Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis: A Randomized Trial

Effectiveness and safety of Tai Chi for chronic pain of knee osteoarthritis: A protocol for systematic review and meta-analysis

BACKGROUND

Chronic pain (CP) has been a major area of interest in the field of knee osteoarthritis (KOA), further aggravating the dysthymia, stiffness, and dysfunction of KOA patients. As an important part of complementary and alternative medicine, Tai Chi has a positive effect on KOA patients. The systematic review is to evaluate the effectiveness and safety of Tai Chi for KOA patients with CP.

METHODS

A systematic search will be performed in the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of Tai Chi in treating chronic pain of knee osteoarthritis: the Cochrane Library, PubMed, EMBASE, OVID-MEDLINE, and four Chinese databases (Wan Fang, CNKI, CBMdisc and VIP). Each database will be searched from inception to Dec. 2021. The process will include study selection, data extraction, risk of bias assessment and meta-analysis.

RESULTS

This proposed study will evaluate the effectiveness and safety of Tai Chi for KOA patients with CP. Improvement in pain and adverse effects of KOA will be included in our measure.

CONCLUSIONS

This proposed systematic review and meta-analysis will evaluate the existing evidence on the effectiveness and safety of Tai Chi for KOA patients with CP.

DISSEMINATION AND ETHICS

The results of this review will be disseminated through peer-reviewed publication. This review does not require ethical approval because all of the data used in this systematic review and meta-analysis have already been published. Furthermore, all of these data will be analyzed anonymously during the review process.

INPLASY REGISTRATION NUMBER

INPLASY2021120020.

Beneficial Effects and Potential Mechanisms of Tai Chi on Lower Limb Osteoarthritis: A Biopsychosocial Perspective

Lower limb osteoarthritis (OA) is a chronic, multifactorial disease characterized by impaired physical function, chronic pain, compromised psychological health and decreased social functioning. Chronic inflammation plays a critical role in the pathophysiology of OA. Tai Chi is a type of classical mind-body exercise derived from ancient Chinese martial arts. Evidence supports that Tai Chi has significant benefits for relieving lower limb OA symptoms. Using a biopsychosocial framework, this review aims to elucidate the beneficial effects of Tai Chi in lower limb OA and disentangle its potential mechanisms from the perspective of biology, psychology, and social factors. Complex biomechanical, biochemical, neurological, psychological, and social mechanisms, including strengthening of muscles, proprioception improvement, joint mechanical stress reduction, change of brain activation and sensitization, attenuation of inflammation, emotion modulation and social support, are discussed.

An Updated Systematic Review and Meta-analysis of Duloxetine for Knee Osteoarthritis Pain

OBJECTIVE

We conducted the updated systematic review and meta-analysis of the best available quantitative and qualitative evidence to evaluate the effects and safety of duloxetine for the treatment of knee osteoarthritis (OA) pain.

METHODS

A comprehensive literature search used 3 English and 4 Chinese biomedical databases from inception through July 10, 2020. We included randomized controlled trials of duloxetine with intervention duration of 2 weeks or longer for knee OA. The primary outcome was pain intensity measured by Brief Pain Inventory and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Secondary outcome measurements included 36-Item Short Form Health Survey, Patient's Global Impression of Improvement, Clinical Global Impressions of Severity, and adverse events (AEs). The quality of all included studies was evaluated using the Cochrane risk-of-bias criteria. The review was registered in the PROSPERO (CRD 42020194072).

RESULTS

Six studies totaling 2059 patients met the eligibility criteria. Duloxetine had significant reductions in Brief Pain Inventory 24 hours average pain (mean difference [MD]=-0.74; 95% confidence interval [CI], -0.92 to -0.57; P<0.00001; I2=13%; 5 trials; 1695 patients); patient general activity (MD=-0.76; 95% CI, -0.96 to -0.56; P<0.00001; I2=0%; 5 trials; 1694 patients) WOMAC physical function subscale (MD=-4.22; 95% CI, -5.14 to -3.30; P<0.00001; I2=26%; 5 trials; 1986 patients); Patient's Global Impression of Improvement (MD=-0.48; 95% CI, -0.58 to -0.37; P<0.00001; I2=29%; 5 trials; 1741 patients); and Clinical Global Impressions of Severity (MD=-0.34; 95% CI, -0.44 to -0.24; P<0.00001; I2=0%; 4 trials; 1178 patients) compared with placebo control. However, no difference on WOMAC pain subscale (standard mean difference=-1.68; 95% CI, -3.45 to 0.08; P=0.06; I2=100%; 3 trials; 1104 patients) and in serious AEs (risk ratio=0.92; 95% CI, 0.40-2.11; P=0.84; I2=0%; 5 trials; 1762 patients) between duloxetine and placebo. Furthermore, duloxetine failed to show superior effects for improving the life quality and demonstrated more treatment-emergent AEs.

CONCLUSION

Duloxetine may be an effective treatment option for knee OA patients but further rigorously designed and well-controlled randomized trials are warranted.

Effects of Diet Control and Telemedicine-Based Resistance Exercise Intervention on Patients with Obesity and Knee Osteoarthritis: A Randomized Control Trial

This study investigated the effects of home-based nutritional and telemedicine-based resistance exercise interventions on improving body composition, blood biochemistry, and lower-limb functional performance. In total, 66 obese patients with mild-to-moderate knee osteoarthritis were randomly divided into a diet control group (D), elastic band resistance exercise group (E), and diet control plus elastic band exercise group (D + E). Each group was supervised by a clinical dietitian and follow-up was conducted via telephone calls or a communication application to track the participants’ progress. After 12 weeks of intervention, the D (p < 0.001) and D + E (p < 0.001) groups achieved significant weight loss. The D + E group exhibited a significant reduction in body fat relative to the D (p = 0.019) and E (p = 0.012) groups. Compared with the D (p = 0.002) and E (p = 0.019) groups, the D + E group achieved significant improvements in the timed up-and-go test and Western Ontario and McMaster Universities Osteoarthritis total scale. The D + E group experienced significant improvements in total cholesterol (p = 0.001), low-density lipoprotein cholesterol (p = 0.01), and triglyceride levels (p = 0.007) relative to other groups. In conclusion, individual diet control intervention combined with telemedicine-based resistance exercise intervention significantly improved the body composition, blood biochemistry, and lower-limb functional performance of the investigated population with comorbid conditions.

Correlation between pain severity and levels of anxiety and depression in osteoarthritis patients: a systematic review and meta-analysis

OBJECTIVES

Osteoarthritis (OA) is a chronic degenerative musculoskeletal disease that causes articular damage and chronic pain, with a prevalence of up to 50% in individuals >60 years of age. Patients suffering from chronic painful conditions, including OA, also frequently report anxiety or depression. A systematic review and meta-analysis were performed to assess the correlation between pain severity and depressive and anxious symptomatology in OA patients.

METHODS

A systematic search was conducted using four databases (PubMed, Medline, Scopus, and Web of Science) from inception up to 14th January of 2020. We included original articles evaluating pain severity and anxiety and/or depression severity in OA-diagnosed patients. Detailed data were extracted from each study, including patients' characteristics and pain, anxiety, and depression severity. When available, the Pearson correlation coefficient between pain and depression severity and pain and anxiety severity was collected and a meta-analysis of random effects was applied.

RESULTS

This systematic review included 121 studies, with a total of 38085 participants. The mean age was 64.3 years old and subjects were predominantly female (63%). The most used scale to evaluate pain severity was the Western Ontario and the McMaster Universities Osteoarthritis Index, while for anxiety and depression, the Hospital Anxiety and Depression Scale was the most used. The meta-analysis showed a moderate positive correlation between pain severity and both anxious (r = 0.31, p < 0.001) and depressive symptomatology (r = 0.36, p < 0.001).

CONCLUSIONS

Our results demonstrate a significant correlation between pain and depression/anxiety severity in OA patients, highlighting the need for its routine evaluation by clinicians.

