Tai Chi for Knee Osteoarthritis

描述（由申请人提供）：膝关节骨关节炎（OA）导致疼痛和长期残疾，每年给美国造成的损失超过650亿美元。随着人口老龄化，这种影响将会加剧。除了疗效不一致外，目前的治疗方法，如非甾体类抗炎药、膝关节置换术和物理治疗可能很昂贵，导致严重的不良反应，降低身体功能，并不能改善精神健康。寻找有效的治疗方法来维持OA患者的功能和生活质量是医学研究所今年确定的国家优先事项之一。以前的研究表明，太极拳是一种越来越受欢迎的补充和替代疗法，兼具身心成分，可以改善身心健康；它可以增强肌肉力量，平衡和灵活性，可以提高生活质量。然而，没有临床试验证明其临床效果与标准治疗方案的物理治疗（PT）或其成本效益在医疗保健市场。因此，我们建议在大量有症状的膝关节OA人群中进行太极拳与PT的首次有效性和成本效益比较试验。我们的目标是证明，与标准的PT相比，太极拳是一种更具成本效益的干预措施，可以控制疼痛，减少影响数百万膝关节OA患者生活质量的功能限制。我们相信，我们的工作将说服临床社区将太极拳作为这种致残疾病的一线治疗方法。为了实现这一目标，我们将在180名符合美国风湿病学会膝关节OA标准的患者中进行太极拳与PT的单盲、随机、对照试验。患者将被随机分为12周的太极（2次/周）或标准PT（2次/周，持续6周，然后是6周严格监督的家庭运动），随访24周和52周。我们的目标是证明：1)太极拳比标准的PT方案更有效地减轻膝关节疼痛（使用西安大略省和麦克马斯特大学指数[WOMAC]疼痛量表）；2)与PT相比，太极拳更有效、持续时间更长地改善功能能力（WOMAC功能量表和椅站立性能）、肌肉力量、膝关节本体感觉、健康相关生活质量（SF36）和社会心理功能（情绪、压力、自我效能和社会支持措施）；3)与标准的PT方案相比，太极拳降低了医疗保健利用率，从而降低了成本。拟议研究的成功完成将证明太极拳是一种简单，廉价，有效，持久的治疗主要致残疾病的方法，具有巨大的社会和经济成本。

DESCRIPTION (provided by applicant): Knee osteoarthritis (OA) causes pain and long-term disability and costs the US more than $65 billion per year. The impact will increase as the population ages. In addition to inconsistent effectiveness, current treatments such as nonsteroidal anti-inflammatory drugs, knee replacement, and physical therapy may be expensive, cause serious adverse effects, reduce physical function, and fail to improve mental well-being. Finding effective treatments to maintain function and quality of life in OA patients is one of the national priorities identified this year by the Institute of Medicine. Previous research has demonstrated that Tai Chi, an increasingly popular complementary and alternative therapy with both mind and body components, can improve physical and mental health; it can increase muscle strength, balance, and flexibility and can improve quality of life. However, no clinical trials have demonstrated its clinical effectiveness compared to a standard therapeutic regimen of physical therapy (PT) or its cost effectiveness in the healthcare marketplace. Therefore, we propose to conduct the first comparative effectiveness and cost-effectiveness trial of Tai Chi vs. PT in a large symptomatic knee OA population. We aim to demonstrate that, compared to standard PT, Tai Chi is a more cost-effective intervention for managing pain and reducing the functional limitations that impact quality of life for millions of individuals with knee OA. We believe that our work will convince the clinical community to implement Tai Chi as a first-line treatment for this crippling disease. To achieve this goal, we will conduct a single-blind, randomized, controlled trial of Tai Chi vs. PT in 180 patients who meet the American College of Rheumatology criteria for Knee OA. Patients will be randomized to 12 weeks of treatment with Tai Chi (2x/week) or Standard PT (2x/week for 6 weeks, followed by 6 weeks of rigorous supervised home exercise) with 24 and 52 week follow-ups. We aim to show that: 1) Tai Chi reduces knee pain more effectively than a standard regimen of PT (using the Western Ontario and McMaster University Index [WOMAC] pain subscale); 2) Tai Chi improves functional capacity (WOMAC function subscale, and chair-stand performance), muscle strength, knee joint proprioception, health related quality of life (SF36), and psychosocial functioning (mood, stress, self-efficacy and social support measures) more effectively and for longer periods than PT; and 3) Tai Chi decreases healthcare utilization and thus reduces costs as compared with a standard regimen of PT. Successful completion of the proposed study will demonstrate that Tai Chi is a simple, inexpensive, effective, durable treatment for a major disabling disease with great social and economic costs. PUBLIC HEALTH RELEVANCE: Knee Osteoarthritis (Knee OA) is the most common musculoskeletal disorder in the world, with no currently proven disease-modifying medical remedies. Tai Chi offers a novel, logistically feasible exercise regimen and a complementary mind-body approach to manage pain and enhance physical and mental health and wellness in patients with Knee OA. Successful completion of the proposed study will demonstrate that Tai Chi is a simple, inexpensive, effective, durable treatment for a major disabling disease with great social and economic costs.