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Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis

BMJ 2012; 345 doi: (Published 06 August 2012) Cite this as: BMJ 2012;345:e5004

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Re: Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis

We read the article by Tomlinson CL et al. with great interest.1 In this systematic review, Randomised controlled trials comparing physiotherapy with no intervention in patients with Parkinson's disease were eligible. Martial arts (Tai Chi and Qi Gong) as one of the six different physiotherapy interventions were included.
In this article, a systematic search of the literature to the end of January 2012 found 4 trials: 3 Tai Chi trials (only 1 RCT included in meta-analysis ,2 others were conference abstracts which lack of data3 4) and 1 Qigong trial.5 However, the literature search they adopted was not comprehensive enough to identify all eligible studies. Traditional Chinese Medicine (TCM) has a long history in East Asia (China, Japan, and Korea), a growing number of researchers to carry out a variety of high-quality research that we could not ignore, so it is necessary to include these countries database retrieval. By our search strategy, we find two potentially studies in Chinese database.6,7 I think we can also get additional trials from Japan and Korea.
At the same time, The author merged data from Tai Chi and Qi gong in one meta-analysis which I think is not appropriate. Tai Chi is an ancient Chinese martial art that consists of a series of slow, continuous, and gentle movements dynamically shifting body weight from double-limb to single-limb support. Tai Chi emphasizes the use of mind or concentration on control of breathing and circular body movement to facilitate the flow of qi in order to sustain the harmony of body homeostasis, ultimately leading to longevity. Whereas, Qigong is an exercise therapy based on the principles of traditional Chinese medicine. The exercises combine the practice of motion and rest, both guided by mental imagery. The movements or postures are thought to promote an “energy flow” along meridians that are not related to anatomic structures. In Traditional Chinese Medicine (TCM) view, Tai Chi and Qi gong are two different interventions.
Overall, the possible ways to perfect this systematic review are as follows: (1) Tomlinson and colleagues do a supplementary East Asian literature search to see whether more studies could be included in this systematic review (Table 1); (2) Separate Tai Chi and Qi gong in meta-analysis; (3) Also, there is an important eligible study published in the New England journal of medicine in February 2012 which should be included in the future.8

We declare that we have no conflicts of interest.

1、Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, et al. Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis.BMJ. 2012 Aug 6;345:e5004. doi: 10.1136/bmj. e5004.
2、Hackney ME,Earhart GM. Health-related quality of life and alternative forms of exercise in Parkinson disease.Parkinsonism Relat Disord 2009; 15:644-8.
3、Marjama-Lyons J, Smith L, Mylar B,Nelson J, Holliday G, Seracino D.Tai chi and reduced rate of falling in Parkinson’s disease: a single-blinded pilot study[abstract]. MovDisord 2002;17(suppl 5): S190.
4、Purchas MA,Mac Mahon DG.The effects of tai chi training on general well being and motor performance in patients with Parkinson’s disease (PD):a pilot study [abstract]. Mov Disord 2007;22 (suppl 16):S260.
5、Schmitz-Hubsch T, Pyfer D, Kielwein K, Fimmers R,Klockgether T, Wullner U. Qigong exercise for the symptoms of Parkinson’s disease: a randomized, controlled pilot study. Mov Disord 2006;21:543-8.
6、Zhu Y, Li JX, Li N, Jin HZ, Hua L, Dong Q. Effect of Taijiquan on Motion Control for Parkinson's Disease at Early Stage. Chin J Rehabil Theroy Pract 2011;17:355-358.
7、Zhou Y, Wu L. The Influences of Taiji Softball Exercise With Drug Therapy in Mild Parkinson’s Patients on the Rehabilition. Fujian Sports Science and Technology 2009;28:15-20.
8、Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R, Galver J, et al. Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med. 2012 Feb 9;366(6):511-9.

Competing interests: No competing interests

09 December 2012
Hongliang Tian
Evidence-based Medicine
Jinhui Tian, Kehu Yang
Evidence-based Medicine centre of Lanzhou University
DongGang West Road 199, Lanzhou City, China