Enhanced Tai Chi for Parkinson's Disease (Enhanced Tai Chi PD)

Clinician-rated assessment using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, Part III (MDS-UPDRS III), performed in the ON medication state. Total score ranges from 0 to 132, with higher scores indicating greater motor impairment. Reductions in score indicate improvement in motor symptoms.

Assesses frequency and severity of non-motor symptoms in Parkinson's disease. Total score ranges from 0 to 360, with higher scores indicating greater non-motor symptom burden. Interpretation of scores is as follows: Mild (1-44 points), Moderate (45-78 points), Severe (79-112 points), and very severe (>112).

Participant-reported overall perception of change in health status. Scored on a 7-point Likert scale (1 = very much improved, 4 = no change, 7 = very much worse). Lower scores indicate perceived improvement, while higher scores indicate worsening.

Self-reported measure of health-related quality of life. Total score ranges from 0 to 32, with lower scores indicating better quality of life. A decrease in score reflects improvement. For this study, a meaningful change is defined as a change of 5-7 points, indicating clinical significant impact to quality of life.

Brief cognitive screening tool. Total score ranges from 0 to 30, with higher scores indicating better cognitive function. Scores 26-30 (normal), 18-25 (mild cognitive impairment), 10-17 (moderate cognitive impairment), and <10 (severe cognitive impairment). Increases in score suggest improvement or preservation of cognitive function.

Clinician-rated assessment of Parkinson's disease-related pain across multiple domains. Total score ranges from 0 to 168, with higher scores indicating greater pain severity. Lower scores represent improvement in pain symptoms. Interpretation for this study: score 0 (no pain), scores 17-34 (mild to moderate), 68-70 (moderate to severe). Minimal clinical important difference is measured by a change of 3 points to indicate meaningful change.

Assesses sleep disturbances in Parkinson's disease. Total score ranges from 0 to 60, with higher scores indicating worse sleep quality. For this study, meaningful change is defined as a decrease of at least 3.44 points for improvement or an increase of at least 2.07 points for worsening.

Self-reported fatigue severity scale. Total score ranges from 16 to 80, with higher scores indicating greater fatigue.

Self-reported assessment of anxiety and depression using two subscales (HADS-A and HADS-D). Each subscale ranges from 0 to 21, with higher scores indicating greater symptom severity. Scores 0-7 (normal), 8-10 (mild/borderline), 11-14 (moderate), and 15-21 (severe). Lower scores indicate improvement in anxiety and/or depressive symptoms. Meaningful change is defined as change of 2 points.

Self-reported measure of apathy. Total score ranges from 0 to 42, with higher scores indicating greater apathy. PD patients with scores over 14 suggest clinically significant meaningful apathy. Lower scores represent improvement in motivational symptoms.

Self-reported assessment of physical activity over the previous week. Scores typically range from 0 to >400, with higher scores indicating greater levels of physical activity. Increases in score indicate higher activity levels.

Clinician-rated global assessment across four domains (motor signs, disability, cognitive status, and complications). Each domain is scored from 0 to 6, giving a total score range of 0 to 24, with higher scores indicating greater disease severity. A reduction in total score over time indicates clinical improvement.

Clinician-rated 14-item assessment of balance performance. Total score ranges from 0 to 56, with higher scores indicating better balance. For this study we consider 0-20 (wheelchair/ high fall risk), 21-40 (needing aids/ moderate risk), 41-56 (independent, low risk), with scores <45 indicating increased risk of falls for the PD population. Increases in score indicate improvement in balance ability.

Performance-based assessment measuring the time (in seconds) required to stand from a seated position, walk 3 meters, turn, return, and sit down. Lower times indicate better mobility and functional performance. For this study with PD patients our scoring is as follows: <12 seconds (good mobility), 12-14 seconds (differentiates PD fallers vs non-fallers, with higher end being riskier), >14 seconds (high risk for fall), >20 seconds (needs assistance for basic transfer), and >30 seconds (limited mobility, decreased independence).

Performance-based assessment measuring the time (in seconds) to walk 10 meters at a comfortable pace. Lower times indicate faster walking speed and improved gait performance. For this study, there needs to be a minimum detectable change of approximately 0.18 m/s (comfortable) or 0.25 m/s (fast) to show real improvement, not just testing variation.

Self-reported number of falls recorded using participant-maintained fall diaries. Higher values indicate increased fall frequency, while reductions indicate improvement in fall risk.

17a. Intervention adherence: Percentage of scheduled Enhanced Tai Chi sessions attended during the intervention period. Values range from 0% to 100%, with higher percentages indicating better adherence.

17b. Intervention tolerability: Proportion of participants who discontinue the intervention due to tolerability issues. Values range from 0 to 100%, with lower percentages indicating better tolerability.