A systematic review and meta-analysis of Tai Chi for osteoarthritis of the knee

doi:10.1016/j.ctim.2013.06.001

Complementary Therapies in Medicine

Volume 21, Issue 4, August 2013, Pages 396-406

https://doi.org/10.1016/j.ctim.2013.06.001 Get rights and content

Summary

Objectives

This paper aimed to systematically review and meta-analyze the effectiveness of Tai Chi for osteoarthritis of the knee.

Methods

MEDLINE, the Cochrane Library, EMBASE, Scopus, PsycInfo and CAMBASE were screened through April 2013. Randomized controlled trials (RCTs) comparing Tai Chi to control conditions were included. Two authors independently assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group. Outcome measures included pain, physical functional, joint stiffness, quality of life, and safety. For each outcome, standardized mean differences and 95% confidence intervals were calculated.

Results

5 RCTs with a total of 252 patients were included. Four studies had a low risk of bias. Analysis showed moderate overall evidence for short-term effectiveness for pain, physical function, and stiffness. Strong evidence was found for short-term improvement of the physical component of quality of life. No long-term effects were observed. Tai Chi therapy was not associated with serious adverse events.

Conclusion

This systematic review found moderate evidence for short-term improvement of pain, physical function and stiffness in patients with osteoarthritis of the knee practicing Tai Chi. Assuming that Tai Chi is at least short-term effective and safe it might be preliminarily recommended as an adjuvant treatment for patients with osteoarthritis of the knee. More high quality RCTs are urgently needed to confirm these results.

Introduction

Osteoarthritis of the knee is one of the most common chronic diseases among older adults with high impact on physical function¹; about one fourth of people over 55 years will report a significant episode of pain in the knee in the last year.² Osteoarthritis of the knee is a condition which is associated with articular cartilage destruction in addition to underlying bony changes at the joint margins.³ Main complaints include pain and functional impairment during everyday activities which severely affects quality of life in these patients.⁴

Symptomatic therapeutic approaches mainly consist of physiotherapy, pharmacological therapy or, if therapies fail, joint replacement therapy.5, [6] Patients are also encouraged to use some kind of joint-friendly strengthening and aerobic exercises,[6], [7] as it may reduce pain, increase function and reduce the progression of the osteoarthritis.

Tai Chi, developed as martial art in China, has been practiced for centuries. After introduction in Europe and America the perception of Tai Chi shifted and it is nowadays regarded a form of exercise or gymnastics. Tai Chi typically includes a series of dance-like movements that combine to postures or forms. The forms are executed using slow and smooth movements that flow into each other. Tai Chi not only is a movement therapy, but it also includes meditative aspects.⁸ Due to its meditative character it may also reduce stress and increase psychological well-being.

Patients with osteoarthritis of the knee might benefit from Tai Chi by increasing lower extremity muscular strength and joint stability,⁹ for example Tai Chi has been found to reduce falls in older adults.¹⁰ The meditative aspect might further decrease stress and improve well-being and since Tai Chi can be offered as group therapy this might foster contact and social support. Therefore Tai Chi might be a supplementary therapeutic option for patients suffering from osteoarthritis of the knee.

To our knowledge, a recent review has investigated the effectiveness of Tai Chi for osteoarthritis in general¹¹ however no long-term effects were evaluated. Therefore, the aim of this review was to systematically assess and meta-analyze the short- and long-term effectiveness of Tai Chi therapy for osteoarthritis of the knee.

Section snippets

Protocol and registration

The review was planned and conducted in accordance with the PRISMA guidelines for systematic reviews and meta-analyses¹² and the recommendations of the Cochrane Back Review Group.[13], [14] The protocol had not been registered prior to conducting the review.