Analysis of Movement-Based Mind-Body Interventions to Guide the Implementation of Osteoarthritis Exercise Programs: A Descriptive Review of Randomized Controlled Trials

Background: Clear and complete reporting of the components of complex interventions is required in clinical trials to ensure that research can be reliably replicated and successfully translated into clinical practice. Movement-based mind-body exercises, such as Tai Chi, qigong, and Yoga (TQY), are considered complex interventions and recommended for individuals with osteoarthritis in the latest guidelines of the American College of Rheumatology. This review analyzes the intervention reporting of randomized controlled trials of TQY to guide the implementation in osteoarthritis exercise programs. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials, and EMBASE for TQY exercise trials in osteoarthritis between 2000 and 2020. Pairs of researchers independently screened the records, extracted study characteristics, and assessed 19 items on the Consensus on Exercise Reporting Template (CERT) checklist. For each of these items, the numbers of studies that clearly reported the item were calculated. We then identified the items in the studies that are key to delivering home-based exercises for further analysis. Results: We included 27 publications reporting 22 TQY interventions in the analysis. None of the studies reported sufficient details on all the 19 CERT items. The median completeness of reporting score was 11 and ranged from 6 to 15 of 19. The most frequently incompletely reported items (number reporting and percentage of studies) were "starting level rule" (n = 1, 5%) and "progression rule" (n = 1, 5%). Other incompletely reported items included "fidelity or adherence (planned)" (n = 9, 41%), "motivations" (n = 9, 41%), and "progression description" (n = 5, 23%). Conclusions: The content analysis highlights motivational strategies for long-term adherence to home-based exercises, which may help clinicians develop interventions for their patients. Details of TQY exercises interventions for osteoarthritis are incompletely reported in the included studies. The study suggests that improvements in content reporting are especially needed on items related to exercise intensity and program progression decisions, and motivational strategies in future implementation.

Efficacy and safety of Shi-style cervical manipulation therapy for treating acute and subacute neck pain: study protocol for a randomized controlled trial

Background

Neck pain is a common clinical disease, which seriously affects people’s mental health and quality of life and results in loss of social productivity. Improving neck pain’s curative effect and reducing its recurrence rate are major medical problems. Shi’s manipulation therapy has unique advantages and technical features that aid in the diagnosis and treatment of neck pain. Compared with first-line non-steroidal anti-inflammatory drug (NSAID) treatment of neck pain, Shi’s cervical manipulation lacks the relevant research basis of therapeutic advantage, safety, and satisfaction for treating acute and subacute neck pain. Herein, we aim to confirm our hypothesis in a clinical trial that the safety and efficacy of Shi’s cervical manipulation will be more effective, safer, and more satisfactory than NSAIDs to treat acute and subacute neck pain.

Methods

In this multicenter, positive-controlled, randomized clinical trial, traditional analgesic drug (NSAID) is used to evaluate and show that Shi’s manipulation is more effective, safe, and satisfactory for treating acute and subacute neck pain. Overall, 240 subjects are randomly divided into the trial and control groups, with both groups treated by the corresponding main intervention method for up to 12 weeks. Clinical data will be collected before the intervention and immediately after the first treatment; at 3 days and 1, 2, 4, 8, and 12 weeks after the intervention; and at 26 and 52 weeks after treatment follow-up of clinical observation index data collection. The clinical observation indices are as follows: (1) cervical pain is the primary observation index, measured by Numerical Rating Scale. The secondary indices include the following: (2) cervical dysfunction index, measured by patient self-evaluation using cervical Neck Disability Index; (3) cervical activity measurement, measured by the cervical vertebra mobility measurement program of Android mobile phone system; (4) overall improvement, measured by patient self-evaluation with SF-36; and (5) satisfactory treatment, determined by patient self-evaluation.

Discussion

We will discuss whether Shi’s cervical manipulation has greater advantages in efficacy, safety, and satisfaction of acute and subacute neck pain than traditional NSAIDs, to provide a scientific basis for the dissemination and application of Shi’s cervical manipulation.

Trial registration

China Registered Clinical Trial Registration Center ChiCTR1900021371. Registered on 17 February 2019

The effectiveness and safety of Tai Chi for patients with essential hypertension: study protocol for an open-label single-center randomized controlled trial

BACKGROUND

Evidence showed that Tai Chi may have beneficial effects among hypertensive individuals, although the results are not convincing. We aim to conduct a high-quality clinical trial with 24-h BP measurement to provide robust evidence of Tai Chi for essential hypertension.

METHODS

This is an open-label single-center randomized controlled trial with 3 parallel arms. We will compare Tai Chi with walking and waiting-list control. We will recruit 234 hypertensive patients with mild to moderate essential hypertension and randomly assign them to 3 different groups. Participants in Tai Chi group will receive a group-format Yang style 24-form Tai Chi exercise program, 3 sessions per week for 12 weeks. The walking group will be asked to walk, 3 sessions per week for 12 weeks. The waiting-list group will not receive any interventions and/or exercise training. The primary outcome is the change in average 24-h systolic blood pressure (SBP) between baseline and 12 weeks after randomization. The secondary outcomes include 24-h Diastolic Blood Pressure (DBP), average SBP and average DBP during the daytime and night-time, blood pressure (BP) variability, SBP load and DBP load, circadian rhythm of BP, and morning BP surge, endothelial functional indicators, home measured BP, quality of life, adverse events and so on.

DISCUSSION

We expect findings of this trial will provide important insight into application of Tai Chi as an effective and acceptable method for hypertensive patients. Successful completion of this proposed study will also contribute to promotion of Tai Chi in the community in the future.

TRIAL REGISTRATION

Clinicaltrials.gov registry: https://clinicaltrials.gov/ct2/show/NCT04267471 , date: February 12, 2020.

A Self-Efficacy Reinforcement Stretching Exercise Program for Community-Dwelling Older Women With Osteoarthritis: A Pilot Study

PURPOSE

This study evaluated the effectiveness of the Self-Efficacy Reinforcement Stretching Exercise Program to improve osteoarthritis (OA)-related symptoms in older women with OA.

DESIGN

A quasi-experimental design was used in this study.

METHODS

The experimental group participated in the Self-Efficacy Reinforcement Stretching Exercise Program, a 6-week program composed of stretching exercises and self-efficacy reinforcement strategies, whereas the control group did not. All participants were assessed on pain; joint stiffness; physical function disability; body mass index; depression; and quality of life at the beginning, end, and 4 weeks after the program ended.

FINDINGS

After participation, the experimental group had significantly less joint stiffness, physical function disability, and depression scores and significantly higher self-efficacy and quality of life than the control group.

CONCLUSIONS

This intervention program led to an improvement in OA-related symptoms, self-efficacy, and quality of life in older women with OA.

CLINICAL RELEVANCE

The sustained effects of acquired exercise behaviors that persisted up to 4 weeks after the program ended could be of interest to rehabilitation nurses and other healthcare professionals.

In the Eyes of Those Who Were Randomized: Perceptions of Disadvantaged Older Adults in a Tai Chi Trial

BACKGROUND AND OBJECTIVES

Older adults living in subsidized housing have typically been excluded from exercise intervention studies. We conducted a qualitative study to explore the perceived physical, psychological, social, and economic factors that influenced participation in and adherence to a year-long Tai Chi intervention within an ongoing cluster-randomized controlled trial (RCT) for older adults living within subsidized housing facilities.

RESEARCH DESIGN AND METHODS

Focus groups were held with participants of the RCT who were allocated to the trial's Tai Chi intervention. Individual phone interviews were conducted with those allocated to Tai Chi who had low adherence or who had withdrawn their participation from the study. Emergent themes were extracted using grounded-theory methods.

RESULTS

In this qualitative study, we enrolled 41 participants who were allocated to the RCT's Tai Chi intervention: 38 completed and 3 withdrew from the study. Average Tai Chi class attendance was 64.3%. Pragmatic factors that led to higher adherence and retention included: locating classes within each facility; providing programs at no cost; and deployment of a skilled research support team. In addition, the use of an accessible, simplified Tai Chi program improved confidence, social support, self-efficacy, and self-reported improvements in physical and psychological well-being.

DISCUSSION AND IMPLICATIONS

Perceived physical, psychological, social benefits, and self-efficacy likely enhance adherence and retention to research-based Tai Chi interventions for older adults. Delivering an on-site, no cost, and supportive program appears critical to overcoming financial and environmental barriers to participation for those living within subsidized housing.

Regular Tai Chi Practice Is Associated With Improved Memory as Well as Structural and Functional Alterations of the Hippocampus in the Elderly

OBJECTIVE

The current study aimed at comparing the effects of Tai Chi (a motor-cognitive exercise) with walking (an exercise without cognitive demands) on cognitive performance, brain structure, and brain function in the elderly.

METHODS

This cross-sectional study included 42 healthy elderly women within two groups: Tai Chi (n = 20; mean age = 62.90 ± 2.38 years) and brisk walking exercise (n = 22; mean age = 63.27 ± 3.58 years). All the participants underwent a cognitive assessment via the Montreal Cognitive Assessment and brain structural and resting state functional magnetic resonance imaging (rsfMRI) assessments.

RESULTS

Episodic memory in the Tai Chi group was superior to that of the walking group. Higher gray matter density in the inferior and medial temporal regions (including the hippocampus) and higher ReHo in temporal regions (specifically the fusiform gyrus and hippocampus) were found in the Tai Chi group. Significant partial correlations were found between the gray matter density of the left hippocampus and episodic memory in the whole sample. Significant partial correlations were observed between the ReHo in left hippocampus, left parahippocampal, left fusiform, and delayed memory task, which was observed among all subjects.

