Tai Chi for Knee Osteoarthritis

描述(申请人提供)：膝骨性关节炎(OA)导致疼痛和长期残疾，每年给美国造成超过650亿美元的损失。随着人口老龄化，这种影响将会增加。除了疗效不一致外，目前的治疗方法，如非类固醇抗炎药、膝关节置换和物理治疗，可能会价格昂贵，导致严重的不良反应，降低身体功能，并无法改善精神健康。找到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。先前的研究表明，太极拳是一种越来越受欢迎的补充和替代疗法，它包括精神和身体两部分，可以改善身心健康；它可以增加肌肉力量、平衡和灵活性，并可以提高生活质量。然而，在医疗保健市场上，还没有临床试验证明它的临床有效性与物理疗法(PT)的标准治疗方案相比，或者它的成本效益。因此，我们建议在大量有症状的膝骨性关节炎人群中进行太极拳和PT的疗效和成本效益比较试验。我们的目的是证明，与标准的PT相比，太极是一种更具成本效益的干预措施，可以控制疼痛，减少影响数百万膝骨性关节炎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作为这种严重疾病的一线治疗。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骨性关节炎标准的患者中进行太极拳和PT的单盲、随机、对照试验。患者将随机接受12周的太极拳(2次/周)或标准PT(2次/周，持续6周，然后是6周的严格监督家庭锻炼)治疗，并进行24周和52周的随访。我们的目标是证明：1)太极比标准太极疗法更有效地缓解膝关节疼痛(使用安大略省西部和麦克马斯特大学指数[WOMAC]疼痛分量表)；2)太极可以改善功能能力(WOMAC功能分量表，以及椅子-站立性能)、肌肉力量、膝关节本体感觉、与健康相关的生活质量(SF36)，以及心理社会功能(情绪、压力、自我效能和社会支持措施)，比PT更有效，持续时间更长；以及3)与标准太极疗法相比，太极减少了医疗保健利用率，从而降低了成本。这项拟议研究的成功完成将证明，太极是一种简单、廉价、有效、持久的治疗方法，可以治疗一种具有巨大社会和经济代价的主要致残性疾病。 与公共卫生相关：膝骨性关节炎(膝骨性关节炎)是世界上最常见的肌肉骨骼疾病，目前还没有被证明可以改变疾病的药物。太极提供了一种新颖的、在后勤上可行的锻炼方案和一种补充的心身方法来管理疼痛，并增强膝骨性关节炎患者的身心健康。这项拟议研究的成功完成将证明，太极是一种简单、廉价、有效、持久的治疗方法，可以治疗一种具有巨大社会和经济代价的主要致残性疾病。

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.