Remote Tai Chi for Knee Osteoarthritis

(TAICHIKNEE Trial)

Overseen By William Harvey, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Tufts Medical Center

Disqualifiers: Tai chi practice, Dementia, Neuro disorders, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 27

Duration: 12 weeks

480 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether remote Tai Chi can reduce knee pain in individuals with knee osteoarthritis. Researchers aim to determine if adding Tai Chi to regular care improves pain, eases daily activities, and enhances quality of life compared to routine care alone. The trial also examines whether Tai Chi can reduce healthcare and painkiller use over a year. Suitable participants have been diagnosed with knee osteoarthritis, experience significant knee pain, and are not currently practicing Tai Chi. Participants will either receive regular care or attend twice-weekly online Tai Chi sessions for 12 weeks. As an unphased trial, this study provides a unique opportunity to explore the benefits of Tai Chi from home.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems that the focus is on adding Tai Chi to your routine care, so you may not need to stop your medications, but it's best to confirm with the trial organizers.

What prior data suggests that remote Tai Chi is safe for treating knee osteoarthritis?

Studies have shown that practicing Tai Chi online is a safe option for people with knee osteoarthritis. Research indicates that this form of Tai Chi can reduce pain and improve quality of life. No major reports of adverse reactions have been linked to online Tai Chi, which reassures its safety.

Tai Chi involves gentle, low-impact movements, making it easy on the body. People with knee problems find it manageable. The online format eliminates the need to travel, offering convenience for some.

This trial examines Tai Chi in a new way (online), so it doesn't fit into the usual study phases. The focus is more on how the treatment is delivered, as previous research has already established its safety.

In summary, online Tai Chi is safe and easy to do. It offers a promising way to help manage knee pain without significant risks. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Unlike the standard treatments for knee osteoarthritis, which often include pain relievers, physical therapy, and sometimes surgery, Remote Tai Chi offers a holistic and non-invasive approach. This method is delivered via a secure video platform, allowing participants to engage in Tai Chi sessions from the comfort of their homes. Researchers are excited because Tai Chi combines movement, meditation, and breathing techniques, potentially improving joint function and reducing pain without the side effects linked to medications. Plus, it promotes overall well-being, making it a comprehensive alternative to traditional therapies.

What evidence suggests that remote Tai Chi might be an effective treatment for knee osteoarthritis?

Research shows that Tai Chi can help reduce knee pain for people with knee osteoarthritis. Studies have found that those who practice Tai Chi report less pain during activities like walking. This ancient exercise also seems to enhance mobility and overall quality of life. One study discovered that practicing Tai Chi twice a week for three months led to significant improvements in pain and stiffness. In this trial, participants in the Tai Chi + Routine Care arm will practice Tai Chi remotely, which might effectively manage knee osteoarthritis pain. ^{2 3 5 6 7}

Who Is on the Research Team?

Chenchen Wang, MD, MSc

Principal Investigator

Tufts Medical Center

Eric Roseen, DC, PhD

Principal Investigator

Boston Medical Center

Robert Saper, MD, MPH

Principal Investigator

The Cleveland Clinic

Helen Lavetrsky, MD, MS

Principal Investigator

University of California, Los Angeles

Are You a Good Fit for This Trial?

This trial is for adults with knee osteoarthritis who experience pain that affects their daily activities. Participants will be randomly assigned to either add remote Tai Chi sessions to their routine care or continue with their usual treatment without Tai Chi.

Inclusion Criteria

Able to provide informed consent

Has access to a home computer or device that will allow telehealth delivery of the intervention

PROMIS Pain Interference Short Form 6b; score 4 or 5 on at least 1 of 6 questions

Exclusion Criteria

I need a cane or another device to walk.

I have had reconstructive surgery before.

Currently practicing Tai Chi

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive remote Tai Chi sessions twice a week for 3 months

12 weeks

24 sessions (virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 months

Evaluations at 3, 6, and 12 months

Open-label extension (optional)

Participants in the routine care group are offered access to Tai Chi session recordings after the trial

Post-trial

What Are the Treatments Tested in This Trial?

Interventions

• Remote Tai Chi

Trial Overview

The study is testing if practicing Tai Chi remotely can reduce the impact of knee pain on physical, mental, and social activities. It also looks at improvements in knee function and whether participants use fewer painkillers as a result.

How Is the Trial Designed?

Group I: Tai Chi + Routine Care Experimental Treatment 1 Intervention

The intervention will be delivered via a HIPAA-secure web-based video platform. All remote Tai Chi sessions will be 60 minutes, twice a week, for 3 months. All program components will use the Yang style Tai Chi, and every session will include warm up, review of principles, meditation with movement, breathing techniques and relaxation.

Group II: Routine Care Active Control 1 Intervention

Participants will be encouraged to continue their ongoing care for Knee OA by their providers. In addition, primary care providers and other participating clinicians in the health system will receive information from the study team on routine care or "2019 ACR Guideline-Based Care." At the end of the 12-month trial period, routine care participants will be offered access to recordings for the full 3-month Tai Chi program (24 sessions).

Who Is Running the Clinical Trial?