CONCLUSION

The present study suggests that long-term Tai Chi practice may improve memory performance via remodeling the structure and function of the hippocampus.

Effectiveness of Traditional Chinese Exercise for Symptoms of Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Growing evidences have advocated the potential benefits of traditional Chinese exercise (TCE) on symptomatic improvement of knee osteoarthritis (KOA). However, most of them have been derived from cross-sectional studies or case reports; the effectiveness of TCE therapies has not been fully assessed with a randomized control trial (RCT). In order to evaluate the combined clinical effectiveness of TCE for KOA, we conducted a systematic review and meta-analysis on the existing RCTs on KOA. Methods: A systematic search was performed in four electronic databases: PubMed, Web of Science, Cochrane Library, and EMBASE from the time of their inception to February 2020. All eligible RCTs were included in which TCE was utilized for treating KOA as compared to a control group. Two reviewers independently extracted the data and evaluated the risk of bias following the Cochrane Risk of Bias Tool for RCT. The symptoms of KOA evaluated by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were regarded as the primary outcomes in this study. Each outcome measure was pooled by a standardized mean difference (SMD) with 95% confidence intervals (CI). A meta-analysis was applied with a random or fixed effect model for the collected data to calculate the summary SMD with 95% CI based on different statistical heterogeneity. In addition, subgroup analyses were used to investigate heterogeneity and sensitivity analysis was carried out for the results of the meta-analysis. Egger’s test and the funnel plots were used to examine the potential bias in the RCTs. Results: A total of 14 RCTs involving 815 patients with KOA were included. Compared with a control group; the synthesized data of TCE showed a significant improvement in WOMAC/KOOS pain score (SMD = −0.61; 95% CI: −0.86 to −0.37; p < 0.001), stiffness score (SMD = −0.75; 95% CI: −1.09 to −0.41; p < 0.001), and physical function score (SMD = −0.67; 95% CI: −0.82 to −0.53; p < 0.001). Conclusions: Our meta-analysis suggested that TCE may be effective in alleviating pain; relieving stiffness and improving the physical function for patients with KOA. Yet; given the methodological limitations of included RCTs in this meta-analysis; more high-quality RCTs with large sample size and long-term intervention are required to further confirm the effectiveness and underlying mechanisms of TCE for treating KOA.

Tai Chi exercise can ameliorate physical and mental health of patients with knee osteoarthritis: systematic review and meta-analysis

OBJECTIVE

To systematically review the effects of Tai Chi exercise as a nonpharmacological therapeutic strategy on the physical and mental health in individuals with knee osteoarthritis.

DATA SOURCES

A systematic literature retrieval has been conducted in PubMed, Web of Science, EMbase, CENTRAL, OVID, CINAHL, Physiotherapy Evidence Database, Chinese Biomedical Database and China National Knowledge Infrastructure up to June 2020 to identify the relevant randomised controlled trials (RCTs).

METHODS

Two authors assessed independently the risk of bias using the Cochrane Collaboration's tool. Standardised mean difference (SMD) and 95% CI were calculated and data were combined using the fixed or random-effect model. The strength of evidence was rated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

RESULTS

A total of 16 RCTs involving 986 patients with knee osteoarthritis met the established inclusion criteria. The strength of evidence for the main outcomes was low or moderate. The systematic review illustrated the efficacy of Tai Chi exercise in treating and managing knee osteoarthritis. Patients' outcomes practising Tai Chi exercise were improved significantly, including pain (SMD = ‒0.69, 95%CI: ‒0.95 to ‒0.44, P < 0.001), stiffness (SMD = ‒0.59, 95%CI: ‒0.91 to ‒0.27, P < 0.001), physical function (SMD = ‒0.92, 95%CI: -1.16 to ‒0.69, P < 0.001), dynamic balance (SMD = 0.69, 95%CI: 0.38 to 0.99, P < 0.001), physiological and psychological health (SF-36 PCS: SMD = 0.48, 95%CI: 0.28 to 0.68, P < 0.001; SF-36 MCS: SMD = 0.26, 95%CI: 0.06 to 0.45, P = 0.01). No adverse events associated with Tai Chi exercise were reported.

CONCLUSION

Tai Chi exercise was beneficial for ameliorating physical and mental health of patients with knee osteoarthritis and should be available as an alternative non-pharmacological therapy in rehabilitation programmes.

Physical Activity and Healthy Aging

Healthy aging is the ability to maintain independence, purpose, vitality, and quality of life into old age despite unexpected medical conditions, accidents, and unhelpful social determinants of health. Exercise, or physical activity, is an important component of healthy aging, preventing or mitigating falls, pain, sarcopenia, osteoporosis, and cognitive impairment. A well-balanced exercise program includes daily aerobic, strength, balance, and flexibility components. Most older adults do not meet the currently recommended minutes of regular physical activity weekly. Counseling by health care providers may help older adults improve exercise habits, but it is also important to take advantage of community-based exercise opportunities.

Effects of Wuqinxi in the Patients with Chronic Low Back Pain: A Randomized Controlled Trial

Low back pain (LBP) is one of the major concerns of the current health care. The guidelines for chronic LBP recommend traditional Chinese exercise as an effective treatment. As one of the representatives of traditional Chinese exercise, Wuqinxi has been famous in China for its effects on improving health and treating chronic diseases for thousands of years. The objectives of the study were to assess the effects of Wuqinxi in the patients with chronic LBP on pain intensity, trunk muscle strength, and quality of life. The primary outcome measure was assessed by the Short-Form McGill Pain Questionnaire (SF-MPQ), including the Visual Analog Scale (VAS) and Present Pain Intensity (PPI) as the subtables. The effects of Wuqinxi on the quality of life were also assessed by the Short-Form Health Survey (SF-36) and the Pittsburgh Sleep Quality Index (PSQI) from physical component summary (PCS), mental component summary (MCS), and sleep quality. Besides, the electrical activities of the rectus abdominis (RA), obliquus externus abdominis (OEA), lumbar erector spinae (ES), and multifidus (MF) were assessed by integrated electromyogram (iEMG) after the end of the intervention. Both the groups showed statistically significant improvement in SF-MPQ, SF-36, PSQI, and iEMG at 12 weeks and 24 weeks when compared with baseline (P < 0.05). However, Wuqinxi demonstrated better effects in SF-MPQ and MCS after 24 weeks of intervention compared with the general exercise (P < 0.05). The patients in the Wuqinxi group (WQXG) also showed a significantly higher iEMG on OEA than the general exercise group (GEG) in 30°/s and 90°/s (P < 0.05). Our results showed that Wuqinxi had better effects on chronic LBP for a long time compared with general exercise, including pain intensity and quality of life. Thus, Wuqinxi should be recognized as a possible standalone therapy and self-management skill in chronic LBP, which is suitable for long-term practice.

The Effects of Tai Chi and Qigong on Immune Responses: A Systematic Review and Meta-Analysis

Background: Effective preventative health interventions are essential to maintain well-being among healthcare professionals and the public, especially during times of health crises. Several studies have suggested that Tai Chi and Qigong (TQ) have positive impacts on the immune system and its response to inflammation. The aim of this review is to evaluate the current evidence of the effects of TQ on these parameters. Methods: Electronic searches were conducted on databases (Medline, PubMed, Embase and ScienceDirect). Searches were performed using the following keywords: "Tai Chi or Qigong" and "immune system, immune function, immunity, Immun*, inflammation and cytokines". Studies published as full-text randomized controlled trials (RCTs) in English were included. Estimates of change in the levels of immune cells and inflammatory biomarkers were pooled using a random-effects meta-analysis where randomised comparisons were available for TQ versus active controls and TQ versus non-active controls. Results: Nineteen RCTs were selected for review with a total of 1686 participants and a range of 32 to 252 participants within the studies. Overall, a random-effects meta-analysis found that, compared with control conditions, TQ has a significant small effect of increasing the levels of immune cells (SMD, 0.28; 95% CI, 0.13 to 0.43, p = 0.00), I2 = 45%, but not a significant effect on reducing the levels of inflammation (SMD, -0.15; 95% CI, -0.39 to 0.09, p = 0.21), I2 = 85%, as measured by the systemic inflammation biomarker C-reactive protein (CRP) and cell mediated biomarker cytokines. This difference in results is due to the bidirectional regulation of cytokines. An overall risk of bias assessment found three RCTs with a low risk of bias, six RCTs with some concerns of bias, and ten RCTs with a high risk of bias. Conclusions: Current evidence indicates that practising TQ has a physiologic impact on immune system functioning and inflammatory responses. Rigorous studies are needed to guide clinical guidelines and harness the power of TQ to promote health and wellbeing.

