Search

Background: Satisfaction with current treatment options for irritable bowel syndrome with constipation (IBS‐C) is low, with many patients turning to complementary treatments. Tai Chi is a mind–body medicine practice with proven efficacy in other functional disorders. As a proof‐of‐concept, we tested the feasibility and preliminary clinical outcomes associated with a Tai Chi program designed for IBS‐C. Methods: A total of 27 IBS‐C patients participated in a single‐arm trial of 8 sessions of Tai Chi delivered weekly over 7 weeks via live videoconferencing in group format. Clinical improvement was assessed via change in IBS Symptom Severity Score (IBS‐SSS) from baseline to 4 weeks posttreatment (week 11) with secondary outcomes exploring symptom ratings, IBS‐related quality of life (IBS‐QOL), GI‐specific anxiety, abdominal distention, and psychological factors. Key Results: Despite substantial dropout (n = 7; 26%), the treatment protocol had moderate to excellent feasibility for other criteria. Treatment satisfaction was excellent. Exit interviews confirmed high satisfaction with the program among completers, but a high burden of data collection was noted. One participant experienced an adverse event (mild, exacerbation of sciatica). There was a significant improvement in intra‐individual IBS‐SSS between baseline and posttreatment (average change −66.5, 95% CI −118.6 to −14.3, p = 0.01). Secondary outcomes were notable for improvements in other IBS symptom scoring measures, IBS‐QOL, measured abdominal diameter, and leg strength. Conclusions and Inferences: Our data provide preliminary evidence of the feasibility of a Tai Chi intervention for IBS‐C, show promise for improving outcomes, and identify more streamlined data collection as an area for further program improvement. [ABSTRACT FROM AUTHOR]

This study examines altered resting state functional connectivity (rsFC) of the cognitive control network (CCN) in fibromyalgia patients as compared to healthy controls, as well as how an effective mind-body intervention, Tai Chi, can modulate the altered rsFC of the CCN. Patients with fibromyalgia and matched healthy subjects were recruited in this study. Fibromyalgia patients were scanned 12 weeks before and after intervention. The bilateral dorsolateral prefrontal cortex (DLPFC) was used as a seed to explore the rsFC of the CCN. Data analysis was conducted with 21 patients and 20 healthy subjects. Compared to healthy subjects, fibromyalgia patients exhibited increased rsFC between the DLPFC and the bilateral rostral anterior cingulate cortex (rACC) and medial prefrontal cortex (MPFC) at baseline. The rsFC between the CCN and rACC/MPFC further increased after Tai Chi intervention, and this increase was accompanied by clinical improvements. This rsFC change was also significantly associated with corresponding changes in the Overall Impact domain of the Revised Fibromyalgia Impact Questionnaire (FIQR). Further analysis showed that the rACC/MPFC rsFC with both the PAG and hippocampus significantly decreased following Tai Chi intervention. Our study suggests that fibromyalgia is associated with altered CCN rsFC and that effective mind-body treatment may elicit clinical improvements by further increasing this altered rsFC. Elucidating this mechanism of enhancing the allostasis process will deepen our understanding of the mechanisms underlying mind-body interventions in fibromyalgia patients and facilitate the development of new pain management methods. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (OA) causes pain and long-term disability with annual healthcare costs exceeding $185 billion in the United States. Few medical remedies effectively influence the course of the disease. Finding effective treatments to maintain function and quality of life in patients with knee OA is one of the national priorities identified by the Institute of Medicine. We are currently conducting the first comparative effectiveness and cost-effectiveness randomized trial of Tai Chi versus a physical-therapy regimen in a sample of patients with symptomatic and radiographically confirmed knee OA. This article describes the design and conduct of this trial. Methods/Design: A single-center, 52-week, comparative effectiveness randomized controlled trial of Tai Chi versus a standardized physical-therapy regimen is being conducted at an urban tertiary medical center in Boston, Massachusetts. The study population consists of adults ≥ 40 years of age with symptomatic and radiographic knee OA (American College of Rheumatology criteria). Participants are randomly allocated to either 12 weeks of Tai Chi (2x/week) or Physical Therapy (2x/week for 6 weeks, followed by 6 weeks of rigorously monitored home exercise). The primary outcome measure is pain (Western Ontario and McMaster Universities WOMAC) subscale at 12 weeks. Secondary outcomes include WOMAC stkiffness and function domain scores, lower extremity strength and power, functional balance, physical performance tests, psychological and psychosocial functioning, durability effects, health related quality of life, and healthcare utilization at 12, 24 and 52 weeks. Discussion: This study will be the first randomized comparative-effectiveness and cost-effectiveness trial of Tai Chi versus Physical Therapy in a large symptomatic knee OA population with long-term follow up. We present here a robust and well-designed randomized comparative-effectiveness trial that also explores multiple outcomes to elucidate the potential mechanisms of mind-body effect for a major disabling disease with substantial health burdens and economic costs. Results of this study are expected to have important public health implications for the large and growing population with knee OA. Trial registration: ClinicalTrials.gov identifier: NCT01258985 [ABSTRACT FROM AUTHOR]

The article discusses the study which evaluates the effectiveness of tai chi in the treatment of knee osteoarthritis (OA) symptoms. The study reveals that tai chi appears to decrease pain and improve the physical function, self-efficacy, and health status for knee OA. It is noted that further evaluation on the biologic mechanisms and approaches of tai chi is needed in order to extend its benefits to a broader population.

Background: Knee Osteoarthritis (KOA) is a major cause of pain and functional impairment among elders. Currently, there are neither feasible preventive intervention strategies nor effective medical remedies for the management of KOA. Tai Chi, an ancient Chinese mind-body exercise that is reported to enhance muscle function, balance and flexibility, and to reduce pain, depression and anxiety, may safely and effectively be used to treat KOA. However, current evidence is inconclusive. Our study examines the effects of a 12-week Tai Chi program compared with an attention control (wellness education and stretching) on pain, functional capacity, psychosocial variables, joint proprioception and health status in elderly people with KOA. The study will be completed by July 2009. Methods/Design: Forty eligible patients, age > 55 yr, BMI ≤ 40 kg/m² with tibiofemoral osteoarthritis (American College of Rheumatology criteria) are identified and randomly allocated to either Tai Chi (10 modified forms from classical Yang style Tai Chi) or attention control (wellness education and stretching). The 60-minute intervention sessions take place twice weekly for 12 weeks. The study is conducted at an urban tertiary medical center in Boston, Massachusetts. The primary outcome measure is the Western Ontario and McMaster Universities (WOMAC) pain subscale at 12 weeks. Secondary outcomes include weekly WOMAC pain, function and stiffness scores, patient and physician global assessments, lower-extremity function, knee proprioception, depression, self-efficacy, social support, health-related quality of life, adherence and occurrence of adverse events after 12, 24 and 48 weeks. Discussion: In this article, we present the challenges of designing a randomized controlled trial with long-term follow up. The challenges encountered in this design are: strategies for recruitment, avoidance of selection bias, the actual practice of Tai Chi, and the maximization of adherence/follow-up while conducting the clinical trial for the evaluation of the effectiveness of Tai Chi on KOA. Trial registration: ClinicalTrials.gov identifier: NCT00362453 [ABSTRACT FROM AUTHOR]