INTRODUCTION: Tai Chi (TC), a gentle exercise, incorporates meditative movement and respiratory control. The high risk of cross infection for people with cystic fibrosis (CF) requires close management in healthcare settings, limiting group activities such as TC. A mixed-methods randomized controlled feasibility study compared teaching TC over the internet with in-person, face to face TC tuition provided to CF patients. This article explores qualitative data from patients and TC instructors on their attitudes, acceptability and engagement with the two modes of TC delivery. METHODS: Qualitative data from CF patients (>6 years) were collected using Skype interviews/focus groups and written feedback. TC instructors provided weekly written feedback, and took part in interviews/ focus groups at the end of the study. Patient and instructor interviews explored their experiences and engagement with TC online delivery and ability to practice. RESULTS: Irrespective of the type of TC delivery, all CF participants interviewed (n = 28) practiced between lessons and most wanted to continue TC. Teenagers were more likely to miss TC appointments. Internet delivery was well received by both patients and TC instructors. Two patients reported difficulties with screen size/camera and one with internet connectivity. CONCLUSION: Both face-to-face and internet delivery of TC lessons were equally well received and perceived as beneficial. In the current COVID-19 pandemic, CF patients self-isolating could find this intervention provides important support, therefore the programme was made available on YouTube in April 2020 and linked to the websites of the CF charities funding the research.
OBJECTIVE: To investigate perceptions and acceptability of, and attitudes towards, acupuncture for post-acute stroke and rehabilitation care by exploring the views of different stakeholders. METHODS: Three electronic surveys were conducted to gauge the breadth of knowledge and acceptance of acupuncture in post-acute stroke and rehabilitation care among three stakeholder groups: (1) traditional acupuncturists registered with the British Acupuncture Council (BAcC); (2) National Health Service (NHS) professionals attending the 2017 UK Stroke Forum conference; and (3) the UK network of Stroke Club co-ordinators. RESULTS: Of 278 NHS respondents, 31% were doctors. Over half (52%) of all NHS respondents reported they had insufficient knowledge about acupuncture, its effectiveness (23%) or how to refer (21%). Only 12% had previously referred stroke patients for acupuncture but 46% thought that there was role for acupuncture in post-acute stroke care (50% were unsure). Two thirds of BAcC acupuncturist respondents had treated at least one stroke patient, with 70.1% having treated 1-5 stroke patients and 71% having provided treatment in the last year, most commonly for motor impairment (88.2%). Of 99 Stroke Club coordinators who responded, only seven had ever been asked about acupuncture by patients, but most felt there would be interest. CONCLUSION: Interest in the provision of acupuncture for post-acute stroke care was expressed by both NHS practitioners and acupuncturists. Further research is required on the acceptability of acupuncture to patients as well as evidence of its clinical and cost effectiveness.
Acupuncture Therapy/methods , Attitude of Health Personnel , Stroke Rehabilitation/methods , Adult , Female , Humans , Male , Middle Aged , Surveys and Questionnaires
Virtual healthcare is fast entering medical practice. Research into the feasibility of using it to teach treatment regimens such as exercise has not been explored. Maintaining an exercise regime can be difficult in cystic fibrosis: group classes risk potential infection, yet motivation is hard to maintain when alone. Tai Chi is a low-impact exercise and involves gentle, demanding movements. This study aimed to assess the feasibility, safety and acceptability of learning Tai Chi via an internet-based approach and compared patient-reported outcomes. Children and adults with cystic fibrosis were recruited to a randomised, comparative effectiveness trial. Participants learnt eight Tai Chi movements; teaching was delivered in eight lessons over 3â months: delivered either via the internet or face-to-face. Assessments were at 3-monthly intervals over 9â months. Outcomes included health status, quality of life, sleep, mindfulness and instructor-led questions. 40 adults and children completed the eight sets of Tai Chi lessons. The median age was 22.8â years (range 6.1-51.5â years); 27 patients were female. The cohort comprised 26 adults (aged >16â years), six teenagers and eight children (aged <12â years). The groups were well matched. Feasibility and safety were demonstrated. Participants showed significant improvements in self-reported sleep, cough (both daytime and night-time), stomach ache and breathing. No differences in lung function, health status, quality of life, sleep or mindfulness was shown before or after completing the lessons. Tai Chi was safe and well tolerated; it was feasible to deliver individual lessons via the internet, reducing concerns regarding cross-infection, and appeared to improve self-reported symptoms.