Effect of Tai Chi Chuan in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Background: Tai Chi Chuan(TCC), as a mind-body exercise, may have a positive impact on physical function and psychological well-being in breast cancer patients. The latest systematic review and meta-analysis of TCC for breast cancer was made 4 years ago and some new clinical trials about it were published. We remade a systematic review and meta-analysis to evaluate the effect of TCC in breast cancer patients.

Methods: In this systematic review and meta-analysis, we searched MEDLINE (via PubMed), EMBASE (via embase.com), CENTRAL, CNKI, COVIP, Wanfang, Chaoxing, CiNii, J-SSTAGE, DBpia, and ThaiJO with no language restrictions from inception to December 31, 2018 (updated on February 16, 2020), for randomized clinical trials comparing TCC with non-exercised therapy in breast cancer patients. The primary outcome was quality of life in patients with breast cancer and data pooled by a random-effects model. Subgroup analyses were conducted to estimate the effect of different durations of TCC for breast cancer patients. This study was registered in PROSPERO, number CRD 4201810326.

Results: Fifteen articles involving a total of 885 breast cancer participants were included in this review. Compared with non-exercised therapy, TCC had a significant effect on quality of life in breast cancer patients (SMD = 0.37, 95% CI 0.15–0.59, p = 0.001), and subgroup analysis found that TCC showed beneficial effect in 12 weeks and 25 weeks (12 weeks: SMD = 0.40, 95% CI 0.19–0.62, p = 0.0003; 25 weeks: SMD = 0.38, 95% CI 0.15–0.62, p = 0.002). Meta-analyses of secondary outcomes showed that 3 weeks TCC increased shoulder function (SMD = 1.08, 95% CI 0.28–1.87, p = 0.008), 12 weeks TCC improved pain (SMD = 0.30, 95% CI 0.08–0.51, p = 0.007), shoulder function (SMD = 1.34, 95% CI 0.43–2.25, p = 0.004), strength of arm (SMD = 0.44, 95% CI 0.20–0.68, p = 0.0004), and anxiety (MD = −4.90, 95% CI −7.83 to −1.98, p = 0.001) in breast cancer patients compared with the control group.

Conclusions: TCC appears to be effective on some physical and psychological symptoms and improves the quality of life in patients with breast cancer. Additional randomized controlled trials with a rigorous methodology and low risk of bias are needed to provide more reliable evidence.

T'ai Chi for Chronic Low Back Pain in Older Adults: A Feasibility Trial

Objectives: T'ai chi (TC) has been found effective for improving chronic low back pain (cLBP). However, such studies did not include adults over 65 years of age. This study was designed to evaluate the feasibility and acceptability of TC in this population compared with Health Education (HE) and with Usual Care (UC). Design: Feasibility randomized controlled trial. Settings/Location: Participants were recruited from Kaiser Permanente Washington and classes took place in a Kaiser facility. Patients: Adults 65 years of age and older with cLBP. Interventions: Twenty-eight participants were randomized to 12 weeks of TC followed by a 24-week tapered TC program, 12 were assigned to a 12-week HE intervention and 17 were assigned to UC only. Outcome Measures: Feasibility and acceptability were determined by recruitment, retention and 12-, 26-, and 52-week follow-up rates, instructor adherence to protocol, class attendance, TC home practice, class satisfaction, and adverse events. Results: Fifty-seven participants were enrolled in two cohorts of 28 and 29 during two 4-month recruitment periods. Questionnaire follow-up completion rates ranged between 88% and 93%. Two major class protocol deviations were noted in TC and none in HE. Sixty-two percent of TC participants versus 50% of HE participants attended at least 70% of the classes during the 12-week initial intervention period. Weekly rates of TC home practice were high among class attendees (median of 4.2 days) at 12 weeks, with fewer people practicing at 26 and 52 weeks. By 52 weeks, 70% of TC participants reported practicing the week before, with a median of 3 days per week and 15 min/session. TC participants rated the helpfulness of their classes significantly higher than did HE participants, but the groups were similarly likely to recommend the classes. Conclusion: The TC intervention is feasible in this population, while the HE group requires modifications in delivery.

The Effects of Baduanjin Qigong on Postural Stability, Proprioception, and Symptoms of Patients With Knee Osteoarthritis: A Randomized Controlled Trial

Background: Knee osteoarthritis is a common disease affecting a large number of old individuals worldwide. This study aimed to explore the effects of Baduanjin Qigong in patients with knee osteoarthritis. Methods: Fifty participants with knee osteoarthritis were randomly assigned to either an experimental group (n = 25) or a control group (n = 25). Participants in the experimental group received Baduanjin Qigong training for 12 weeks, with three sessions per week lasting 40 min per session. Participants in the control group did not receive any additional physical training. All of participants completed outcome (proprioception, postural stability, and functional ability) assessments at three time points (baseline, Week 8, 12). Results: Proprioception and Western Ontario and McMaster Universities Osteoarthritis Index function were statistically improved at eighth and 12th week of the intervention in the Baduanjin Qigong group (p < 0.05), while the control group did not have any significant changes. For postural stability at the anterior-posterior direction with eyes closed, Baduanjin Qigong group showed significant improvement compared to controls after the 12 weeks of intervention (p < 0.05). Conclusions: Regular Baduanjin Qigong practice helped the improvement of knee joint proprioception and postural stability, and reduction of pain, stiffness, and functional impairments of old adults with knee osteoarthritis. Well-designed randomized controlled trials with long-term assessment are needed. The trial was registered in Chinese Clinical Trial Registry (ChiCTR-IOR-16010042). URL: http://www.chictr.org.cn/hvshowproject.aspx?id=10550.

Tai Chi for type 2 diabetes mellitus: A protocol for systematic review

BACKGROUND

Tai Chi is gaining an increasing popularity in rehabilitation management of chronic conditions. Yet no consensus has reached on its efficacy and safety of type 2 diabetes despite that several systematic reviews (SRs) were published on this topic. Therefore, we will conduct an overview to critically evaluate current SRs and implement an updated metaanalysis with recently published randomized controlled trials (RCTs).

METHODS

A systematic literature search of relevant RCTs-based SRs will be conducted in electronic databases including Medline, Embase, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database from their inceptions to search date without language restrictions. Eligible SRs will be methodologically assessed by the assessment of multiple SRs 2 and Risk of Bias in SRs tool and their RCTs included will be extracted for further evidence synthesis. To update current meta-analysis on this topic, a supplementary search will be implemented for related newly emerged RCTs. Cochrane risk of bias assessment tool will be applied for RCTs quality evaluation. The grading of recommendations assessment, development and evaluation will be utilized for evidence quality assessment of outcomes. Study characteristic information on participants, interventions, outcomes, comparisons and conclusions will be described in detail. Review Manager V5.3 will be used for risk of bias assessment and Stata 14.0 for meta-analysis and sensitivity analysis.

RESULTS

The study results will be disseminated through a peer-reviewed journal publication or conference presentation.

CONCLUSIONS

This study finding will provide an updated evidence of Tai Chi for patients with type 2 diabetes mellitus (T2DM), thus to help inform clinical physicians, T2DM patients and their families to develop better rehabilitation plans and to draw more attention of decision-makers in exercise rehabilitation related policy-making.This study protocol has been applied for registration on PROSPERO platform (https://www.crd.york.ac.uk/PROSPERO/), with an assigned ID: CRD42019140988.

Association between Pre-Intervention Physical Activity Level and Treatment Response to Exercise Therapy in Persons with Knee Osteoarthritis - An Exploratory Study

Objective

Examine whether pre‐intervention physical activity (PA) level is associated with achieving a positive treatment response of pain and/or function improvement after a 12‐week exercise intervention in participants with knee osteoarthritis (OA).

Methods

We performed a secondary analysis of a randomized, single‐blind comparative effectiveness trial showing similar treatment effects between Tai Chi mind‐body exercise and standard physical therapy intervention for knee OA. Baseline PA was assessed by a Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire and, in a subsample, by tri‐axial accelerometers. The Outcome Measures in Rheumatoid Arthritis Clinical Trials–Osteoarthritis Research Society International (OMERACT‐OARSI) dichotomous responder criteria was used for clinically meaningful improvement at follow‐up. Associations between baseline self‐reported PA by the CHAMPS questionnaire and outcomes of responders vs. nonresponders (reference group) were assessed using logistic regressions, adjusting for demographic covariates. We compared objectively measured PA by accelerometry between responders vs. nonresponders using Wilcoxon tests.

