Comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: a randomized trial

Authors: WANG, CHENCHEN - Tufts University; SCHMID, CHRISTOPHER - Brown University; IVERSEN, MAURA - Northeastern University; HARVEY, WILLIAM - Tufts University; FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; DRIBAN, JEFFREY - Tufts University; PRICE, LORI LYN - Tufts University; WONG, JOHN - Tufts University; REID, KIERAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; RONES, RAMEL - The Center For Mind-Body Therapies; MCALINDON, TIMOTHY - Tufts University

Submitted to: Annals of Internal Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/29/2016
Publication Date: 5/17/2016
Citation: Wang, C., Schmid, C.H., Iversen, M.D., Harvey, W.F., Fielding, R.A., Driban, J.B., Price, L., Wong, J.B., Reid, K.F., Rones, R., Mcalindon, T. 2016. Comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: a randomized trial. Annals Of Internal Medicine. doi: 10.7326/M15-2143.

Interpretive Summary: There are very few options for the effective treatment of knee osteoarthritis (OA.) Studies suggest that Tai Chi can improve pain and quality of life and reduce disability in patients with knee OA. However, to date, no studies have compared the benefits of Tai Chi to standard therapies for knee OA. The purpose of this study was to compare the effectiveness of 12 weeks of Tai Chi against a standard physical therapy regimen among 204 patients with knee OA. Patients were primarily white and obese women with an average age of 60 years. After 12 weeks, pain was significantly reduced in both groups (Tai Chi and physical therapy,) but the group difference was not significant. However, the Tai Chi group improved their quality of life and depression scores significantly more than the physical therapy group. Overall, Tai Chi could be considered as a safe and effective therapeutic option to treat knee OA.

Technical Abstract: 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. 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.