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Original Research |

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

Chenchen Wang, MD, MSc; Christopher H. Schmid, PhD; Maura D. Iversen, SD, DPT, MPH; William F. Harvey, MD, MSc; Roger A. Fielding, PhD; Jeffrey B. Driban, PhD; Lori Lyn Price, MAS; John B. Wong, MD; Kieran F. Reid, PhD, MPH; Ramel Rones; and Timothy McAlindon, MD, MPH
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 17 May 2016.


From Tufts Medical Center, Tufts University School of Medicine, Tufts University, Northeastern University, Brigham and Women's Hospital, Harvard Medical School, and Center for Mind–Body Therapies, Boston, Massachusetts, and Brown University School of Public Health, Providence, Rhode Island.

Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Complementary and Integrative Health at the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this article are those of the authors and do not necessarily reflect the views of the U.S. Department of Agriculture.

Acknowledgment: The authors thank the data and safety monitoring board members (Drs. Wenjun Li, Yvonne Lee, and Kristin Baker) for their insightful suggestions and comments on the study protocol; Marcie Griffith, Fatima Shahzad, Tressa Gamache, Dr. John Griffith, Dr. Ronenn Roubenoff, and the Clinical and Translational Research Center nurses for their help with various aspects of the study; Dorri Li and Brian Muccio for their expertise in teaching the Tai Chi groups; Megan Whitmore, Marie Boneparth, and Jane Lucas for their expert physical therapy instruction; and the study participants, whose cooperation, encouragement, and enthusiasm are an inspiration to the authors.

Financial Support: By the National Center for Complementary and Integrative Health of the National Institutes of Health (R01 AT005521 and K24 AT007323), the National Center for Research Resources of the National Institutes of Health (UL1 RR025752), and the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR000073 and UL1TR001064). Dr. Fielding was partially supported by the U.S. Department of Agriculture under agreement 58-1950-4-003, the Boston Claude D. Pepper Older Americans Independence Center (1P30AG031679), and the Boston Rehabilitation Outcomes Center (1R24HD065688-01A1).

Disclosures: Dr. Schmid reports grants from Brown University during the conduct of the study and personal fees from Pfizer outside the submitted work. Dr. Harvey reports grants from Samumed, AbbVie, and Fidia Pharma outside the submitted work. Dr. Fielding reports grants from the National Institutes of Health during the conduct of the study; grants from Nestlé, Regeneron, Astellas Pharma, and Pronutria Biosciences outside the submitted work; personal fees from Nestlé, Regeneron, Astellas Pharma, Pronutria Biosciences, GlaxoSmithKline, ICON, and Biophytis outside the submitted work; and nonfinancial support from Pronutria and Myosyntax outside the submitted work. Dr. Wong reports grants from the Patient-Centered Outcomes Research Institute and the Rheumatology Research Foundation of the American College of Rheumatology and nonfinancial support from the European League Against Rheumatism outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2143.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.

Reproducible Research Statement:Study protocol: See the Supplement. Statistical code and data set: Available from Dr. Wang (e-mail, cwang2@tuftsmedicalcenter.org).

Requests for Single Reprints: Chenchen Wang, MD, MSc, Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 406, Boston, MA 02111; e-mail, cwang2@tuftsmedicalcenter.org.

Current Author Addresses: Dr. Wang: Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 406, Boston, MA 02111.

Dr. Schmid: Center for Evidence-based Medicine, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI 02912.

Dr. Iversen: Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, Room 301c, Robinson Hall, Boston, MA 02115.

Drs. Harvey, Driban, and McAlindon: Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Box 406, Boston, MA 02111.

Drs. Fielding and Reid: Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111.

Ms. Price: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Box 063, Boston, MA 02111.

Dr. Wong: Center for Clinical Decision Making, Department of Medicine, Tufts Medical Center, Box 302, Boston, MA 02111.

Mr. Rones: RR Productions, 17 Parker Street, Lexington, MA 02421.

Author Contributions: Conception and design: C. Wang, C.H. Schmid, M.D. Iversen, J.B. Wong, R. Rones, T. McAlindon.

Analysis and interpretation of the data: C. Wang, C.H. Schmid, M.D. Iversen, W.F. Harvey, R.A. Fielding, J.B. Driban, L.L. Price, J.B. Wong, K.F. Reid, R. Rones, T. McAlindon.

Drafting of the article: C. Wang, C.H. Schmid, M.D. Iversen, W.F. Harvey, R.A. Fielding, J.B. Driban, L.L. Price, K.F. Reid, T. McAlindon.

Critical revision of the article for important intellectual content: C. Wang, C.H. Schmid, M.D. Iversen, W.F. Harvey, R.A. Fielding, J.B. Driban, L.L. Price, J.B. Wong, K.F. Reid, T. McAlindon.

Final approval of the article: C. Wang, C.H. Schmid, M.D. Iversen, W.F. Harvey, R.A. Fielding, J.B. Driban, L.L. Price, J.B. Wong, K.F. Reid, R. Rones, T. McAlindon.

Provision of study materials or patients: W.F. Harvey.

Statistical expertise: C.H. Schmid, L.L. Price, J.B. Wong.

Obtaining of funding: C. Wang, J.B. Wong.

Administrative, technical, or logistic support: C. Wang, J.B. Driban.

Collection and assembly of data: C.H. Schmid, W.F. Harvey, R.A. Fielding, J.B. Driban, L.L. Price, K.F. Reid.


Ann Intern Med. 2016;165(2):77-86. doi:10.7326/M15-2143
© 2016 American College of Physicians
Text Size: A A A

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.

Figures

Grahic Jump Location
Figure 1.

Study flow diagram.

* Two participants were inadvertently randomly assigned twice. Data from the first randomization were analyzed using the intention-to-treat principle.

Grahic Jump Location
Grahic Jump Location
Figure 2.

Mean change in outcomes, by treatment group.

Measurements were obtained at baseline and at 12, 24, and 52 wk, but data points are offset slightly for clarity. SF-36 = 36-item Short Form Health Survey; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.

Grahic Jump Location

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