Results

Our sample consisted of 166 participants with knee OA who completed both baseline and 12‐week postintervention evaluations: mean age 60.7 year (SD 10.5), body mass index 32.4 kg/m² (6.9), 119 (72%) women, and 138 (83%) OMERACT‐OARSI responders. Neither time spent in total PA [odds ratio (OR) 1.00; 95% confidence interval (CI) 0.96, 1.03] nor time in moderate‐to‐vigorous PA (OR 1.01; 95% CI 0.93, 1.09) at pre‐intervention were associated with being a responder. Similar findings were observed in 42 accelerometry sub‐cohort participants.

Conclusion

Pre‐intervention PA levels (subjective report or objective measurement) were not associated with individuals achieving favorable treatment outcomes after a 12‐week exercise intervention, which suggests that regardless of pre‐intervention PA level, individuals will likely benefit from structured exercise interventions.

Different exercise modalities relieve pain syndrome in patients with knee osteoarthritis and modulate the dorsolateral prefrontal cortex: A multiple mode MRI study

OBJECTIVES

Knee osteoarthritis (KOA) is a common degenerative joint disease with no satisfactory intervention. Recently, both physical and mindfulness exercises have received considerable attention for their implications in KOA pain management, and the dorsolateral prefrontal cortex (DLPFC) has displayed a critical role in pain modulation. This study aimed to comparatively investigate the modulation effects of different exercises using multidisciplinary measurements.

METHODS

140 KOA patients were randomized into Tai Chi, Baduanjin, stationary cycling, or health education control groups for 12 weeks. Knee Injury and Osteoarthritis Outcome Score (KOOS), resting state functional magnetic resonance imaging (fMRI), structural MRI, and serum biomarkers were measured at baseline and at the end of the study.

RESULTS

We found: 1) increased KOOS pain subscores (pain reduction) and serum programmed cell death protein 1 (PD-1) levels in the three exercise groups compared to the control group; 2) decreased resting state functional connectivity (rsFC) of the DLPFC-supplementary motor area (SMA) and increased rsFC between the DLPFC and anterior cingulate cortex in all exercise groups compared to the control group; 3) significant associations between DLPFC-SMA rsFC with KOOS pain subscores and serum PD-1 levels at baseline; 4) significantly increased grey matter volume in the SMA in the Tai Chi and stationary cycling groups, and a trend toward significant increase in the Baduanjin group compared to the control group; 5) significant DLPFC rsFC differences among different exercise groups; and 6) that baseline DLPFC-SMA rsFC can predict the effect of mind-body exercise on pain improvement in KOA.

CONCLUSION

Our results suggest that different exercises can modulate both common and unique DLPFC (cognitive control) pathways, and altered DLPFC-SMA rsFC is associated with serum biomarker levels. Our findings also highlight the potentials of neuroimaging biomarkers in predicting the therapeutic effect of mind-body exercises on KOA pain.

Modulatory effects of different exercise modalities on the functional connectivity of the periaqueductal grey and ventral tegmental area in patients with knee osteoarthritis: a randomised multimodal magnetic resonance imaging study

BACKGROUND

Knee osteoarthritis is a prevalent disorder with unsatisfactory treatment options. Both physical and mindful exercises may be able to relieve its pain symptoms. We compared the modulatory effects of different exercise modalities on the periaqueductal grey (PAG) and ventral tegmental area (VTA), which play important roles in descending opioidergic pathways and reward/motivation systems in patients with knee osteoarthritis.

METHODS

We recruited and randomised 140 patients into Tai Chi, Baduanjin, stationary cycling, and health education control groups for 12 weeks. Knee injury and Osteoarthritis Outcome Score (KOOS), functional and structural MRI, and blood biomarkers were measured at the beginning and end of the experiment. We used the PAG and VTA as seeds in resting-state functional connectivity (rsFC) analysis.

RESULTS

Compared with the control group: (i) all exercises significantly increased KOOS pain sub-scores (pain reduction) and serum programmed death 1 (PD-1) concentrations; (ii) all exercises decreased right PAG rsFC with the medial orbital prefrontal cortex, and the decreased rsFC was associated with improvements in knee pain; and (iii) grey matter volume in the medial orbital prefrontal cortex was significantly increased in all exercise groups. There was also significantly decreased rsFC between the left VTA and the medial orbital prefrontal cortex in the Tai Chi and Baduanjin groups.

CONCLUSIONS

Exercise can simultaneously modulate the rsFC of the descending opioidergic pathway and reward/motivation system and blood inflammation markers. Elucidating the shared and unique mechanisms of different exercise modalities may facilitate the development of exercise-based interventions for chronic pain.

CLINICAL TRIAL REGISTRATION

ChiCTR-IOR-16009308.

Multimodal non-surgical intervention for individuals with knee osteoarthritis: a retrospective case series

INTRODUCTION

The purpose of this study is to review the pain and functional outcomes of a multimodal intervention in three patients with knee osteoarthritis (OA). This study explores how manual therapy can be delivered within an evidence-based framework for the management of knee OA.

METHODS

Medical records were reviewed for three patients with knee OA who underwent a standardized multimodal intervention including education, exercise, and manual therapy. Changes in pain intensity and function from baseline to post-intervention were calculated and compared to thresholds for minimal clinically important differences.

RESULTS

One participant met the threshold for clinically significant improvement in pain and two participants for function. No adverse events were reported.

CONCLUSION

Combined education, exercise, and manual therapy delivered over a 6-week period improved function in two of the three patients reviewed. Higher quality research is required to explore whether this multimodal intervention may improve outcomes in individuals with knee OA.

Convergent Points for Conventional Medicine and Whole Systems Research: A User's Guide

CONTEXT

Value-based health care has emerged as a manifestation of the conventional medicine community's awareness of the overlapping needs to both better incorporate patient centeredness into practice and research paradigms and further develop a systemic approach to cost reduction.

BACKGROUND

The origins of the whole systems research (WSR) movement date to the late 1990s, when the U.S. Congress legislated appropriation of funds to stimulate the U.S. National Institutes of Health to evaluate popular traditional, complementary, and integrative medicine (TCIM) practices. Questions immediately arose over how well these forms of practice could be measured through standard randomized controlled trials, and the WSR community began to articulate and adapt innovative methodologies for evaluating TCIM interventions.

DISCUSSION

This column explores the potential impact of WSR methods and exemplars on the clinical practice and research communities seeking to successfully implement and measure the complexities of value-based health care. Four potentially cross-talking themes are specifically discussed: complex behaviorally focused interventions, patient-centered outcomes, team-based care, and resilience and well-being.

CONCLUSION

The time is ripe for clinicians and investigators to capitalize on methodologies, exemplars, and learnings from the WSR literature toward improving care, developing more robust research strategies, and furthering the dialogue between the TCIM and conventional medicine communities.

Whole Systems Research Methods in Health Care: A Scoping Review

Objectives: This scoping review evaluates two decades of methodological advances made by “whole systems research” (WSR) pioneers in the fields of traditional, complementary, and integrative medicine (TCIM). Rooted in critiques of the classical randomized controlled trial (RCT)'s suitability for evaluating holistic, complex TCIM interventions, WSR centralizes the principle of “model validity,” representing a “fit” between research design and therapeutic paradigm.

Design: In consultation with field experts, 41 clinical research exemplars were selected for review from across 13 TCIM disciplines, with the aim of mapping the range and methodological characteristics of WSR studies. Using an analytic charting approach, these studies' primary and secondary features are characterized with reference to three focal areas: research method, intervention design, and outcome assessment.

Results: The reviewed WSR exemplars investigate a wide range of multimodal and multicomponent TCIM interventions, typified by wellness-geared, multitarget, and multimorbid therapeutic aims. Most studies include a behavioral focus, at times in multidisciplinary or team-based contexts. Treatments are variously individualized, often with reference to “dual” (biomedical and paradigm-specific) diagnoses. Prospective and retrospective study designs substantially reflect established biomedical research methods. Pragmatic, randomized, open label comparative effectiveness designs with “usual care” comparators are most widely used, at times with factorial treatment arms. Only two studies adopt a double-blind, placebo-controlled RCT format. Some cohort-based controlled trials engage nonrandomized allocation strategies (e.g., matched controls, preference-based assignment, and minimization); other key designs include single-cohort pre–post studies, modified n-of-1 series, case series, case report, and ethnography. Mixed methods designs (i.e., qualitative research and economic evaluations) are evident in about one-third of exemplars. Primary and secondary outcomes are predominantly assessed, at multiple intervals, through patient-reported measures for symptom severity, quality of life/wellness, and/or treatment satisfaction; some studies concurrently evaluate objective outcomes.

Conclusions: Aligned with trends emphasizing “fit-for-purpose” research designs to study the “real-world” effectiveness of complex, personalized clinical interventions, WSR has emerged as a maturing scholarly discipline. The field is distinguished by its patient-centered salutogenic focus and engagement with nonbiomedical diagnostic and treatment frameworks. The rigorous pursuit of model validity may be further advanced by emphasizing complex analytic models, paradigm-specific outcome assessment, inter-rater reliability, and ethnographically informed designs. Policy makers and funders seeking to support best practices in TCIM research may refer to this review as a key resource.

