Establishing Tai Chi as Usable, Credible,Accepted Complementary/Alternative Medicine Practice

As a Tai Chi teacher in the communities of NE Connecticut for the last 15 years, I have found consistently that Physical Therapists, Occupational Therapists, Recreation Therapists, MD's and Nurses will almost universally affirm a patient's practice of Tai Chi for many chronic health conditions, but few will extend themselves to referring patients to local classes. Wanting to change that, I began working on a program to bring Tai Chi and its successes more fully into the awareness of the local healthcare community. I have had modest success, more importantly I have learned a great many lessons from my “audience”.

Currently, Tai Chi is taught in many local communities and its popularity is increasing. Most of these programs have one thing in common: the lack of long and deep scientifically developed evidence base. Typically they do not focus on a single chronic condition, where measurements in behavioral change can be made. There is not much in the way of consistent practice guidelines or Tai Chi program protocols, teaching materials, or implementation procedures, which makes understanding and acceptance of Tai Chi as Therapy, in community settings very difficult. We teach the classes and get very complementary feedback about changes in our students' well-being, and we “hope” to hear more.

Medical professionals have little knowledge of what Tai Chi is or what it can do. In some cases, they feel their domain threatened by a common, community-based activity. On-going studies by CDC, the National Institutes for Health, and other bodies show that medical community lack of knowledge, our lack of consistency and parochialism, and little monetary incentive for prevention practices (for the trained medical professional) are distractors which cause the professionals to fall back on Medicare and other Health Insurance providers' approved practices. Dr Mary Tinetti at Yale University, probably the world's leading authority on fall prevention and balance training in communities, has also assessed possible solutions from a “global to local” perspective. Two published articles are revealing, and for the ambitious reader, will shed tremendous light on why Tai Chi (among other practices) is not well received: Dissemination of an Evidence-Based Multicomponent Fall Risk-Assessment and Management Strategy Throughout a Geographic Area, Journal of the American Geriatrics Society 2005; 53:675-680. and Perceptions of Physicians on the Barriers and Facilitators to Integrating Fall Risk Evaluation and Management into Practice Journal of General Internal Medicine 2006; 21(2):117-122. These studies also show that too many health care providers are actually resistant to learning and understanding these new ideas.

In 2011, the first time since 2001, the American Geriatrics Society and the British Geriatrics Society have updated their clinical guidelines for preventing falls in older people. The update includes two notable changes: One recommends tai chi — the meditative, slow-motion Chinese exercise — as an effective way to prevent falls. The perceptive reader at this point will realize that the Guidelines refers to fall prevention; not knee extensor strengthening, or improving balance. Neither of these, and the many, many other very detailed and impressive “evidence base” factors elicited from the best scientific practices in measuring what Tai Chi can do; address a single, specific, costly, PREVENTABLE chronic behavioral condition: falling.

Fall prevention is a topic looming large in the health care because of its tremendous cost in dollars, and in largely preventable human suffering and death, and “look-back liability*”. In 2000, the total direct medical costs of all fall injuries for people 65 and older exceeded $19 billion: $0.2 billion for fatal falls, and $19 billion for nonfatal falls. By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 billion (in 2007 dollars). http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html. Referring back to the two previously cited articles by Dr Tinetti, it is plain to see that health care professionals do not have a good perspective on just how big the problem is.

The Centers for Disease Control and Prevention publication Preventing Falls: What Works A CDC Compendium of Effective Community-based Interventions from Around the World http://www.cdc.gov/HomeandRecreationalSafety/pdf/CDC_Falls_Compendium_lo...
Of 10 exercise based fall intervention programs discussed, 3 are Tai Chi: Tai Chi: Moving for Better Balance (Li, et al.),Central Sydney Tai Chi Trial (Voukelatos, et al.), and Simplified Tai Chi (Wolf, et al.). Two of the programs are Yang Style Tai Chi based programs, while the Sydney Trial it is pointed out, did not attribute any specific Tai Chi Style. The Li, et al research was extended to develop a program which can easily be disseminated (transmitted in the Tai Chi lexicon) into communities.

The medical community, and health insurance providers follow their patients, case in point: acupuncture. Acupuncture was brought into the mainstream with limited government approval for a specific approach to stopping addiction. After years of repeated success, additional acupuncture techniques were permitted for a broadening scope of maladies. Today, many people can get insurance with coverage for acupuncture: the insurance companies' customers demand it.

In order to establish Tai Chi as a widely recognized and accepted adjunct or alternative to any therapy, and to persuade health care providers to be more willing to make a referral to a community Tai Chi program, we need to be talking about a single specific purpose for Tai Chi first. Tai Chi has demonstrated an amazing 55% reduction in the rate of falls injuries, death and cost. We need to be talking about a single, simple, evidence based Tai Chi protocol, or regimen, that has clearly addressed the problem empirically. We need to be able to demonstrate success in the community with more than stories. We need to establish a usable, credible standard between Tai Chi teachers and the communities we live in, including medical professionals. Community based, evidence based, tai chi fall prevention exercise classes are our best chance to crack the door open in the near term.

Learn a clinically proven individual and small group therapeutic activity, mostly lab based training: learn a brief tai chi form, learn to implement reliable program: Balance/Fall Prevention, Tai Chi for Parkinson’s Disease, Depression. Contact me at laddie@taichi4therapy.com. 860333 2651

*look-back liability: for example: institutions that release patients as “well and fit”, will be responsible for the cost incurred by a patient fall in a (6 month) look-back period.