Tufts Medical Center

Lead Sponsor

Trials

264

Recruited

264,000+

University of California, Los Angeles

Collaborator

Trials

1,594

Recruited

10,430,000+

Boston Medical Center

Collaborator

Trials

410

Recruited

890,000+

The Cleveland Clinic

Collaborator

Trials

1,072

Recruited

1,377,000+

National Center for Complementary and Integrative Health (NCCIH)

Collaborator

Trials

886

Recruited

677,000+

Published Research Related to This Trial

Tai chi may help reduce pain in patients with knee osteoarthritis, as indicated by two out of five randomized clinical trials showing significant pain reduction compared to routine treatment.

However, the overall evidence for tai chi's effectiveness in improving physical function and pain reduction is not strong, highlighting the need for larger and longer-term studies with better controls.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tai chi for osteoarthritis: a systematic review. Lee, MS., Pittler, MH., Ernst, E.[2022]

Teaching Tai Chi, specifically the 12-form Sun-style, to elders with mild cognitive impairment can effectively relieve knee pain caused by osteoarthritis.

The program demonstrates that with tailored teaching strategies, Tai Chi can be a unique and cost-effective intervention for improving the quality of life in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teaching Tai Chi to elders with osteoarthritis pain and mild cognitive impairment. Chang, JY., Tsai, PF., Woods, S., et al.[2021]

In a study of 40 individuals with knee osteoarthritis, Tai Chi significantly reduced pain and improved physical function compared to a control group, with notable improvements in WOMAC pain and function scores after 12 weeks.

Participants practicing Tai Chi also experienced enhancements in self-efficacy, depression levels, and overall quality of life, with no severe adverse events reported, indicating it is a safe and effective intervention for managing knee OA symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Wang, C., Schmid, CH., Hibberd, PL., et al.[2022]

A study involving 152 older adults with chronic hip or knee osteoarthritis showed that both hydrotherapy and Tai Chi classes led to significant improvements in pain and physical function after 12 weeks, with benefits sustained at 24 weeks.

Hydrotherapy classes resulted in greater improvements in physical performance measures compared to Tai Chi, and had higher attendance rates, suggesting it may be a more effective option for older individuals with osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Fransen, M., Nairn, L., Winstanley, J., et al.[2008]

A 12-week tai chi program, consisting of group sessions followed by home training, significantly reduced knee pain and improved physical function in 41 elderly participants with knee osteoarthritis, compared to a control group that received health lectures.

Improvements in pain and function were observed during the intervention but disappeared after a six-week period of no tai chi practice, indicating the need for ongoing practice to maintain benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Brismée, JM., Paige, RL., Chyu, MC., et al.[2022]

Tai Chi exercise significantly improves pain, stiffness, physical function, and dynamic balance in patients with knee osteoarthritis, based on a systematic review of 16 randomized controlled trials involving 986 participants.

No adverse events were reported, indicating that Tai Chi is a safe and effective non-pharmacological therapy for enhancing both physical and mental health in individuals with knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tai Chi exercise can ameliorate physical and mental health of patients with knee osteoarthritis: systematic review and meta-analysis. Hu, L., Wang, Y., Liu, X., et al.[2022]

T'ai chi has shown promising effects in reducing pain, improving physical function, and decreasing joint stiffness in patients with knee osteoarthritis, based on a meta-analysis of nine randomized clinical trials involving 256 participants.

Despite these positive findings, the overall evidence is limited due to significant methodological weaknesses in the studies, indicating a need for more rigorous research to confirm the efficacy of t'ai chi for osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

T'ai chi for the treatment of osteoarthritis: a systematic review and meta-analysis. Kang, JW., Lee, MS., Posadzki, P., et al.[2022]

Tai chi (TC) is generally safe, with no serious adverse events reported in a review of 153 randomized controlled trials, primarily involving older adults, although minor musculoskeletal issues like knee and back pain were noted.

Only 33% of the trials reported adverse events, and just 12% had a clear protocol for monitoring them, indicating that the inconsistent reporting limits our understanding of TC's safety profile.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What do we really know about the safety of tai chi?: A systematic review of adverse event reports in randomized trials. Wayne, PM., Berkowitz, DL., Litrownik, DE., et al.[2022]

A systematic review of 11 randomized trials involving 1861 participants found that remote exercise programs can lead to clinically meaningful improvements in knee pain for individuals with osteoarthritis, although only one trial showed significant differences between groups.

The most effective interventions included personalized communication to tailor the exercise programs, highlighting the importance of engagement in remote management strategies for knee OA pain relief.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of remote exercise programs in reducing pain for patients with knee osteoarthritis: A systematic review of randomized trials. McHugh, CG., Kostic, AM., Katz, JN., et al.[2022]

Teaching the 12-form Sun-style Tai Chi to mildly cognitively impaired elders can effectively relieve knee pain caused by osteoarthritis, making it a beneficial exercise option for this population.

The program highlights the need for tailored teaching strategies that accommodate the physical and cognitive challenges faced by older adults, ensuring safety and efficacy in their practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teaching Tai Chi to elders with osteoarthritis pain and mild cognitive impairment. Chang, JY., Tsai, PF., Woods, S., et al.[2021]

Tai Chi (TC) has been shown to effectively improve symptoms of knee osteoarthritis (KOA), including pain, stiffness, physical function, and mental quality of life, based on a review of seven systematic reviews and meta-analyses.

Despite these positive findings, the overall methodological quality of the studies was low, with only one deemed high quality, indicating that the results should be interpreted cautiously and highlighting the need for more rigorous research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Tai chi in knee osteoarthritis patients: An overview of systematic reviews and meta-analyses. Zhang, N., Cui, H., Li, H., et al.[2023]

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