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

项目摘要 膝关节骨关节炎（KOA）是一种常见的年龄相关疾病，也是长期疼痛的主要原因， 残疾，在这方面存在着巨大的治疗差距。八段锦是一种独特的身心运动 包括八个动作，可以在家里练习视频指导，从而使其成为一个合适的 为患有KOA的老年人提供的选择。我们最近的研究表明，BDJ可以显着减轻患者的疼痛 关于KOA然而，对BDJ干预的反应是异质的，有些人只表现出 温和的反应。因此，迫切需要从机理上进行研究，以提高调制效果 这个有前途的身心疗法的一部分 BDJ的一个特点是控制精细的身体/肢体运动和肌肉和肌腱的练习 加强。这表明运动学习和控制可能在BDJ中起重要作用。改善 运动表现应该增强这种有希望的身心干预的调节效果。的 初级运动皮层（M1）是运动系统的主要脑区， 皮层脑区产生神经冲动，传递到脊髓和控制执行 运动因此，M1可能在BDJ实践中发挥关键作用。 经颅直流电刺激（tDCS）是一种安全且临床适用的神经调节工具， 改变皮层兴奋性，并已被用于研究大脑和行为之间的因果关系。 研究表明，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 是疼痛管理中最常用的神经调节靶点。该提案旨在调查 我们是否可以通过增强大脑皮层， 膝关节骨关节炎患者使用多灶tDCS的双侧M1兴奋性。具体来说，我们将 采用2 × 2析因设计进行随机研究，其中140名KOA患者将被随机分配至一个 四组：1）BDJ +真实的tDCS，2）BDJ +假tDCS，3）拉伸+真实的tDCS，和4）拉伸+假 tDCS。将在基线和12周时进行多学科评估，并在24周时进行随访。 我们的预期成果是重要的和高度创新的，因为所获得的发现将导致 为KOA建立一种新的临床可实施的治疗模式，并广泛适用于 慢性肌肉骨骼疼痛的管理。

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.