured interviews were conducted. Qualitative content analysis was performed. The design and implementation of LACE was guided by Watson’s theory of caring. Findings: Twenty-four participants completed the study. Four themes emerged from participants’ account of experiences with the LACE: (1) appreciation of opportunities, (2) appreciation of self, (3) appreciation of others, and (4) appreciation of life. Conclusion: From the perspective of the participants, engaging in LACE enhances their sense of enjoyment and self-expression. Furthermore, they perceived LACE as an affirmation of life and an empowering process strengthening their connection and appreciation with the self and others. Clinical Relevance: This study adds evidence to existing literature on Watson’s theory-guided design and implementation of caring initiatives for community rehabilitation and has laid the groundwork for developing further evidencebased research in leisure art-based caring occasions for promoting holistic well-being in stroke rehabilitation.

Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial

Background Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients’ ability to participate in self-management. Purpose To examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery. Methods This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

Quality of life and palliative care needs of elderly patients with advanced heart failure

Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure (HF). Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire (MQoL), were used for measurement. Multiple regression analysis was performed to determine factors for predicting quality of life. Results A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness (5.96 ± 2.78), drowsiness (5.47 ± 2.93), and shortness of breath (5.34 ± 2.96). Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest (4.20 ± 1.767), whereas their mean psychological subscale was the highest (7.14 ± 2.39). However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. Conclusions The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients.

Effects of Tai Chi-based cardiac rehabilitation on aerobic endurance, psychosocial well-being, and cardiovascular risk reduction among patients with coronary heart disease: A systematic review and meta-analysis:

Introduction: Tai Chi is an attractive exercise to improve cardiovascular health. This review aimed to synthesize articles written both in Chinese and in English to evaluate the effects of Tai Chi-based cardiac rehabilitation on aerobic endurance, psychosocial well-being and cardiovascular diseases risk reduction for coronary heart diseases patients. Methods: PRISMA guidelines were used to search major health databases to identify randomized controlled trials or non-randomized controlled clinical trials that evaluated Tai Chi intervention compared with active or non-active control groups in coronary heart disease patients. When suitable, data were pooled using a random-effects meta-analysis model. Results: Thirteen studies met the inclusion criteria. Tai Chi groups showed a large and significant improvement in aerobic endurance compared with both active and non-active control interventions (standard mean difference (SMD) 1.12; 95% confidence interval (CI): 0.58–1.66; p <0.001). Tai Chi groups also showed a significantly lower level of anxiety (SMD=9.28; CI: 17.46–1.10; p=0.03) and depression (SMD=9.42; CI: 13.59–5.26; p <0.001), and significantly better quality of life (SMD=0.73; 95% CI: 0.39–1.08; p <0.001) compared with non-active control groups. Conclusion: Significant effects of Tai Chi have been found in improving aerobic endurance and psychosocial well-being among coronary heart disease patients. Tai Chi could be a cost-effective and safe exercise option in cardiac rehabilitation. However, the effect of Tai Chi on cardiovascular disease risk reduction has not been amply investigated among coronary heart disease patients. Caution is also warranted in view of a small number of studies for this meta-analysis and potential heterogeneity in differences in the varied designs of Tai Chi intervention.