Summary of findings 4. Summary of findings: 3D (Tai Chi) exercise versus control (e.g. usual activities).
| 3D (Tai Chi) exercise versus control (e.g. usual activities) for preventing falls in older people in the community | ||||||
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Patient or population: Older people living in the community (trials focusing on people recently discharged from hospital were not included) Settings: Community, either at home or in places of residence that, on the whole, do not provide residential health‐related care Intervention: Exercise, type = 3D (Tai Chi) traininga Comparison: Usual care (no change in usual activities) or a control (non‐active) interventionb | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Exercise (3D (Tai Chi)) | |||||
| Rate of falls (falls per person‐year) Follow‐up: range 6 to 17 months |
All studies population | Rate ratio 0.81 (0.67 to 0.99) | 2655 (7 RCTs) | ⊕⊕⊝⊝d low | Overall, there may be a reduction of 19% (95% CI 1% to 33%) in the number of falls. Guide to the data based on the all‐studies estimate. If 1000 people were followed over 1 year, the number of falls may be 689 (95% CI 570 to 842) compared with 850 in the group receiving usual care or attention control |
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| 850 per 1000c | 689 per 1000 (570 to 842) | |||||
| Specific exercise population | ||||||
| 1020 per 1000c | 827 per 1000 (684 to 1010) | |||||
| Number of people who experienced one or more falls Follow‐up: range 5 to 17 months |
All studies population | RR 0.80 (0.70 to 0.91) | 2677 (8 RCTs) |
⊕⊕⊕⊕f high | Overall, there is a reduction of 20% (95% CI 9% to 30%) in the number of people who experienced one or more falls Guide to the data based on the all‐studies estimate. If 1000 people were followed over 1 year, the number of people who experienced one or more falls would be 384 (95% CI 336 to 437) compared with 480 in the group receiving usual care or attention control |
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| 480 per 1000e | 384 per 1000 (336 to 437) | |||||
| Specific exercise population | ||||||
| 437 per 1000e | 350 per 1000 (306 to 398) | |||||
| Number of people who experienced one or more fall‐related fractures | See comment | Not estimable | See comment | ‐ | This outcomes was not reported | |
| Adverse events | See comment | Not estimable | 474 (2 RCTs) |
⊕⊝⊝⊝g very low | Adverse events were reported in two of 10 trials (474 participants) with 3D (Tai Chi) as the primary intervention. There were no occurrences of adverse events | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
aUsing Prevention of Falls Network Europe (ProFaNE) taxonomy, 3D (Tai Chi) training uses upright posture, specific weight transferences and movements of the head and gaze, during constant movement in a fluid, repetitive, controlled manner through three spatial planes. Exercise programmes included in this analysis had 3D (Tai Chi) training as the single primary exercise category; these exercise programmes may also include secondary categories of exercise. bA control intervention is one that is not thought to reduce falls, such as general health education, social visits, very gentle exercise, or 'sham' exercise not expected to impact on falls. cThe all‐studies population risk was based on the number of events and the number of participants in the control group for this outcome over the 59 all‐exercise types RCTs. The specific exercise population risk was based on the number of events and the number of participants in the control group for this outcome over the seven RCTs. dDowngraded by two levels due to inconsistency (there was substantial heterogeneity (I² = 74%)), and risk of bias (removing studies with high risk of bias in one or more items had a marked impact on results). eThe all‐studies population risk was based on the number of events and the number of participants in the control group for this outcome over the 63 all‐exercise types RCTs. The specific exercise population risk was based on the number of events and the number of participants in the control group for this outcome over the eight RCTs. fWe did not downgrade for risk of bias, as results were essentially unchanged with removal of the trials with a high risk of bias in one or more items. gDowngraded by three levels due to only 30% of trials reporting adverse events to any degree, and limitations in the design of studies suggesting a high likelihood of bias (no trials in this analysis measured the number of participants experiencing adverse events in both groups throughout the trial period).