Osteoarthritis (OA) refers to a clinical syndrome of joint pain accompanied by varying degrees of functional disability and impaired quality of life. The prevalence increases with age, and OA is one of the leading causes of pain and disability for the adult population worldwide (NICE 2008).
Tai Chi is a form of exercise that focuses on controlled movements combined with diaphragmatic breathing and relaxation while maintaining good posture (Hall et al 2009). This randomised controlled trial included modified Yang-style Tai Chi so as to be suitable for persons with knee pain. Previous studies of Tai Chi for this patient group have not shown convincing evidence, as the quality and quantity of the studies have been limited (Lee et al 2008, Hall et al 2009).
The trial is very well designed and reported; impressively, there is no attrition, high intervention attendance, and a long follow-up. The authors acknowledge that the trial was underpowered with only 40 participants, which resulted in fairly imprecise effect sizes. The trial showed promising results with benefits in physical function, pain, and psychological measures. As expected, the effects on pain and function started declining when treatment sessions ended. However, benefits in psychological measures persisted as far as 48 weeks. The study should be replicated on a larger scale in order to confirm the results.
Current guidelines consider non-pharmacological treatment modalities as the cornerstones in modern management of OA with information, exercise, and weight loss as core treatments (NICE 2008). Although this trial involved instruction by a Tai Chi master and selected participants, the study results might encourage physiotherapists to consider Tai Chi as an alternative, or additional, form of exercise for persons with knee OA.
Journal of Physiotherapy 2010 Vol. 56 – © Australian Physiotherapy Association 2010 - Nina Østerås and Camilla Fongen
National Resource Centre for Rehabilitation in Rheumatology, Norway
References: Hall A et al (2009) Arthritis Rheum 6: 717–724. Lee SL et al (2008) Clin Rheumatol 27: 211–218. National Institute for Health and Clinical Excellence (NICE) (2008) Osteoarthritis: the care and management in of
osteoarthritis in adults. (NICE Clinical Guideline 59)