University Research Consent Form
Title: The Effect of a Tai Chi Program on Falling in the Elderly
Principal Investigator: Joe Smith, Ph. D.
About this form:
This form gives you important information about a research study. Please read it carefully. One of our staff members will be with you to answer any questions you may have about the study and what you will be asked to do. If you decide to be a participant (called a "subject"), you will have to sign this form. We will give you a copy of it to keep.
Why is this research being done?
The purpose of this research is to find out if special exercises (Tai Chi) are helpful in preventing falls and helping people to be more confident in doing daily activities. We are inviting you to join the study because you have told your doctor that you have fallen down a few times this year. We would like about 100 people to take part in this study.
How long will I take part in this study?
You will spend 10 weeks from the beginning to the end of the study. During this time, we will teach you activities that you will do at home every other day and you will come to this clinic for learning the activities and for testing.
What will happen in this research study?
If you agree to be in this study, you will be assigned by chance (like flipping a coin) to receive one of two activity programs. One of these is called Tai Chi Chuan that includes gentle stretching, standing and balancing. The other group will be instructed in a daily activity program.
Before your program begins, you will perform a walking test. You will walk down the corridor as fast as you can. A tester will time how fast you go. You will also do a few balance tests, like standing on one leg, standing with your feet one in front of the other, standing with eyes closed and turning around. We will also ask you to complete a questionnaire about how confident you are about doing certain daily activities like reaching overhead or going shopping.
If you are in the Tai Chi group, you will come to the clinic and will learn a series of special exercises. You will be given pictures and descriptions of what to do at home. Once a week, one of us will come to your home to review the exercises with you.
If you are in the activity program group, you will come to the clinic and will review your daily activities with one of us. We will give you a list of activities that you should be sure to do every other day.
We will give you a calendar chart for marking each time you do your planned exercise or activity program and to make a note if you have a fall at any time.
You will return to ...