| Objective:Parkinson’s disease(PD)severely affects patient’s motor symptoms,balance ability and quality of life.Tai Chi,a popular traditional health exercise in China,has been proven to be effective in improving PD symptoms.However,traditional Tai Chi movements are complex,difficult to remember,and poorly targeted.Therefore,there is an urgent need to design a set of targeted Tai Chi movements that are simple,easy to practice,and effective.In addition,PD patients mainly use drugs to control their condition in a home setting,and lack complete medication management and rehabilitation guidance.The development of Internet technology provides possibilities for tele-health management and rehabilitation guidance.Therefore,the purpose of this study is to: 1)Patients with PD will undergo a 16-week Tai Chi program,and then the subjects will be evaluated for motor symptoms,balance ability and quality of life to verify the effectiveness of this Tai Chi program;2)Build a PD remote management platform with the characteristics of combining medical and sport,and explore the application of Tai Chi combined with Internet technology in patients with mild to moderate PD,in order to provide PD patients with traditional sports rehabilitation in a home setting.Methods:1.This study recruited 70 subjects with mild to moderate PD who met the criteria and were randomly divided into Tai Chi group,exercise group and control group.Participants in the control group had a public lecture about PD once every two weeks.On the basis of the control group,subjects in the Tai Chi group practiced Tai Chi for60 minutes each time,3 times a week,for a total of 16 weeks,48 times in total.The exercise group performed “Tongji Hospital’s PD Exercise” on the basis of the control group.The exercise time and frequency were the same as those in the Tai Chi group.The subjects performed exercise and balance function tests before and after the intervention,including the third part of the Unified Parkinson’s Disease Rating Scale(UPDRS-Ⅲ),the Berg Balance Scale(BBS),the 10-meter walking test(10MWT),the6-minute walking test(6WMT),and the timed up-and-go test(TUGT),30-second Chair Stand Test(30s-CST),muscle strength,functional reach test(FRT),limit of stability(LOS),Parkinson’s Disease Questionnaire-39(PDQ-39).SPSS 23.0 software was used for statistical analysis,and all data were presented in the form of mean ±standard deviation.Paired t-test was used to compare the differences between the subjects within the group,and one-way analysis of variance was used to compare the outcome indicators difference before and after the intervention between the groups.2.In order to achieve remote rehabilitation guidance for PD patients.This study analyzed the domestic PD management applications,combined with the needs in the management of patients with mild to moderate PD,and with the help of the original Care-PD software,the rehabilitation guidance function and self-assessment function were added to build a complete service platform with PD-the “Care-PD” We Chat applet(hereinafter referred to as the “Care-PD” platform).3.Based on the Care-PD platform,the practical value of online Tai Chi in improving the condition of PD patients in the home environment was verified.This part of the study is based entirely on online,180 subjects were included,and they were randomly divided into Tai Chi + APP group,APP medication management group(hereinafter referred to as APP group)and control group.APP group: use the Care-PD platform to realize self-administration of medication;Tai Chi + APP group: on the basis of the APP group,allow participation in Tai Chi intervention in the “Exploratory and Research” module,3 times a week,40 minutes each time;control group: maintain the original daily habits.The 12-week Care-PD platform was used to assess the motor-experience daily living and non-motor-experience daily living(MEDL,n-MEDL),caregiver stress index(CSI),simple fall prediction,and Freezing of Gait Questionnaire(FOGQ),The Parkinson’s Disease Questionnaire-39(PDQ-39),Wearing off questionnaire-9(WOQ-9).The statistical method is the same as in part 1.Results:1.The effect of Tai Chi on the motor and balance ability of patients with mild to moderate PDMotor symptoms: Multiple comparisons of the difference between the three groups before and after intervention showed that the UPDRS-Ⅲ score difference of the Tai Chi group was significantly different from the control group(-3.05 ± 1.60 vs.