Tai Chi Is Effective in Treating Knee Osteoarthritis: A Randomized Controlled Trial

Division of Rheumatology, Tufts Medical Center, Box 406, Tufts University School of Medicine, Boston, MA 02111, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 09/2008; 61(11):1545-53. DOI: 10.1002/art.24832
Source: PubMed


To evaluate the effectiveness of Tai Chi in the treatment of knee osteoarthritis (OA) symptoms.
We conducted a prospective, single-blind, randomized controlled trial of 40 individuals with symptomatic tibiofemoral OA. Patients were randomly assigned to 60 minutes of Tai Chi (10 modified forms from classic Yang style) or attention control (wellness education and stretching) twice weekly for 12 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score at 12 weeks. Secondary outcomes included WOMAC function, patient and physician global assessments, timed chair stand, depression index, self-efficacy scale, and quality of life. We repeated these assessments at 24 and 48 weeks. Analyses were compared by intent-to-treat principles.
The 40 patients had a mean age of 65 years and a mean body mass index of 30.0 kg/m(2). Compared with the controls, patients assigned to Tai Chi exhibited significantly greater improvement in WOMAC pain (mean difference at 12 weeks -118.80 mm [95% confidence interval (95% CI) -183.66, -53.94; P = 0.0005]), WOMAC physical function (-324.60 mm [95% CI -513.98, -135.22; P = 0.001]), patient global visual analog scale (VAS; -2.15 cm [95% CI -3.82, -0.49; P = 0.01]), physician global VAS (-1.71 cm [95% CI -2.75, -0.66; P = 0.002]), chair stand time (-10.88 seconds [95% CI -15.91, -5.84; P = 0.00005]), Center for Epidemiologic Studies Depression Scale (-6.70 [95% CI -11.63, -1.77; P = 0.009]), self-efficacy score (0.71 [95% CI 0.03, 1.39; P = 0.04]), and Short Form 36 physical component summary (7.43 [95% CI 2.50, 12.36; P = 0.004]). No severe adverse events were observed.
Tai Chi reduces pain and improves physical function, self-efficacy, depression, and health-related quality of life for knee OA.