Eligibility criteria

The following conditions had to be met in order to include a study into this review:

1)
Types of studies. Only randomized controlled trials (RCTs) were considered eligible.
2)
Types of participants. Studies of adults (18 years of age and older) with

Study selection

Literature search retrieved 272 records, 102 of them were duplicates (Fig. 1). Sixteen full-text articles were assessed for eligibility[20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36] (Fig. 1). Eleven full text articles were excluded because they investigated mixed patient samples,[28], [31], [35] were not randomized,[29], [30], [33], [34], [36] did not measure relevant outcomes²⁷ or were withdrawn.³² Another study was published twice,[23],

Summary of main results

This meta-analysis found moderate overall evidence for short-term improvement of pain, physical function and stiffness, and strong evidence for short-term improvement of the physical component of quality of life. Compared to attention control, Tai Chi showed moderate evidence for short-term improvement of pain and physical function, and compared to wait-list there was limited evidence for short-term improvement of pain, physical function and stiffness, however due to the high risk of bias the

Conclusion

Source of funding

This review was supported by a grant from the Rut- and Klaus-Bahlsen-Foundation. The funding source had no role in the study design, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

Conflicts of interest

The authors declare that no financial or non-financial conflict of interest exists.

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Cited by (80)

Effects of Tai chi in knee osteoarthritis patients: An overview of systematic reviews and meta-analyses
2023, Complementary Therapies in Medicine
Tai Chi (TC) is a complementary therapy for knee osteoarthritis (KOA). Although systematic reviews (SRs) and meta-analyses (Mas) of efficacy studies have been published, the results remain uncertain, and their quality has not yet been fully evaluated. Here, we summarize the existing SRs/Mas, evaluate their quality and level of evidence, and provide a reference for the effectiveness of TC.
SRs/Mas of TC therapy for KOA published before February 2023 were retrieved from eight databases in Chinese and English. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, and the Risk of Bias in Systematic (ROBIS) scale were used to assess methodological quality, reporting quality, and risk of bias.
Seven SRs/Mas were finally included. One was deemed high quality by AMASTAR-2, while the rest were of critically low quality. In the PRISMA2020 assessment, the response rate of “Yes” for Q7, Q15, Q22, Q24, and Q27 was less than 50%. In the ROBIS assessment, three reports in Phase 3 were high risk and four were low risk. In the efficacy assessment, TC has shown varying degrees of improvement in physical function, pain, stiffness, 6-minute walk test, mental quality of life, TUG, and balance in patients with KOA.
TC effectively treats KOA-associated pain, stiffness, body function, and mental quality of life. However, the low methodological quality of the studies and the high risk of migration reduced their reliability. Therefore, these conclusions should be taken with caution. High-quality, large-sample research is needed to provide stronger and more scientific evidence.
Effectiveness of Tai Chi on quality of life, depressive symptoms and physical function among community-dwelling older adults with chronic disease: A systematic review and meta-analysis
2020, International Journal of Nursing Studies
With a rapid increase in aging population and prevalence of chronic diseases worldwide, older adults are seen facing more physical and psychological burdens, affecting their quality of life (QoL). Tai Chi, a traditional Chinese mind-body physical activity, appeals to many older adults and has been extensively studied. However, the effectiveness of Tai Chi on QoL, depressive symptoms and physical function on community-dwelling older adults remains vague.
To synthesise and evaluate effectiveness of Tai Chi on QoL, depressive symptoms and physical function among community-dwelling older adults with chronic disease.
Searches were performed across seven databases systematically (PubMed, Embase, Cochrane, CINAHL, Scopus, ProQuest, CNKI). Only randomised controlled trials (RCTs), written in English or Chinese were included. All eligible studies were screened with risk of bias examined by two independent reviewers. Meta-analyses were conducted using RevMan 5.3 software while narrative syntheses were performed where meta-analysis was inappropriate and heterogeneity was present.
A total of 3416 records were generated and 13 RCTs were eligible for inclusion. Meta-analysis reported statistically significant small effect size favouring Tai Chi on QoL and depressive symptoms. No statistically significant differences were seen for mobility and endurance of physical function. Majority had high heterogeneity hence findings should be interpreted carefully.
Tai Chi was found to have favourable effects on QoL and depressive symptoms of older adults with chronic disease which can act as a complement to disease management. However, future research can be improved to explore theoretical framework and include high-quality studies with larger sample sizes.
Holistic/Integrative Interventions Relieve Knee Osteoarthritis Pain in Older Adults
2020, Journal for Nurse Practitioners
Citation Excerpt :
A systematic review included 6 studies and 372 participants with knee OA.15 The most common yoga time frames were 45 to 90 minutes and an 8-week duration.13 The review revealed that yoga may have positive effects regarding pain reduction and mobility, but the effects on quality of life are not clear.15
Older adults have often used multiple treatment strategies for knee osteoarthritis (OA). Furthermore, older adults may have limited treatment options available because of issues such as morbidity, polypharmacy, and adverse drug reactions. Holistic/integrative interventions may be a viable option to decrease knee OA pain. Guidelines and literature are used to assist primary care providers in determining optimal holistic/integrative interventions for older adults with knee OA.
The safety of tai chi: A meta-analysis of adverse events in randomized controlled trials
2019, Contemporary Clinical Trials
To review current publications to examine safety of tai chi (TC).
Cochrane Library, EBSCO host and MEDLINE/PubMed were searched for randomized controlled trials (RCTs) including TC as the core intervention and reporting adverse events (AEs). Data were extracted considering active vs. inactive control group comparisons and presence of an AE monitoring protocol. Meta-analyses were conducted for overall results as well as control group and reporting specific conditions.
In 256 RCTs of TC, 24 met eligibility criteria (1794 participants) and were assessed using the Cochrane Risk of Bias tool. The frequency of non-serious, serious and intervention-related AEs were not found to be significantly different between TC and inactive or active control conditions. In studies with an AE monitoring protocol, more non-serious adverse events (RD = 0.05; 95% CI: 0.00, 0.10; P = 0.05) were reported for TC compared to inactive interventions. Given the higher overall AE risks related to studies of participants with heart failure, additional analyses examined this set separately. More serious AEs were found for inactive interventions compared with TC in studies with heart failure participants (RD = −0.11; 95% CI: −0.20, −0.03; P = 0.01).
Findings indicate that TC does not result in more AEs than active and inactive control conditions, and produces fewer AEs than inactive control conditions for heart failure patients.
An unsupervised online Tai Chi program for people with knee osteoarthritis (“My Joint Tai Chi”): protocol for the RETREAT randomised controlled trial
2024, Research Square
Concept for integrative pain treatment of osteoarthritis of the knee based on the evidence for conservative and complementary therapies
2023, Schmerz