-0.95 ± 2.22)(p<0.01).The UPDRS-Ⅲ score difference between the Tai Chi group and the exercise group(-3.05 ± 1.60 vs.-2.10 ± 1.90)did not show a significant difference,and it was the same between the exercise group and the control group.Walking ability: The difference of TUGT(s),10WMT(m/s)and 6WMT(m)in the Tai Chi group was significantly different from the control group(-1.06 ± 0.58 vs.0.097 ± 0.71;0.18 ± 0.12 vs.-0.05 ± 0.12;33.19 ± 9.27 vs.-0.48 ± 16.98)(p﹤0.01);the difference between TUGT(s)(-1.06 ± 0.58 vs.-0.29 ± 0.71)and 6WMT(m)(33.19 ± 9.27 vs.18.00 ± 15.68)of Tai Chi group was significantly different from exercise group(p﹤0.01),while 10WMT(m/s)(33.19 ± 9.27 vs.18.00 ± 15.68)showed no significant difference;the difference of 10WMT(m/s)and 6WMT(m)of the exercise group was significantly different from that of the control group(p<0.01),while the difference of TUGT(s)did not show a significant difference.Balance ability: The difference between Berg(points)and FRT(cm)in the Tai Chi group is significantly different from the control group(4.00 ± 3.15 vs.1.38 ± 3.69;3.55 ± 3.17 vs.-1.38 ± 0.69)(p﹤0.01);the difference between Berg(points)and FRT(cm)in the Tai Chi group is significantly different from the exercise group(4.00 ±3.15 vs.0.62 ± 2.18;3.55 ± 3.17 vs.1.39 ± 2.61)(p﹤0.01);the FRT(cm)difference of the exercise group has a significant difference compared with the control group(p﹤0.01),while the Berg(point)difference does not show a significant difference.Limit of Stability(LOS)includes: Reaction Time(RT),Movement Velocity(MVL),Endpoint Excursion(EPE),Maximum Excursion(MXE),and Directional Control(DCL).Compared with the control group,the LOS difference of the Tai Chi group is significantly different in RT(s),EPE(%),MXE(%)(-0.11 ± 0.13 vs.0.11 ± 0.13;2.81± 4.79 vs.-1.38 ± 3.96;5.52 ± 3.86 vs.-0.52 ± 3.42)(p﹤0.01);MVL(°/s),DCL(%)(0.14 ± 0.14 vs.-0.02 ± 0.32;4.38 ± 6.19 vs.0.19 ± 5.56)(p﹤0.05);the difference ofMXE(%)and DCL(%)of the Tai Chi group was significantly different from the exercise group(5.52 ± 3.86 vs.2.52 ± 3.42;4.38 ± 6.19 vs.0.81 ± 4.77)(p﹤0.01;p﹤0.05),while RT(s)(-0.11 ± 0.13 vs.-0.10 ± 0.12),EPE(%)(2.81 ± 4.79 vs.-1.38 ±3.96),MVL(°/s)(0.14 ± 0.14 vs.0.03 ± 0.17)showed no significant difference;the difference of RT(s),EPE(%),MXE(%)in the exercise group was significantly different from the control group(p﹤0.01),while MVL(°/s),DCL(%)difference did not show significant differences.Muscle strength of upper and lower limbs: Compared with the control group,the average grip strength difference and 30s-CST difference in the Tai Chi group were significantly different from those in the control group(2.03 ± 1.81 vs.0.58 ± 2.21,p﹤0.05;1.67 ± 1.32 vs.-0.14 ± 1.85,p﹤0.01).The 30s-CST(times)difference of the Tai Chi group was significantly different from the exercise group(1.67 ± 1.32 vs.0.43± 1.43)(p﹤0.05),but the average grip strength difference(2.03 ± 1.81 vs.1.85 ±1.40)did not show a significant difference;compared with the control group,the average grip strength difference of the exercise group was significantly different(p﹤0.05),and the 30s-CST(times)difference did not show a significant difference.Quality of life: Compared with the control group,the difference in PDQ-39 score of the Tai Chi group(-4.76 ± 3.71 vs.0.48 ± 3.83)has a significant difference(p﹤0.01);compared with the exercise group(-4.76 ± 3.71 vs.