Tai chi compares to physical therapy for knee osteoarthritis

Tai chi can improve the symptoms of knee osteoarthritis as much as — or more than — standard physical therapy, new research suggests.

Laird Harrison, Medscape Multispecialty November 15, 2015

“The value of tai chi goes beyond physical therapy because it includes movement, meditation, mindfulness, breathing, social support, and strength training,” Chenchen Wang, MD, told Medscape Medical News. “Here you have mind, body, and spirit integrated together.”

Dr. Wang, from Tufts University School of Medicine in Boston, Massachusetts, presented the finding here at the American College of Rheumatology (ACR) 2015 Annual Meeting.

In a previous study, Dr Wang and colleagues showed that the discipline was more effective in treating knee osteoarthritis than stretching and wellness education.

In the new study, they wanted to see how tai chi would compare with physical therapy, the movement modality most often prescribed for osteoarthritis in the United States.

The researchers recruited 204 patients whose knees met ACR criteria for osteoarthritis and randomly assigned them into two groups.

The first group of 106 patients completed 12 weeks of classical Yang style tai chi for 1 hour twice a week. Each session included a warm up and review of tai chi, meditation with tai chi movement, breathing techniques, and relaxation.

A protocol for the approach Dr. Wang posted online has already been downloaded “a couple thousand times,” she said.

The second group, consisting of 98 patients, completed standard physical therapy 30 minutes twice a week for 6 weeks, which included an initial musculoskeletal exam, personalized therapy to address specific treatment goals, and reminders to practice daily. The patients then continued with 6 more weeks of rigorously monitored home exercises 30 minutes a week, four times a week.

On average, the participants were 60 years old, had suffered from knee osteoarthritis for 8 years, and had a body mass index of 33. Two thirds were women. About half of the patients were white, a third were black, and the rest were Asian.

At baseline, all participants had similar scores on the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and depression, quality-of-life, pain medication usage, and walking tests.

Two thirds of the participants completed all 52 weeks of their respective programs.

Both groups experienced a steep drop in their WOMAC scores at 12 weeks and maintained the improved level until the end of the year. And both groups used less medication as the year went on.

In multiple measures of pain and physical functioning, patients practicing the ancient Chinese discipline showed a trend toward more improvement than patients receiving standard physical therapy.

On questionnaires about overall health status and emotional well-being, the superiority of tai chi reached statistical significance.

Test	Tai Chi Group	Physical Therapy Group	P Value
Patient global assessment	−3.0	−2.2	.06
6-minute walk test, m	28.6	26.1	.76
20-m walk, s	−1.6	−1.1	.40
Beck Depression Inventory II	−2.2	0.5	.008
36-Item Short-Form Health Survey physical component summary	6.3	3.1	.01
Chronic pain self-efficacy	1.3	0.8	.22
WOMAC tests
Pain subscore	−167.2	−143.0	.16
Physical function score	−608.3	−494.2	.06
Table. Change in Pain and Function at 12 Weeks

The researchers found no differences among the four tai chi instructors, suggesting the program can be standardized.

It’s low-cost and low-risk. I think it’s a good option for people interested in that sort of therapy. – Dr Kelli Allen

The study provides solid evidence for tai chi as an osteoarthritis treatment, said session moderator Kelli Allen, PhD, from the University of North Carolina, Chapel Hill.

“It showed it’s as good as physical therapy,” she told Medscape Medical News. “It’s low-cost and low-risk. I think it’s a good option for people interested in that sort of therapy.”

The study was funded by the National Center for Complementary and Integrative Health. Dr Wang and Dr Allen have disclosed no relevant financial relationships.

Source Medscape Multispecialty

[mdi-icon name=”book-open” size=”default” color=”black”] References

Wang_et_al-2009-Arthritis_Care__Research
Tai Chi Is Effective in Treating Knee Osteoarthritis: A Randomized Controlled Trial, Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, McAlindon T. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 61, No. 11, November 15, 2009, pp 1545–1553 DOI 10.1002/art.24832

acrabstracts_org_abstract_comparative_effectiveness_of_tai_c
Comparative Effectiveness of Tai Chi Versus Physical Therapy in Treating Knee Osteoarthritis: A Randomized, Single-Blind, Trial, Chenchen Wang MD, Nov. 8, 2:30 pm – 4 pm. 2015 ACR/ARHP Annual Meeting, San Francisco, CA

Assessing the comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: design and rationale for a randomized trial, Wang C, Iversen MD, McAlindon T, Harvey WF, Wong JB, Fielding RA, Driban JB, Price LL, Rones R, Gamache T, Schmid CH. BMC Complement Altern Med. 2014 Sep 8;14:333. doi: 10.1186/1472-6882-14-333. Full text

Effects of Tai Chi versus Physical Therapy on Mindfulness in Knee Osteoarthritis, Lee AC, Harvey WF, Wong JB, Price LL, Han X, Chung M, Driban JB, Morgan LPK, Morgan NL, Wang C. Mindfulness (N Y). 2017 Oct;8(5):1195-1205. doi: 10.1007/s12671-017-0692-3. Epub 2017 Feb 23. Full text

Also see
Tai Chi Leads to 167-Point Drop in Pain in Knee Osteoarthritis in Rheumatology Network