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Tai Chi no different from standard physiotherapy for arthritis

PainSci » bibliography » Wang et al 2016
Tags: treatment, knee, exercise, arthritis, leg, limbs, pain problems, self-treatment, aging

One article on PainSci cites Wang 2016: T’ai Chi Helps Fibromyalgia, but It’s Not “Alternative” Medicine

PainSci commentary on Wang 2016: ?This page is one of thousands in the 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 wherever possible.

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.

~ Paul Ingraham

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. ( 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.

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