-2.00 ± 3.49),there is a significant difference(p﹤0.05);compared with the control group,the difference of PDQ-39 score in the exercise group(-2.00 ± 3.49 vs.0.48 ± 3.83)was significantly different(p﹤0.05).2.Research on the construction of Internet-based “Care-PD” platformThis part builds a “Care-PD” platform to promote Tai Chi movement based on the Internet.In order to better provide PD patients with rehabilitation guidance services in the home environment,this platform analyzes the current status of domestic PD management apps and the needs of PD patients’ condition management.Based on the original Care-PD software,it adds rehabilitation guidance and self-evaluation,to establish a perfect PD management Care-PD platform jointly used by PD patients and specialist doctors.PD patients can rely on the Care-PD to implement Tai Chi training and self-assessment in a family environment to promote Tai Chi,facilitate home rehabilitation activities for patients,and relieve the pressure on patients and families caused by insufficient medical resources and financial burdens.3.Application research of PD rehabilitation training based on “Care-PD”platformAfter the 12-week Tai Chi training based on the Care-PD platform,multiple comparisons of the difference between groups of patients before and after the intervention showed that the MEDL score difference of the Tai Chi + APP group was significantly different from the control group and the APP group(-1.02 ± 2.16 vs.0.17± 2.44;-1.02 ± 2.16 vs.0.26 ± 2.35)(p﹤0.01);there was no significant difference between the APP group and the control group.Compared with the control group,the difference in n-MEDL scores between the Tai Chi + APP group and the APP group was significantly different(-1.38 ± 1.29 vs.-0.19 ± 1.57;-0.94 ± 1.00 vs.-0.19 ± 1.57)(p﹤0.01);there was no significant difference between the Tai Chi + APP group and the APP group.Compared with the control group,the difference of the simple fall prediction scores of the Tai Chi + APP group and the APP group(-1.08 ± 2.29 vs.1.28 ± 1.84;-0.22 ± 1.68 vs.1.28 ± 1.84)was significantly different(p﹤0.01);the difference between the Tai Chi + APP group and the APP group was significantly different(p﹤0.05).Compared with the control group and APP group,the difference in CSI scores of the Tai Chi + APP group(-1.02 ± 1.20 vs.0.04 ± 1.23;-1.02 ± 1.20 vs.-0.22 ± 1.49)was significantly different(p﹤0.01);the difference between the APP group and the control group did not show a significant difference.Compared with the control group,the difference of FOGQ scores between the Tai Chi + APP group and the APP group(-1.32 ± 1.25 vs.0.33 ± 1.52;-0.91 ± 1.42 vs.0.33 ± 1.52)was significantly different(p﹤0.01);the difference between the Tai Chi+ APP group and the APP group did not show a significant difference.Compared with the control group,the difference of PDQ-39 score between the Tai Chi + APP group and the APP group(-2.94 ± 4.04 vs.3.56 ± 3.87;0.04 ± 4.21 vs.3.56 ± 3.87)was significantly different(p<0.01);the difference between the Tai Chi +APP group and the APP group did not show a significant difference.Compared with the control group and APP group,the difference in WOQ-9scores of the Tai Chi + APP group(-0.51 ± 1.31 vs.0.04 ± 1.20,p﹤0.05;-0.51 ± 1.31 vs.0.19 ± 1.01,p﹤0.01)has significant differences;the APP group and the control group did not show significant differences.Conclusion:1.Tai Chi can improve the motor symptoms,walking ability,balance ability,upper and lower limb muscle strength of patients with mild to moderate PD,and improve the quality of life of patients as a whole.In addition,Tai Chi is better than Parkinson’s exercises in improving walking ability,balance ability,lower limb muscle strength,and quality of life.It can be considered that Tai Chi is suitable for long-term practice for patients with mild to moderate PD.2.Relying on the “Care-PD” platform,Tai Chi provides support for rehabilitation training in the home environment,which provides new ideas for reducing the burden of national medical and health resources and formulating home management strategies for PD patients.3.Tai Chi relying on the “Care-PD” platform can effectively improve the motor and non-motor behaviors,caregiver pressure,quality of life,etc.in the daily life of PD patients,which verifies the feasibility and effectiveness of remote Tai Chi intervention based on the platform.. |
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