BACKGROUND: Cystic fibrosis (CF) is a genetic disorder affecting respiratory and digestive systems. People with CF experience physical symptoms; cough, poor lung ventilation, recurrent infections, poor weight gain, diarrhoea, and malnutrition, as well as lower quality of life. Tai Chi, a Chinese form of meditative movement, may help with the symptoms of CF and help people with CF to exercise. However, there is very little research in this area. OBJECTIVE: To evaluate the feasibility of studying Tai Chi for CF and to compare the effectiveness of Tai Chi to standard care and face-to-face Tai Chi with online Tai Chi for people with CF. METHODS: This is a comparative effectiveness trial with 72 people with CF over 6 years old and a patient at the Royal Brompton Hospital, London, UK. Participants receive 8 Tai Chi sessions, then home practice with a DVD. Sessions are one-on-one for group A, online for group B. Group B is a no treatment standard care control (first 3 months). At baseline, 3, 6 and 9 months, questionnaires will be used to measure quality of life, mindfulness and sleep, and medical data health and respiratory function. At Tai Chi sessions and at 4 follow-up points, the Borg Scale and healthcare use data will be collected. At 9 months online focus groups will assess participants' experience, Tai Chi feasibility, perceived health impact, and study participation. Recruitment will use adverts in hospital clinics and website, and letter/phone for non-regularly attending patients. Block randomisation will use random number tables. The two groups will be compared for: weeks 1 to 12 (Tai Chi vs. standard care); before and after intervention (differences in delivery method); week 1 (of intervention) to month 9 (long-term impact). Qualitative data will use Framework analysis. DISCUSSION: We believe this is the first trial of Tai Chi for CF. Tai Chi may help with the physiological symptoms of CF and increase levels of exercise by providing a self-management technique and low stress activity. This study will provide data on the feasibility of a randomized controlled trial of Tai Chi for CF, including data for a sample size calculation and will inform future study design.
OBJECTIVE: This study explored the effects of individualized acupuncture when used alongside routine care for patients diagnosed with schizophrenia in order to assess the possibility and nature of potential benefits for this patient group. This study used an exploratory case study approach that included both quantitative and qualitative research tools, in order to generate a hypothesis questioning the possible benefits of acupuncture and develop future study designs. METHODS: Eleven patients diagnosed with schizophrenia were given multiple validated quantitative and qualitative assessments before, during and after a 10-week acupuncture intervention. A range of qualitative and quantitative assessments were employed including review of acupuncture, general practitioner and mental health clinical case notes. Qualitative data were interrogated to explore the reliability of participants' reports to researchers, their clinicians and their carers while acting as informants in the study. RESULTS: Eight out of eleven participants completed a course of acupuncture treatment and all eleven reported positive benefits as a result of acupuncture, including improvements in the symptoms of schizophrenia, side effects of medication, energy, motivation, sleep, addictions and other associated physical problems. However, participants' reports to the researcher and the acupuncturists varied at times and were often inconsistent between treatments, with participants revealing more information to the team towards the end of the study. CONCLUSION: The study indicates that patients diagnosed with schizophrenia would benefit from acupuncture treatment alongside conventional treatment. Triangulation of the data highlights some inconsistencies in reporting from participants, but also that this can be overcome through the use of mixed research methods. Comparison of data also shows that future studies would benefit from using a Positive and Negative Syndrome Scale, the Standards for Reporting Interventions in Controlled Trials of Acupuncture and an enhanced questionnaire regarding side effects of medication, exercise, sleep and daily routine. It is also worth noting that future studies of this nature must maintain consideration for the vulnerability of participants as they recover and make support easily accessible.
Acupuncture Therapy/methods , Research Design , Schizophrenia/therapy , Humans , Surveys and Questionnaires , Treatment Outcome