Reporting of Protocol Rationale and Content Validity in Randomized Clinical Trials of T'ai Chi: A Systematic Evaluation

BACKGROUND

Mind-body exercise interventions are typically multimodal, complex, and pluralistic, and few have been developed with the goal of therapeutically targeting a specific medical population. It is thus important that clinical trials evaluating mind-body interventions provide some justification for the use of the specific protocol being evaluated.

OBJECTIVES

This article reports the results of a systematic review of the quality of reporting of protocol rationale and content validity for using a specific t'ai chi protocol in a randomized controlled trial (RCT).

METHODS

Electronic literature searches were conducted using PubMed/MEDLINE, EBSCOhost, and the Cochrane Library from inception through June 2015. Search terms were Tai Chi, Taiji, Tai Chi Chuan; searches were limited to English-language RCTs. Inclusion and exclusion of trials were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors assessed the level of reporting with respect to t'ai chi protocol validation using a 5-point grading system based on whether (1) a specific protocol was mentioned, (2) rationale for the specific protocol was stated and supported, and (3) formal evaluation for content validity was conducted.

RESULTS

There was significant heterogeneity in the quality of reporting related to protocol rationale and content validity. A total of 171 publications were identified. Studies met between 0 and 4 validity criteria (of possible 5, more indicating better quality), with a mean of 2.52 (±SD 1.2) and median of 3. Twenty (12%) trials did not mention a specific t'ai chi protocol, 10 (6%) trials met 0 of 5 criteria, and 47 (31%) studies met 4 of 5 criteria. Formal validity assessments were employed in only one trial.

CONCLUSIONS

The poor quality of protocol rationale and content validity reporting limits our ability to accurately evaluate the evidence of t'ai chi as a therapeutic intervention. The development of formal guidelines for developing and reporting intervention validity for multimodal mind-body exercises like t'ai chi may improve the quality and interpretability of research.

Exercise in the management of knee and hip osteoarthritis

PURPOSE OF REVIEW

This review focuses on studies published during July 2001 to August 2017 of exercise as an intervention in knee and hip osteoarthritis, including its influence on an array of patient outcomes.

RECENT FINDINGS

Studies continue to illustrate the efficacy of exercise in treating and managing osteoarthritis, with current literature more focused on the knee compared with the hip joint. Both traditional (e.g. strength, aerobic, flexibility) and more nontraditional (e.g. yoga, Tai Chi, aquatic) training modes improve patient outcomes related to joint symptoms, mobility, quality of life, psychological health, musculoskeletal properties, body composition, sleep, and fatigue. Exercise that is adequately dosed (e.g. frequency, intensity) and progressive in nature demonstrated the greatest improvements in patient outcomes. Supervised, partially supervised, and nonsupervised interventions can be successful in the treatment of osteoarthritis, but patient preference regarding level of supervision and mode of exercise may be key predictors in exercise adherence and degree of outcome improvement. A topic of increasing interest in osteoarthritis is the supplementary role of behavior training in exercise interventions.

SUMMARY

Osteoarthritis is a complex, multifactorial disease that can be successfully managed and treated through exercise, with minimal risk for negative consequences. However, to have greatest impact, appropriate exercise prescription is needed. Efforts to achieve correct exercise doses and mitigate patient nonadherence are needed to lessen the lifelong burden of osteoarthritis.

Putting Integrative Oncology Into Practice: Concepts and Approaches

Unmet symptom needs and a desire for holistic health approaches or even cure are among the motivations patients have for seeking out complementary and alternative medicine. Using complementary and alternative medicine instead of conventional cancer treatment can have a negative impact on clinical outcomes and survival. Integrative oncology is a patient-centered, evidence-informed field of comprehensive cancer care that uses mind-body practices, natural products, and lifestyle modifications from different traditions alongside conventional cancer treatments. It prioritizes safety and best available evidence to offer appropriate therapeutic interventions along with conventional care. This review summarizes the underlying principles of integrative oncology and how it is distinct from alternative medicine, and it provides a practical guide for the effective application of evidence-based complementary and alternative medicine interventions in patient-centered care. In addition, we recommend resources for patients and clinicians and provide algorithms for appropriate integrative medicine referrals. Finally, we offer suggestions on developing and implementing an integrative oncology program and addressing current challenges in the field.

Tai Chi for older adults with chronic multisite pain: a randomized controlled pilot study

BACKGROUND

Chronic pain is associated with poorer cognition and mobility, and fall risk in older adults.

AIMS

To investigate the feasibility of a randomized controlled trial of mind-body exercise (Tai Chi) versus light physical exercise in older adults with multisite pain.

METHODS

Adults aged ≥ 65 years with multisite pain who reported falling in the past year or current use of an assistive device were recruited from Boston area communities. Participants were randomized to either a Tai Chi or a light physical exercise program, offered twice weekly for 12 weeks. The primary outcomes were feasibility and acceptability. Secondary outcomes included pain characteristics, cognition, physical function, gait mobility, fear of falling, and fall rate.

RESULTS

Of 176 adults screened, 85 were eligible, and 54 consented and enrolled (average age 75 ± 8 years; 96.30% white; 75.93% female). The dropout rate was 18% for Tai Chi and 12% for light physical exercise. For those completing the study, exercise class attendance rate was 76% for Tai Chi and 82% for light physical exercise. There were no significant group differences in most secondary outcomes. Tai Chi significantly lowered pain severity (4.58 ± 1.73 to 3.73 ± 1.79, p < 0.01) and pain interference (4.20 ± 2.53 to 3.16 ± 2.28, p < 0.05), reduced fear of falling (90.82 ± 9.59 to 96.84 ± 10.67, p < 0.05), and improved several single-task and dual-task gait variables, while light physical exercise did not change these measures.

DISCUSSION AND CONCLUSIONS

This study demonstrated the feasibility and acceptability of conducting a larger randomized controlled trial in older adults with multisite pain. Study findings and challenges encountered will inform future research.

Effect of Tai Chi for post-stroke mental disorders and sleep disorders: A protocol for systematic review and meta-analysis

BACKGROUND

Post-stroke mental disorders (PSMDs) and post-stroke sleep disorders (PSSDs) are very common in stroke patients. Recently, Tai Chi (TC) as a form of Chinese traditional mind-body exercise has been gradually applied to stroke rehabilitation although its efficacy for PSMD and PSSD varies across different studies. The aim of this study is to explore the therapeutic effect of TC training for PSMD and PSSD.

METHODS

This review will only include randomized controlled trials (RCTs). Search strategy will be performed in 3 English databases, 4 Chinese databases, and the WHO International Clinical Trials Registry Platform. All English or Chinese RCTs, published from inception to February 28, 2019, will be sought. Two reviewers will screen, select studies, extract data, and assess quality independently. Primary outcomes are clinical scales, mainly including "Hamilton depression scale," "Hamilton anxiety scale," and "Pittsburgh sleep quality index." The methodological quality including the risk of bias of the included studies will be evaluated using a modified assessment form, which is based on Cochrane assessment tool and Physiotherapy Evidence Database scale. Review Manager Software (Revman5.3) will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. We will use GRADE system to evaluate the quality of our evidence.

RESULTS

We will provide some more practical and targeted results investigating the effect of TC exercise for PSMD and PSSD in the current meta-analysis. Meanwhile, we will ascertain study progress of TC for PSMD and PSSD and find out defects or inadequacies of previous studies, so that future researchers could get beneficial guidance for more rigorous study.

CONCLUSION

The stronger evidence about TC's rehabilitative effect and safety for PSMD and PSSD will be provided for clinicians and policymakers.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018106608.

ETHICS AND DISSEMINATION

We do not apply for formal ethical approval from ethics committee because all of the study data in our review will be obtained in an anonymous way. Findings of this study are projected to be disseminated through peer-review publications.

Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT)

OBJECTIVE

Disease-modifying treatments for OA remain elusive, and commonly used medications can have serious side effects. Although meditation and music listening (ML) have been shown to improve outcomes in certain chronic pain populations, research in OA is sparse. In this pilot RCT, we explore the effects of two mind-body practices, mantra meditation (MM) and ML, on knee pain, function, and related outcomes in adults with knee OA.

METHODS

Twenty-two older ambulatory adults diagnosed with knee OA were randomized to a MM (N=11) or ML program (N=11) and asked to practice 15-20 minutes, twice daily for 8 weeks. Core outcomes included knee pain (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Numeric Rating Scale), knee function (KOOS), and perceived OA severity (Patient Global Assessment). Additional outcomes included perceived stress (Perceived Stress Scale), mood (Profile of Mood States), sleep (Pittsburgh Sleep Quality Index), and health-related quality of life (QOL, SF-36). Participants were assessed at baseline and following completion of the program.

