Enhancing modulation Effect of Baduanjin through Non-invasive Neuromodulation for knee Osteoarthritis

项目总结 膝骨性关节炎(KOA)是一种常见的年龄相关性疾病，是长期疼痛和 残疾，这方面有很大的治疗缺口。八段锦是一种独特的身心锻炼方式。 由八个动作组成，可以在家里通过视频指导进行练习，从而使其成为一种合适的 为患有膝关节骨性关节炎的老年人提供选择。我们最近的研究表明，补阳还五汤能显著减轻患者的疼痛。 和KOA一起。然而，对BDJ干预的反应是不同的，一些人只表现出 温和的反应。因此，迫切需要进行机理研究，以增强调制效果 这一充满希望的心身疗法。 BDJ的一个特点是练习受控的身体/肢体精细运动和肌肉和肌腱 正在加强。这一特性表明，运动学习和控制可能在BDJ中起重要作用。改进 运动能力应该会增强这一前景看好的身心干预的调节效果。这个 初级运动皮质(M1)是运动系统的主要大脑区域，它整合了来自 皮质脑区产生神经冲动，向下传递到脊髓并控制执行 有动静。因此，M1可能在BDJ实践中起着至关重要的作用。 经颅直流电刺激是一种安全、临床适用的神经调节工具，可以 改变大脑皮层兴奋性，并已被用于研究大脑和行为之间的因果关系。 研究表明，在M1的tdcs可以促进运动性能。因此，增加M1的兴奋性 使用tdcs应该能够改善BDJ的性能，增加其调制效果。此外，M1 是疼痛治疗中最常用的神经调节靶点。这项提案旨在调查 能否通过增强大脑皮层来增强BDJ心身干预的调节效果 膝关节骨性关节炎患者双侧M1的兴奋性。具体来说，我们将 采用2×2析因设计进行随机研究，将140名膝关节骨性关节炎患者随机分为1组 四组：1)BDJ+真实tDCs，2)BDJ+Sham tDCs，3)拉伸+真实tDCs，4)拉伸+Sham Tdcs。多学科评估将在基线和12周进行评估，后续评估将在24周进行。 我们的预期结果是重要的和高度创新的，因为所获得的发现将导致 建立一种新的可在临床上实施的治疗方案，并广泛适用于 慢性肌肉骨骼疼痛的治疗。

PROJECT SUMMARY Knee osteoarthritis (KOA) is a common age-related disorder and a leading cause of long-term pain and disability, for which there is a substantial therapeutic gap. Baduanjin (BDJ) is a unique mind-body exercise consisting of eight movements that can be practiced at home with video guidance, thereby making it a suitable option for older adults with KOA. Our recent study showed that BDJ can significantly reduce pain in patients with KOA. However, responses to BDJ intervention are heterogeneous, and some individuals demonstrate only a moderate response. Thus, there is an urgent need for mechanistic research to enhance the modulation effect of this promising mind-body therapy. One characteristic of BDJ is the practice of controlled fine body/limb movements and muscle and tendon strengthening. This property suggests motor learning and control may play an important role in BDJ. Improving motor performance should enhance the modulation effect of this promising mind-body intervention. The primary motor cortex (M1) is the principal brain region of the motor system and integrates input from other cortical brain areas to generate neural impulses that pass down the spinal cord and control the execution of movement. Thus, M1 may play a crucial role in BDJ practice. Transcranial direct current stimulation (tDCS) is a safe and clinically applicable neuromodulation tool that can alter cortical excitability and has been used to investigate the causal relationship between brain and behavior. Studies have shown that tDCS at M1 can facilitate motor performance. Thus, increasing the excitability of M1 using tDCS should be able to improve performance of BDJ, increasing its modulation effects. Furthermore, M1 is the most commonly used neuromodulation target for pain management. This proposal aims to investigate whether we can enhance the modulation effects of BDJ mind-body intervention by enhancing the cortical excitability of bilateral M1 using multifocal tDCS in patients with knee osteoarthritis. Specifically, we will conduct a randomized study using a 2 x 2 factorial design in which 140 KOA patients will be randomized to one of four groups: 1) BDJ + real tDCS, 2) BDJ + sham tDCS, 3) stretching + real tDCS, and 4) stretching + sham tDCS. Multidisciplinary assessments will be evaluated at baseline and 12 weeks, with a follow-up at 24 weeks. Our expected outcome is significant and highly innovative in that the findings obtained will lead to the establishment of a new and clinically implementable treatment paradigm for KOA and be broadly applicable to the management of chronic musculoskeletal pain.