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Available from: Ronenn Roubenoff, Oct 10, 2015
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    • "Between group N ¼ 29 Within group N ¼ 28 Between group N ¼ 28 Within group N ¼ 28 Abbott et al., 2013 Aglamis et al., 2008 ✓ ✓ ✓ ✓ Avelar et al., 2011 ✓ # Baker et al., 2001 ✓ ✓ ⃡ ✓ Bautch et al., 1997 ✓ Bennell et al., 2005 ⃡ ✓ ⃡ ✓ Bennell et al. 2010 ✓ ✓ Brismee et al., 2007 ✓ ✓ ✓ ✓ Dias et al., 2003 ✓ ✓ Durmus et al., 2012 ✓ ✓ Ettinger et al., 1997+ ✓ ✓ Farr et al., 2010 ✓ Fitzgerald et al., 2011 ⃡ ✓ Foroughi et al., 2011 ✓ ✓ Foy et al., 2011 ✓ ✓ Hasegawa 2010 ✓ ✓ ✓ ✓ Jenkinson et al., 2009 ✓ ⃡ ✓ ✓ Kawasaki et al., 2008 ✓ ✓ Kawasaki et al. 2009 ⃡ ⃡ Keefe et al., 2004 ⃡ Kirkley et al., 2008 Lim et al., 2008 ✓ ⃡ McCarthy et al., 2004 McKnight et al., 2010 ✓ ✓ Messier et al., 2000 # ✓ Messier et al. 2007 ⃡ # Mikesky et al., 2006 ⃡ Miller et al., 2006 ✓ ✓ Ni et al., 2010 ✓ ✓ Olejerova et al., 2008 O'Reilly et al., 1999 ✓ ✓ ✓ ✓ Osteras et al., 2012 ⃡ Peloquin et al., 1999 ✓ ✓ # # Pisters et al., 2010 ✓ ✓ Rejeski et al., 2002+ # ✓ # # Rogind et al., 1998 ⃡ # ⃡ # Salancinski et al., 2012 ✓ ✓ ⃡ ⃡ Sayers et al., 2012 ⃡ ⃡ ⃡ ⃡ Schlenk et al., 2011 ⃡ ✓ Silva et al., 2008 ✓ ✓ Simao et al., 2012 # ⃡ Somers et al., 2012 ✓ # ✓ # Song et al., 2003 ✓ ✓ Talbot et al., 2003 ⃡ ⃡ ✓ Thomas et al., 2002 ✓ ✓ Topp et al., 2002 ⃡ ✓ ⃡ # Wang et al., 2009 ✓ ✓ ✓ ✓ Wang et al. 2011 ✓ Key: + ¼ findings from primary paper and follow up papers, ✓ ¼ significantly lower pain in physical activity group over time or compared to non-physical activity group/ significantly better physical function in physical activity group over time or compared to non-physical activity group. 4 ¼ no significant difference over time or between groups. "
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    ABSTRACT: To determine whether long-term physical activity is safe for older adults with knee pain. A comprehensive systematic review and narrative synthesis of existing literature was conducted using multiple electronic databases from inception until May 2013. Two reviewers independently screened, checked data extraction and carried out quality assessment. Inclusion criteria for study designs were randomised controlled trials (RCTs), prospective cohort studies or case control studies, which included adults of mean age over 45 years old with knee pain or osteoarthritis (OA), undertaking physical activity over at least three months and which measured a safety related outcome (adverse events, pain, physical functioning, structural OA imaging progression or progression to total knee replacement (TKR)). Of the 8614 unique references identified, 49 studies were included in the review, comprising 48 RCTs and one case control study. RCTs varied in quality and included an array of low impact therapeutic exercise interventions of varying cardiovascular intensity. There was no evidence of serious adverse events, increases in pain, decreases in physical function, progression of structural OA on imaging or increased TKR at group level. The case control study concluded that increasing levels of regular physical activity was associated with lower risk of progression to TKR. Long-term therapeutic exercise lasting three to thirty months is safe for most older adults with knee pain. This evidence supports current clinical guideline recommendations. However, most studies investigated selected, consenting older adults carrying out low impact therapeutic exercise which may affect result generalizability. PROSPERO 2014:CRD42014006913. Copyright © 2015. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 05/2015; 60(9). DOI:10.1016/j.joca.2015.05.002 · 4.17 Impact Factor
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    • "In our preliminary randomized trial, participants with knee OA who completed Tai Chi exhibited greater improvements in pain, physical function, depression, self-efficacy, and health status compared with an attention control group at 12 weeks. Primary and secondary outcomes also showed durable benefits at 24 and 48 weeks [18]. Furthermore, our recent meta-analysis of six Tai Chi studies including 382 participants demonstrated large and significant pain reductions [Effect Size = 0.72 (95% CI 0.97, 0.47)] after 8 to 12 weeks of Tai Chi training compared with a variety of controls with a heterogeneity score (I2) of 0% [21]. "
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    ABSTRACT: BackgroundKnee osteoarthritis (OA) causes pain and long-term disability with annual healthcare costs exceeding $185 billion in the United States. Few medical remedies effectively influence the course of the disease. Finding effective treatments to maintain function and quality of life in patients with knee OA is one of the national priorities identified by the Institute of Medicine. We are currently conducting the first comparative effectiveness and cost-effectiveness randomized trial of Tai Chi versus a physical-therapy regimen in a sample of patients with symptomatic and radiographically confirmed knee OA. This article describes the design and conduct of this trial.Methods/DesignA single-center, 52-week, comparative effectiveness randomized controlled trial of Tai Chi versus a standardized physical-therapy regimen is being conducted at an urban tertiary medical center in Boston, Massachusetts. The study population consists of adults ≥ 40 years of age with symptomatic and radiographic knee OA (American College of Rheumatology criteria). Participants are randomly allocated to either 12 weeks of Tai Chi (2x/week) or Physical Therapy (2x/week for 6 weeks, followed by 6 weeks of rigorously monitored home exercise). The primary outcome measure is pain (Western Ontario and McMaster Universities WOMAC) subscale at 12 weeks. Secondary outcomes include WOMAC stkiffness and function domain scores, lower extremity strength and power, functional balance, physical performance tests, psychological and psychosocial functioning, durability effects, health related quality of life, and healthcare utilization at 12, 24 and 52 weeks.DiscussionThis study will be the first randomized comparative-effectiveness and cost-effectiveness trial of Tai Chi versus Physical Therapy in a large symptomatic knee OA population with long-term follow up. We present here a robust and well-designed randomized comparative-effectiveness trial that also explores multiple outcomes to elucidate the potential mechanisms of mind-body effect for a major disabling disease with substantial health burdens and economic costs. Results of this study are expected to have important public health implications for the large and growing population with knee OA.Trial identifier: NCT01258985Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6882-14-333) contains supplementary material, which is available to authorized users.
    BMC Complementary and Alternative Medicine 09/2014; 14(1):333. DOI:10.1186/1472-6882-14-333 · 2.02 Impact Factor
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    • "In a study in which tai chi and stretching were applied, tai chi was found to be effective for fibromyalgia9). In another study where tai chi was applied to knee osteoarthritis patients, they obtained better results than those who performed stretching exercises10). Previous studies have focused on elderly people, middle-aged males, or patients with specific diseases. "
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    ABSTRACT: [Purpose] This study was to examine the effects of tai chi on low back pain in young males. [Subjects and Methods] Forty males in their 20s with low back pain were randomly assigned to two groups. Tai chi was applied to one group, and stretching was applied to the other group. The subjects conducted exercise for one hour, three times per week for four weeks. They performed warm-up exercises for 10 min at the beginning and end of the sessions and conducted the main exercise for 40 minutes. Wireless surface electromyography (sEMG) and a visual analogue scale (VAS) were employed to measure muscle activity and pain, respectively. [Results] There were significant differences between the two groups in pain and muscle activity. The tai chi group's VAS decreased from 3.1 to 2.1, and its muscle activity decreased from 21.5% maximum voluntary isomeric contraction (MVIC) to 16.4% MVIC. The stretching group's VAS decreased from 3.4 to 2.8, and its muscle activity decreased from 24.1% MVIC to 22.1% MVIC. [Conclusion] Tai chi is more effective for low back pain in males in their 20s than stretching. Tai chi can be considered an effective method to reduce low back pain in males in their 20s.
    Journal of Physical Therapy Science 05/2014; 26(5):679-81. DOI:10.1589/jpts.26.679 · 0.39 Impact Factor
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