Effects of deconstructed Tai Chi step training combined with conventional rehabilitation on lower limb function in brunnstrom stage III stroke patients: A randomized controlled trial
Clinical Snapshot
PICO Framework
| P — Population | 52 patients with subacute stroke (Brunnstrom Stage III, ≤6 months post-stroke) |
| I — Intervention | Conventional rehabilitation plus adapted Tai Chi stepping training (5 days/week for 8 weeks) |
| C — Comparator | Conventional rehabilitation plus limb synergy training (5 days/week for 8 weeks) |
| O — Outcomes | Primary: Fugl-Meyer Assessment for Lower Extremity (FMA-LE) and Holden Walking Function Classification. Secondary: hip, knee, and ankle range of motion |
Bottom Line
This small RCT suggests that adding deconstructed Tai Chi stepping exercises to conventional stroke rehabilitation may provide superior improvements in lower limb function and walking ability compared to standard limb synergy training in Brunnstrom Stage III patients. The large effect size (Cohen's d = 1.32) and clinically meaningful FMA-LE improvements are encouraging. However, the study has significant limitations including small sample size, lack of intention-to-treat analysis, inability to blind participants/therapists, and absence of safety or long-term outcome data. The intervention appears promising but requires validation in larger, more rigorous trials before routine clinical implementation. Australian stroke rehabilitation services could consider pilot programs while awaiting stronger evidence, particularly given the potential for enhanced functional outcomes in this specific patient population.
Key Findings
P Value: p < 0.001 for primary outcomes
Effect Size: Cohen's d = 1.32 (large effect)
Primary Outcome: FMA-LE improved 5.6±1.5 points (experimental) vs 1.8±0.8 points (control)
Nnt Or Sensitivity: NNT approximately 3 for achieving Holden Grades II-III (92% vs 60% success rate)
Confidence Interval: Not reported in abstract
Clinical Application
Requires trained therapists in Tai Chi principles; may be challenging to implement in standard rehabilitation settings Could complement existing stroke rehabilitation programs under Medicare-funded allied health services; would need training investment for physiotherapists Subacute stroke patients in Brunnstrom Stage III with lower limb impairment suitable for active rehabilitation
Abstract
OBJECTIVE: To evaluate whether a deconstructed Tai Chi stepping protocol adapted for patients with Brunnstrom Stage III stroke, when combined with conventional rehabilitation, improves lower limb motor function, walking ability, and joint mobility compared with conventional rehabilitation plus limb synergy training. METHODS: In this assessor-blinded randomized controlled trial, 52 patients with subacute stroke (Brunnstrom Stage III, ≤ 6 months post-stroke) were randomized in a 1:1 ratio to an experimental group (conventional rehabilitation plus adapted Tai Chi stepping training) or a control group (conventional rehabilitation plus limb synergy training). Both interventions were delivered 5 days per week for 8 weeks. Fifty participants completed the study and were included in the final per-protocol analysis (25 per group). Outcomes were assessed at baseline and after intervention. The primary outcomes were the Fugl-Meyer Assessment for Lower Extremity (FMA-LE) and Holden Walking Function Classification. Secondary outcomes were hip, knee, and ankle range of motion (ROM). RESULTS: Both groups improved after treatment, with greater improvement observed in the experimental group. FMA-LE scores increased by 5.6 ± 1.5 points in the experimental group and 1.8 ± 0.8 points in the control group (p < 0.001, Cohen's d = 1.32). In addition, 92% (23/25) of participants in the experimental group achieved Holden Grades II-III compared with 60% (15/25) in the control group (p < 0.001). The experimental group also showed larger gains in joint ROM, including hip flexion (+19.9° vs. + 4.2°), knee external rotation (+9.9° vs. + 3.7°), and ankle dorsiflexion (+7.6° vs. + 1.3°) (all p < 0.001). CONCLUSION: Deconstructed Tai Chi stepping training combined with conventional rehabilitation was associated with greater improvement in lower limb motor function, walking ability, and joint mobility than conventional rehabilitation plus limb synergy training in patients with Brunnstrom Stage III stroke. This stage-specific protocol may represent a practical adjunct to stroke rehabilitation, although confirmation in larger trials is still needed. CLINICAL TRIAL REGISTRATION: International Traditional Medicine Clinical Trial Registry (ITMCTR; a WHO ICTRP Primary Registry), registration number ITMCTR2025000972.
References
- 1.Chang, J., Qu, P., & Li, Y. (2026). Effects of deconstructed Tai Chi step training combined with conventional rehabilitation on lower limb function in brunnstrom stage III stroke patients: A randomized controlled trial. PLoS One. https://doi.org/10.1186/s12984-022-00986-9
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