PainSci summary of Wang 2016?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
This is an NCCAM-funded trial of tai chi for knee osteoarthritis. The risk of bias is probably high (NCCAM exists to fund studies of “alternative” medicine), and it’s the only trial of its kind, so the results and interpretation must be taken with a large grain of salt. (Also, author Chenchen Wang also produced Wang 2010, a study that was embarrassingly touted in The New England Journal of Medicine as a victory for alternative medicine. So this is a case where we really need to consider the source.)
204 patients did either tai chi twice or “standard physical therapy” — mostly light exercise — twice per week for 12 weeks. Both groups improved modestly and equally.
The effectiveness of exercise therapy for arthritic knees is been well-established by many trials, but it’s just as clear that the benefits are minor: according to Fransen 2015, just 12 points on a 100-point scale in the short term (and just 6 points after a few months). This study describes similar benefits in both groups as “substantial”: about 150 points out of the huge total of 2300 possible points for a WOMAC score. Translating that to an easier scale, the improvement was about 7%. While I’d never refuse a 7% improvement in a painful condition, it’s a strange number to call “substantial.” I think it damns both exercise therapy and tai chi with faint praise: they “work,” but not especially well.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: Few remedies effectively treat long-term pain and disability from knee osteoarthritis. Studies suggest that Tai Chi alleviates symptoms, but no trials have directly compared Tai Chi with standard therapies for osteoarthritis.
OBJECTIVE: To compare Tai Chi with standard physical therapy for patients with knee osteoarthritis.
DESIGN: Randomized, 52-week, single-blind comparative effectiveness trial. (ClinicalTrials.gov: NCT01258985).
SETTING: An urban tertiary care academic hospital.
PATIENTS: 204 participants with symptomatic knee osteoarthritis (mean age, 60 years; 70% women; 53% white).
INTERVENTION: Tai Chi (2 times per week for 12 weeks) or standard physical therapy (2 times per week for 6 weeks, followed by 6 weeks of monitored home exercise).
MEASUREMENTS: The primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 weeks. Secondary outcomes included physical function, depression, medication use, and quality of life.
RESULTS: At 12 weeks, the WOMAC score was substantially reduced in both groups (Tai Chi, 167 points [95% CI, 145 to 190 points]; physical therapy, 143 points [CI, 119 to 167 points]). The between-group difference was not significant (24 points [CI, -10 to 58 points]). Both groups also showed similar clinically significant improvement in most secondary outcomes, and the benefits were maintained up to 52 weeks. Of note, the Tai Chi group had significantly greater improvements in depression and the physical component of quality of life. The benefit of Tai Chi was consistent across instructors. No serious adverse events occurred.
LIMITATION: Patients were aware of their treatment group assignment, and the generalizability of the findings to other settings remains undetermined.
CONCLUSION: Tai Chi produced beneficial effects similar to those of a standard course of physical therapy in the treatment of knee osteoarthritis.
PRIMARY FUNDING SOURCE: National Center for Complementary and Integrative Health of the National Institutes of Health.
- “Exercise for osteoarthritis of the knee: a Cochrane systematic review,” Marlene Fransen, Sara McConnell, Alison R Harmer, Martin Van der Esch, Milena Simic, and Kim L Bennell, British Journal of Sports Medicine, 2015.
- “Acupuncture for Chronic Low Back Pain,” Brian M Berman, Helene H Langevin, Claudia M Witt, and Ronald Dubner, New England Journal of Medicine, 2010.
- “A randomized trial of tai chi for fibromyalgia,” Chenchen Wang, Christopher H Schmid, Ramel Rones, Robert Kalish, Janeth Yinh, Don L Goldenberg, Yoojin Lee, and Timothy McAlindon, New England Journal of Medicine, 2010.
- “Tai chi and fibromyalgia in the New England Journal of Medicine: An “alternative” frame succeeds,” David Gorski, ScienceBasedMedicine.org.
- “Acupuncture Pseudoscience in the New England Journal of Medicine,” Steven Novella, ScienceBasedMedicine.org.
- “Tai Chi versus physical therapy for osteoarthritis of the knee: How CAM “rebranding” works,” David Gorski, ScienceBasedMedicine.org.
Specifically regarding Wang 2016:
One article on PainScience.com cites Wang 2016 as a source:
- PS T’ai Chi Helps Fibromyalgia, but It’s Not “Alternative” Medicine — Despite a high profile boost from the New England Journal of Medicine, it’s still just gentle, elegant, and pleasant exercise
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.