Feasibility of Remote-Delivery Interventions: Tai Chi and Wellness for PTSD and Pain in Veterans

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Project Summary Posttraumatic stress disorder (PTSD) affects almost one quarter of military Veterans seeking care from Veterans Administration healthcare facilities. PTSD is associated with many health-related issues, especially chronic musculoskeletal pain, and is increasingly considered a systemic disorder, affecting both mind and body. Accessible treatments that address PTSD and chronic pain are urgently needed. Tai Chi is an ancient Chinese exercise that uses an integrated mind-body approach to enhance quality of life. Tai Chi delivered in groups has been shown to improve both mental health and physical health in patients with a variety of chronic conditions. However, no studies to date have examined Tai Chi for PTSD and pain in Veterans. Since the onset of COVID-19, interventions that can be delivered without the need for face-to-face contact are greatly needed. Remote mind-body interventions delivered via videoconferencing platforms can reduce barriers to treatment for Veterans isolated by PTSD-related avoidance, travel related challenges, or public health social distancing restrictions. The proposed study will evaluate the feasibility of remotely delivered Tai Chi for PTSD and pain in Veterans. This trial represents first steps toward a long-term goal of establishing this mind-body treatment to address these maladies for Veterans via a remote videoconferencing platform. In Phase One, the research team will adapt and do a ‘dry run’ of two existing 12-week, twice per week interventions (Tai Chi and a Wellness control) for delivery via videoconferencing for the study population. In Phase One, the team will recruit 12 participants (6 in each group) and utilize quantitative and qualitative feedback to refine and standardize the interventions. In Phase Two, 36 participants will be randomly assigned over 3 cohorts (n = 12 for each cohort, n = 6 for each group) to either a Tai Chi or a Wellness group for 12 weeks with a three-month post-treatment follow up assessment. The feasibility and acceptability of a remotely delivered randomized trial of these two interventions and the assessment protocols will be determined. Feasibility will be quantified using rates of participant eligibility, recruitment, attrition, and adherence to the treatment and assessment protocols. Feasibility will be indicated (1) by the ability to meet recruitment goals, including women and minority participation, and (2) by having at least 75% of participants regularly attend sessions and engage in home practice and 70% complete post-intervention and follow-up assessments. Acceptability will be assessed via participants’ ratings on a standardized measure of treatment satisfaction, supplemented by qualitative exit interviews. Acceptability will be indicated by 70% of the participants reporting treatment satisfaction and credibility. Information from this trial will be utilized to design a large randomized control study evaluating the efficacy of Tai Chi for improving outcomes for Veterans with PTSD and chronic musculoskeletal pain. The proposed study will be pivotal to establish procedures to fully evaluate a novel, accessible, nonpharmacologic approach for symptom management of PTSD and chronic pain in a future large-scale trial of Tai Chi.