RESULTS

Twenty participants (91%) completed the study (9 MM, 11 ML). Compliance was excellent; participants completed an average of 12.1±0.83 sessions/week. Relative to baseline, participants in both groups demonstrated improvement post-intervention in all core outcomes, including knee pain, function, and perceived OA severity, as well as improvement in mood, perceived stress, and QOL (Physical Health) (p's≤0.05). Relative to ML, the MM group showed greater improvements in overall mood and sleep (p's≤0.04), QOL-Mental Health (p<0.07), kinesiophobia (p=0.09), and two domains of the KOOS (p's<0.09).

CONCLUSIONS

Findings of this exploratory RCT suggest that a simple MM and, possibly, ML program may be effective in reducing knee pain and dysfunction, decreasing stress, and improving mood, sleep, and QOL in adults with knee OA.

Effects of Tai Chi on Self-Efficacy: A Systematic Review

The purpose of this systematic review is to summarize and update the readers regarding clinical studies that have investigated the effects of Tai Chi on self-efficacy and to describe their limitations and biases. Nine electronic databases were searched from the establishment of the database until August 10, 2017. All randomized controlled trials (RCTs), nonrandomized controlled studies (NRSs), quasi-experimental studies, or studies with pre-post design were included if they clearly defined a Tai Chi intervention and evaluated self-efficacy outcomes. We categorized these 27 studies into the "disease category" and the "population category," based on the types of participants. This systematic review summarizes the effects of Tai Chi on self-efficacy in various populations and found that Tai Chi appeared to have positive effects on self-efficacy in some populations. Fifteen research studies showed that Tai Chi had significant positive effects on self-efficacy, while 11 studies did not; only one study found a negative outcome at the follow-up. In addition, it is unclear which type, frequency, and duration of Tai Chi intervention most effectively enhanced self-efficacy. Tai Chi appears to be associated with improvements in self-efficacy. Definitive conclusions were limited due to the variation in study designs, type of Tai Chi intervention, and frequency, and further high-quality studies are required.

Psychobehavioral Effects of Meditation

Meditation is an increasingly popular psychobehavioral therapy. Various meditation techniques in use make it hard to objectively scrutinize the psychological benefits. Therefore, in this study we set out to examine the effects of two fundamentally different meditative techniques, Zazen, 'seated meditation', in which the body and mind are calmed, and Tai Chi, 'meditation in motion', based on energetic martial art performance. The aim was to compare the effects of both techniques on personality structure, emotional intelligence, mood, and coping with stress. The study was conducted in 48 healthy volunteers, aged 39-50, divided into those practicing Zazen, Tai Chi, and the non-meditating controls, each group consisting of 16 persons. The psychometric tools consisted of Coping Inventory for Stressful Situations (CISS), the University of Wales Institute of Science and Technology Mood Adjective Checklist (UMACL), Emotional Intelligence Inventory (INTE), and the NEO Five-Factor Inventory (NEO-FFI). We found that both Zazen and Tai Chi meditations significantly enhanced openness to experience, one of the personality dimensions of the Big Five Model. The enhanced openness was associated with improved strategies for coping with stress. The meditators had less avoidance-oriented approaches to perceived stress. They also had improved mood compared with non-meditating controls. The findings suggest that enhanced openness to experience could shape one's desire to hold onto the meditation regimen. We conclude that both, diametrically different types of meditation, are conducive to mental health by improving the general well-being, counteracting stress, and leading to a better vigor of spirit. Meditation may thus be considered a complimentary, albeit rather modestly acting, adjunct to psychotherapy.

A Research Agenda for Advancing Non-pharmacological Management of Chronic Musculoskeletal Pain: Findings from a VHA State-of-the-art Conference

Chronic pain is widely prevalent among Veterans and can have serious negative consequences for functional status and quality of life among other domains. The Veterans Health Administration (VHA) convened a state-of-the-art (SOTA) conference to develop research priorities for advancing the science and clinical practice of non-pharmacological management of chronic musculoskeletal pain. In this perspective article, we present the methods and consensus recommendations for research priorities emanating from the SOTA. In the months leading up to the SOTA, a core group of researchers defined four areas of focus: psychological/behavioral therapies; exercise/movement therapies; manual therapies; and models for delivering multi-modal pain care and divided into workgroups. Each workgroup, in their respective areas of focus, identified seminal studies capturing the state of the evidence. Herein, we present consensus recommendations ranging from efficacy to effectiveness to implementation/dissemination research depending on the state of the evidence as assessed by participants, including commentary on common elements across workgroups and future areas of innovation in study design, measurement, and outcome ascertainment.

Can Tai Chi and Qigong Postures Shape Our Mood? Toward an Embodied Cognition Framework for Mind-Body Research

Dynamic and static body postures are a defining characteristic of mind-body practices such as Tai Chi and Qigong (TCQ). A growing body of evidence supports the hypothesis that TCQ may be beneficial for psychological health, including management and prevention of depression and anxiety. Although a variety of causal factors have been identified as potential mediators of such health benefits, physical posture, despite its visible prominence, has been largely overlooked. We hypothesize that body posture while standing and/or moving may be a key therapeutic element mediating the influence of TCQ on psychological health. In the present paper, we summarize existing experimental and observational evidence that suggests a bi-directional relationship between body posture and mental states. Drawing from embodied cognitive science, we provide a theoretical framework for further investigation into this interrelationship. We discuss the challenges involved in such an investigation and propose suggestions for future studies. Despite theoretical and practical challenges, we propose that the role of posture in mind-body exercises such as TCQ should be considered in future research.

Pain and functional trajectories in symptomatic knee osteoarthritis over up to 12 weeks of exercise exposure

OBJECTIVE

Exercise is the recommended treatment for knee osteoarthritis (OA). However, heterogeneous patterns in treatment response are poorly understood. Our purpose was to identify pain and functional trajectories from exercise interventions in knee OA, and to determine their association with baseline factors.

METHODS

Prospective cohort of 171 participants (mean age 61 years; BMI 32 kg/m², 71% female; 57% white) with symptomatic knee OA from a randomized trial comparing 12-week Tai Chi and Physical Therapy. We analyzed weekly Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain (0-500) and function (0-1700) scores using group-based trajectory models. Associations between baseline factors and trajectories were examined using multinomial logistic regression.

RESULTS

We identified four pain trajectories: Lower-Early Improvement (43%), Moderate-Early Improvement (32%), Higher-Delayed Improvement (15%), and Higher-No Improvement (10%). We found similar trajectories for function, except that the lower function trajectories diverged into gradual (12%) or delayed-improvement (15%). Compared with the Lower-Early Improvement pain trajectory, moderate and higher trajectories were associated with poorer physical and psychosocial health. A similar pattern of associations were found among the function trajectories.

CONCLUSIONS

We found four distinct trajectories for pain and function over up to 12-weeks of exercise interventions. While most participants experienced improvements over a short-term exposure, subgroups with greater baseline pain/physical disability had either gradual, delayed, or no improvements. These findings help disentangle the heterogeneity of treatment response and may advance patient-centered care in knee OA.

Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial

OBJECTIVES

To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration.

DESIGN

Prospective, randomized, 52 week, single blind comparative effectiveness trial.

SETTING

Urban tertiary care academic hospital in the United States between March 2012 and September 2016.

PARTICIPANTS

226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group.

INTERVENTIONS

Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone.

MAIN OUTCOME MEASURES

The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient's global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life.

RESULTS

FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient's global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly. Participants attended the tai chi training sessions more often than participants attended aerobic exercise. The effects of tai chi were consistent across all instructors. No serious adverse events related to the interventions were reported.

CONCLUSION

Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01420640.

Osteoarthritis year in review 2017: rehabilitation and outcomes

OBJECTIVE

The purpose of this systematic review was to describe studies examining rehabilitation for people with osteoarthritis (OA) and to summarize findings from selected key systematic reviews (SRs) and randomized controlled trials (RCTs).

DESIGN

A systematic search was performed using Pubmed, Embase and Cochrane databases from April 1^st 2016 to May 15^th 2017 using the terms 'osteoarthritis', 'randomized controlled trial', and 'systematic review'. Inclusion criteria were: clinically or radiologically diagnosed patients with OA, rehabilitation treatment, RCT or SRs. A selection of the included studies is discussed based on study quality and perceived importance to the field; including those that are innovative, inform the direction of the field or generate controversy. Methodological quality of the included studies was assessed using the PEDro-scale for RCTs and the Amstar guideline for SRs.

RESULTS

From 1211 articles, 80 articles met the eligibility criteria including 21 SRs and 61 RCTs. The median of the methodological quality of the SRs and RCTs was 7 (2-9) and 6 (3-10), respectively. The studies were grouped into several themes, covering the most important rehabilitation fields.

