Pilot studies of recruitment and feasibility of remote Tai Chi in racially diverse older adults with multisite pain.

BACKGROUND: Multisite musculoskeletal pain is highly prevalent among older adults yet undertreated. Studies support the promise of Tai Chi for managing pain and lowering fall risk. Since the COVID-19 pandemic, effective alternatives to classroom-based exercise programming are warranted. AIMS: To recruit 100 racially diverse older adults with multisite pain and increased fall risk, who are interested in participating in a future Tai Chi clinical trial, and to evaluate the feasibility and acceptability of a short-term, remotely delivered home-based Tai Chi program. METHODS: A random sample of adults aged 65 years or older living in diverse Boston neighborhoods were sent mailed invitations to participate in a telephone screening survey. Eligible adults were invited to join a 4-week Tai Chi program offered online via Zoom. Primary outcomes were class attendance, experience, and program safety. RESULTS: Among 334 survey respondents, 105 were eligible for the intervention. Average age of eligible participants was 74 years, 75% were women, and 62% were Black. We assigned 32 participants to 4 Tai Chi or 2 light exercise groups conducted via Zoom; of these, 24 (75%) completed the program and 79% attended ≥6 of 8 classes. There were no adverse events reported. Two-thirds reported it was very easy to join the online classes and 88%, very easy to see the instructor. CONCLUSION: Mailed invitations were effective for recruiting a racially diverse sample. Remote exercise programming delivered online via live Zoom sessions is safe and feasible for diverse older adults who have multisite pain and risk of falls.

A remote Tai Chi program for diverse older adults with multisite pain during the COVID-19 pandemic

The goal of this study was to evaluate feasibility and acceptability of a remote Tai Chi program in diverse older adults with multisite pain and risk for falls during the COVID-19 pandemic. Adults aged ≥65y living in diverse Boston neighborhoods were invited through mailed letters to participate in a recruitment and screening survey. Eligible adults were re-contacted to join a 4-week Tai Chi or light exercise program offered online twice weekly. We conducted pre- and post-interviews to assess pain characteristics, fall risk, computer use, and satisfaction with the program. Primary outcomes were class attendance, experience, and program safety. Among 335 survey respondents, 105 (31%) were eligible based on multisite pain and fall history or cane/walker use. Of the eligible respondents, average age was 74y, 75% were women, 62% were Black, and 31% had high school education or less. We assigned 32 participants to 4 Tai Chi (Yang-style Tai Chi tailored to older adults with pain) or 2 light exercise (stretching and strength exercise) groups conducted via zoom;of these, 24 (75%) completed the program. Overall, 79% attended ≥6 of 8 classes. There were no adverse events reported. Regarding experiences with remote exercise, 67% reported it was very easy to join, 88%, very easy to see the instructor and 83%, very easy to participate. For future planning, 29% prefer remote classes, 33% prefer in-person classes, and 38% could do either. In conclusion, remote exercise programming is safe and feasible for diverse older adults who have multisite pain and risk of falls.

Home epinephrine-treated reactions in food allergy oral immunotherapy: Lessons from the coronavirus disease 2019 lockdown.

BACKGROUND: Oral immunotherapy (OIT) is effective in desensitizing patients with food allergy but adverse reactions limit its use. OBJECTIVE: To study the effect of the coronavirus disease 2019 lockdown in Israel between March 15, 2020, and April 30, 2020, on the incidence of home epinephrine-treated reactions. METHODS: All patients who were in the up-dosing phase of OIT for greater than or equal to 1 month during the lockdown, or a respective period in years 2015 to 2019, were studied. The incidence of home-epinephrine treated reactions during the 2020 lockdown was compared with that in the respective period in 2015 to 2019 and to periods before and after the lockdown. RESULTS: A total of 1163 OIT treatments were analyzed. Two epinephrine injections occurred during 2020 (0.7%) compared with 29 injections (3.28%) during 2015 to 2019 (P = .03). Patients treated in 2020 were older (8.1 vs 7 years, P < .01) and had a significantly lower single highest tolerated dose (12 vs 20 mg protein, P < .01). The rate of milk-OIT was lower (P = .01), but the total number of milk treatments was higher (99 vs 71 to 82) in 2020 compared with 2015 to 2019. On multivariate analysis, treatments during the 2020 lockdown were performed in older patients (P = .001), primarily for nonmilk (P = .03), began with a lower single highest tolerated dose (P = .006), and were associated with significantly less home epinephrine-treated reactions (P = .05) compared with those in 2015 to 2019. Patients treated in 2020 experienced more epinephrine-treated reactions in adjacent periods before (n = 8) and after (n = 6) the lockdown. CONCLUSION: The lower rate of home epinephrine-treated reactions during the coronavirus disease 2019 lockdown in Israel suggests that potentially avoidable triggers contribute significantly to the rate of adverse reactions during OIT.