1. Health & Rehabilitation Research Institute Denise Taylor, Leigh Hale, Philip Schluter, Debra Waters, Elizabeth Binns, Hamish McCracken, Kathryn McPherson, Steven Wolf THE EFFECTIVENESS AND COST - EFFECTIVENESS OF TAI CHI AS A COMMUNITY BASED FALLS PREVENTION INTERVENTION

2. T HE SIZE OF THE PROBLEM  About 30% of adults over 65 years fall each year  About half of these people experience recurrent falls  Healthcare resource use is high for fallers  Monetary cost is high (2006-7 cost to ACC was $30 million ) (Robertson & Campbell 2008)

3. T AI C HI Low to moderate form of exercise (low impact & low velocity) Increasingly available to and accepted by the general public as a form of exercise

4. T AI C HI TO PREVENT FALLS Favours intervention Favours control Stretching control group – very low level Wait list control Computerised balance training – ½ amount of class practice and no home practice A transitioning to frailty group The controls are much lower intensity or lower frequency No comparison including a more active control matched for setting and matched for dose (Gillespie et al)

5. T HE QUESTIONS Does a programme of modified Tai Chi reduce the rate of falls in community dwelling older adults to a greater extent than an active control (low level exercise programme)? Is there a dose response of Tai Chi? Is Tai Chi cost-effective compared to a low level exercise programme? Do strength and balance change ?

6. M ETHOD : DESIGN Multicentre single-blind randomised control trial Tai Chi 1x week 5 months Tai Chi 2x week 5 months Low level exercise 1x week 5 months Community dwelling older adults Baseline assessment Post intervention assessment 6 month follow up assessment 12 month follow up assessment Monthly calendar 17 months

7. M ETHOD : PARTICIPANTS  65 years or older (>55 years if Maori or PI)  Had a falls risk factor  Telephone MMSE score >23  Ambulate independently (+/- aid)  Not participating in organised exercise currently  Medical clearance from GP

8. M ETHOD : OUTCOMES  Falls rate  Timed up and go  Dynamic balance (step test)  Leg strength (30s chair stand test)  Balance confidence (ABC Scale)  Health status (SF36v2)  Falls related heath care utilisation & costs

9. R ESULTS - PARTICIPANTS 1095 people were screened 684 people were recruited and randomised 233 in the TC1 group 220 in the TC2 group 231 in the LLE group Whangarei Orewa North Shore Auckland West Auckland Tauranga Hamilton Christchurch Dunedin Milton Whangarei Orewa North Shore Auckland West Auckland Tauranga Hamilton Christchurch Dunedin Milton

10. R ESULTS - FALLS Over the whole trial period there were 1060 falls TC1 group = 412 falls LLE group = 350 falls TC2 group = 298 falls

11. F ALLS RATES On average, how many falls did people have over a year? Negative binomial regression No statistically significant difference in the reduction of falls

12. S TRENGTH AND BALANCE Timed up and go Step Test (Right & Left) 30 second Chair Stand Significant time effect No significant group difference at baseline No time x group interaction Multi-level mixed-effects model 

13. C OST - EFFECTIVENESS The joint distribution of cost and effect

14. W HAT WERE THE COSTS OF THE INTERVENTIONS ? Total falls related costs Medical Hospital Ambulance Transport to treatment Therapy Independence Home help Dental Tai Chi x1 Tai Chi x2 Low level exercise x1 NZ$1052 NZ$834 NZ$866 Mean cost per person year Plus Programme costs

15. TC1 TC2 Incremental costs Incremental effects 0.10.20.3-0.1-0.2-0.3 100 200 300 -300 -200 -100 I NCREMENTAL COST EFFECTIVENESS PLANE

16. S O WHAT …  All groups had reduced falls over time (controlling for drop-out)  There was no statistically significant reduction in falls in the TC1 or TC2 group compared to the LLE group  There was no greater reduction of falls in the TC2 group than the TC1 group  Strength and balance measures improved  Functional mobility did not improve  TC2 was more cost-effective than TC1 based on trial only data BUT...

17. A CKNOWLEDGEMENTS Leigh Hale Debra Waters Denise Taylor Philip Schluter Elizabeth Binns Hamish McCracken, Kathryn McPherson Steven Wolf The Accident Compensation Corporation of New Zealand mynetbizz.com

19. FRAT  History of any fall in the previous year,  Four or more prescribed medications,  Diagnosis of stroke or Parkinson’s disease,  Reported problems with balance,  Inability to rise from a chair without using arms.

20. G ROUP EXERCISE ‘ V ’ CONTROL

21. S TATISTICAL ANALYSIS Adjusted negative binomial regression analysis No statistically significant difference in the mean incident rate ratios They all reduced falls at about the same rate