CONCLUSIONS

Striking is the small number of studies investigating another joint (18%) than the knee (82%). Exercise is the most common treatment evaluated and should be accompanied with education to effectuate a behavioural change in physical activity of people with OA. No new insights in the field of braces (or orthoses) and in the field of acupuncture were found.

Dose-Response Effects of Tai Chi and Physical Therapy Exercise Interventions in Symptomatic Knee Osteoarthritis

BACKGROUND

Therapeutic exercise is a currently recommended nonpharmacological treatment for knee osteoarthritis (KOA). The optimal treatment dose (frequency or duration) has not been determined.

OBJECTIVE

To examine dose-response relationships, minimal effective dose, and baseline factors associated with the timing of response from 2 exercise interventions in KOA.

DESIGN

Secondary analysis of a single-blind, randomized trial comparing 12-week Tai Chi and physical therapy exercise programs (Trial Registry #NCT01258985).

SETTING

Urban tertiary care academic hospital PARTICIPANTS: A total of 182 participants with symptomatic KOA (mean age 61 years; BMI 32 kg/m², 70% female; 55% white).

METHODS

We defined dose as cumulative attendance-weeks of intervention, and treatment response as ≥20% and ≥50% improvement in pain and function. Using log-rank tests, we compared time-to-response between interventions, and used Cox regression to examine baseline factors associated with timing of response, including physical and psychosocial health, physical performance, outcome expectations, self-efficacy, and biomechanical factors.

MAIN OUTCOME MEASURES

Weekly Western Ontario and McMasters Osteoarthritis Index (WOMAC) pain (0-500) and function (0-1700) scores.

RESULTS

Both interventions had an approximately linear dose-response effect resulting in a 9- to 11-point reduction in WOMAC pain and a 32- to 41-point improvement in function per attendance-week. There was no significant difference in overall time-to-response for pain and function between treatment groups. Median time-to-response for ≥20% improvement in pain and function was 2 attendance-weeks and for ≥50% improvement was 4-5 attendance-weeks. On multivariable models, outcome expectations were independently associated with incident function response (hazard ratio = 1.47, 95% confidence interval 1.004-2.14).

CONCLUSIONS

Both interventions have approximately linear dose-dependent effects on pain and function; their minimum effective doses range from 2-5 weeks; and patient perceived benefits of exercise influence the timing of response in KOA. These results may help clinicians to optimize patient-centered exercise treatments and better manage patient expectations.

LEVEL OF EVIDENCE

II.

A Systematic Review and Meta-Analysis of Mindfulness-Based (Baduanjin) Exercise for Alleviating Musculoskeletal Pain and Improving Sleep Quality in People with Chronic Diseases

OBJECTIVE

we performed the first systematic review with meta-analyses of the existing studies that examined mindfulness-based Baduanjin exercise for its therapeutic effects for individuals with musculoskeletal pain or insomnia.

METHODS

Both English- (PubMed, Web of Science, Elsevier, and Google Scholar) and Chinese-language (CNKI and Wangfang) electronic databases were used to search relevant articles. We used a modified PEDro scale to evaluate risk of bias across studies selected. All eligible RCTS were considered for meta-analysis. The standardized mean difference was calculated for the pooled effects to determine the magnitude of the Baduanjin intervention effect. For the moderator analysis, we performed subgroup meta-analysis for categorical variables and meta-regression for continuous variables.

RESULTS

The aggregated result has shown a significant benefit in favour of Baduanjin at alleviating musculoskeletal pain (SMD = -0.88, 95% CI -1.02 to -0.74, p < 0.001, I² = 10.29%) and improving overall sleep quality (SMD = -0.48, 95% CI -0.95 to -0.01, p = 004, I² = 84.42%).

CONCLUSIONS

Mindfulness-based Baduanjin exercise may be effective for alleviating musculoskeletal pain and improving overall sleep quality in people with chronic illness. Large, well-designed RCTs are needed to confirm these findings.

Effects of Tai Chi versus Physical Therapy on Mindfulness in Knee Osteoarthritis

Tai Chi mind-body exercise is widely believed to improve mindfulness through incorporating meditative states into physical movements. A growing number of studies indicate that Tai Chi may improve health in knee osteoarthritis (OA), a chronic pain disease and a primary cause of global disability. However, little is known about the contribution of mindfulness to treatment effect of Tai Chi practice. Therefore, our purpose was to investigate the effect of Tai Chi mind-body practice compared to physical therapy (PT) on mindfulness in knee OA. Adults with radiographic-confirmed, symptomatic knee OA were randomized to either 12 weeks (twice weekly) of Tai Chi or PT. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ) before and after intervention along with commonly-used patient-reported outcomes for pain, physical function, and other health-related outcomes. Among 86 participants (74% female, 48% white, mean age 60 years, 85% at least college educated), mean total FFMQ was 142±17. Despite substantial improvements in pain, function, and other health-related outcomes, each treatment group's total FFMQ did not significantly change from baseline (Tai Chi= 0.76, 95% CI: -2.93, 4.45; PT= 1.80, 95% CI: -2.33, 5.93). The difference in total FFMQ between Tai Chi and PT was not significant (-1.04 points, 95% CI: -6.48, 4.39). Mindfulness did not change after Tai Chi or PT intervention in knee OA, which suggests that Tai Chi may not improve health in knee OA through cultivating mindfulness. Further study is needed to identify underlying mechanisms of effective mind-body interventions among people with knee OA.

Effects of whole body vibration exercise on neuromuscular function for individuals with knee osteoarthritis: study protocol for a randomized controlled trial

Background

Knee osteoarthritis (KOA) is a leading cause of public disability. Neuromuscular function contributes to the development and/or progression of KOA. Whole body vibration (WBV) exercise improve the neuromuscular function of patients with neurological disorders and even that of older patients with limited exercise options. Therefore, WBV exercise may offer an efficient and alternative treatment for individuals with KOA. However, the effects of WBV training on the neuromuscular function of individuals with KOA remain unclear. Therefore, this study attempts to investigate the effect of a 12-week WBV exercise on the neuromuscular function of individuals with KOA.

Methods/design

We will conduct a prospective, single-blind randomized controlled trial on 180 KOA patients. Participants will be randomly assigned to the WBV exercise, lower extremity resistance training, and health education groups. The WBV exercise group will participate in a 12-week WBV training. The lower extremity resistance training group will undergo a 12-week lower extremity resistance training of both lower limbs. The control group will receive health education for 12 weeks. After the intervention, the participants will be followed up for 3 months with no active intervention. Primary outcome measures will include anthropometric measurements, gait analysis during walking and stair climbing, muscle strength test of the knee and ankle, proprioception test of the knee and ankle, and neuromuscular response of the leg muscles. Secondary outcome measures will include self-reported pain and physical functional capacity, and physical performance measures. Furthermore, adverse events will be recorded and analyzed. If any participant withdraws from the trial, intention-to-treat analysis will be performed.

Discussion

Important features of this trial mainly include intervention setting, outcome measure selection, and study duration. This study is intended for estimating the effect of WBV intervention on neuromuscular control outcomes. Study results may provide evidence to support the beneficial effects of WBV exercise on the physical performance and neuromuscular control of individuals with KOA to fill the research gap on the efficacy of WBV.

Trial registration

Chinese Clinical Trial Registry, ID: ChiCTR-IOR-16009234. Registered on 21 September 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2170-6) contains supplementary material, which is available to authorized users.

The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing

Supporting the health of growing numbers of frail older adults living in subsidized housing requires interventions that can combat frailty, improve residents' functional abilities, and reduce their health care costs. Tai Chi is an increasingly popular multimodal mind-body exercise that incorporates physical, cognitive, social, and meditative components in the same activity and offers a promising intervention for ameliorating many of the conditions that lead to poor health and excessive health care utilization. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study is an ongoing two-arm cluster randomized, attention-controlled trial designed to examine the impact of Tai Chi on functional indicators of health and health care utilization. We are enrolling participants from 16 urban subsidized housing facilities (n=320 participants), conducting the Tai Chi intervention or education classes and social calls (attention control) in consenting subjects within the facilities for one year, and assessing these subjects at baseline, 6months, and 1year. Physical function (quantified by the Short Physical Performance Battery), and health care utilization (emergency visits, hospitalizations, skilled nursing and nursing home admissions), assessed at 12months are co-primary outcomes. Our discussion highlights our strategy to balance pragmatic and explanatory features into the study design, describes efforts to enhance site recruitment and participant adherence, and summarizes our broader goal of post study dissemination if effectiveness and cost-effectiveness are demonstrated, by preparing training and protocol manuals for use in housing facilities across the U.S.