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View full text

A systematic review and meta-analysis of Tai Chi for osteoarthritis of the knee

Summary

Objectives

Methods

Results

Conclusion

Introduction

Section snippets

Protocol and registration

Eligibility criteria

Study selection

Summary of main results

Conclusion

Source of funding

Conflicts of interest

Osteoarthritis Cartilage

Geriatric Nursing

Osteoarthritis and Cartilage

The effects of specific medical conditions on the functional limitations of elders in the Framingham study

American Journal of Public Health

Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care

Annals of the Rheumatic Diseases

Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association

Arthritis & Rheumatism

The prevalence and burden of arthritis

Rheumatology (Oxford)

EULAR recommendations for the management of knee osteoarthritis: report of a task force of the standing committee for international clinical studies including therapeutic trials (ESCISIT)

Annals of the Rheumatic Diseases

Management of osteoarthritis of the knee

BMJ

Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus

Rheumatology (Oxford)

New horizons.. developing tai chi for health care

Australian Family Physician

Taiji training improves knee extensor strength and force control in older adults

Journals of Gerontology Series A: Biological Sciences and Medical Sciences

Tai Chi and fall reductions in older adults: a randomized controlled trial

Journal of Gerontology

T’ai chi for the treatment of osteoarthritis: a systematic review and meta-analysis

BMJ Open

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement

Annals of Internal Medicine

Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration

2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group

Spine

Statistical power analysis for the behavioral sciences

Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group

Spine

Effectiveness of yoga for menopausal symptoms—a systematic review and meta-analysis of randomized controlled trials

Evidence-Based Complementary and Alternative Medicine