Tai Chi and Knee Osteoarthritis

太极拳与膝骨关节炎

• 批准号: 8113165
• 负责人: CHENCHEN WANG
• 金额: $ 60.75万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2014-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8113165
• 关键词: Acetaminophen; Activities of Daily Living; Adverse effects; Aerobic; Affect; Age; Alternative Therapies; American; Area; Arthritis; Boston; Cardiovascular system; Caring; Clinical; Clinical Treatment; Clinical Trials; Clinical effectiveness; Communities; Complementary therapies; Degenerative polyarthritis; Disease; Effectiveness; Elderly; Equilibrium; Exercise; Expenditure; Goals; Health; Healthcare; Healthcare Systems; Home environment; Individual; Institute of Medicine (U.S.); Insurance Carriers; Knee Osteoarthritis; Knee joint; Lead; Life; Measures; Medical; Mental Health; Mind-Body Intervention; Moods; Muscle; Musculoskeletal Diseases; Non-Steroidal Anti-Inflammatory Agents; Ontario; Operative Surgical Procedures; Pain; Patients; Perception; Performance; Personal Satisfaction; Physical Function; Physical therapy; Policy Maker; Population; Productivity; Proprioception; Psyche structure; Quality of life; Randomized; Randomized Controlled Trials; Regimen; Replacement Arthroplasty; Research; Rheumatology; Self Efficacy; Severities; Social support; Stress; Stretching; Symptoms; Tai Ji; Testing; Therapeutic; United States; Universities; Work; alternative treatment; blind; body-mind; college; combat; comparative effectiveness; cost; cost effective; cost effectiveness; disability; disabling disease; economic cost; effective intervention; effective therapy; effectiveness research; effectiveness trial; flexibility; health care service utilization; health related quality of life; improved; indexing; knee pain; knee replacement arthroplasty; meetings; metropolitan; muscle strength; novel; physical conditioning; psychologic; psychosocial; public health relevance; quadriceps muscle; satisfaction; social; tool

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.

描述（由申请人提供）：膝关节骨关节炎（OA）会导致疼痛和长期残疾，每年造成超过650亿美元的损失。随着人口年龄的增长，影响将增加。除了不一致的有效性外，当前的治疗方法，例如非甾体类抗炎药，膝关节替代和物理治疗可能很昂贵，会引起严重的不良反应，减少身体机能并无法改善心理健康。在OA患者中找到有效的治疗方法以维持职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，Tai Chi是一种越来越流行的互补和替代疗法，可以改善身心健康。它可以提高肌肉力量，平衡和灵活性，并可以改善生活质量。但是，与标准的物理疗法（PT）或医疗保健市场的成本效益相比，尚无临床试验证明其临床有效性。因此，我们建议在大量症状的膝关节OA种群中对Tai Chi与PT进行首次比较有效性和成本效益试验。我们的目的是证明，与标准PT相比，Tai Chi是一种更具成本效益的干预措施，可用于管理疼痛并减少影响数百万膝盖OA个人生活质量的功能局限性。我们认为，我们的工作将说服临床界实施Tai Chi作为这种残酷疾病的一线治疗方法。为了实现这一目标，我们将在符合膝盖OA的美国风湿病学标准的180名患者中对Tai Chi vs. PT进行单盲，随机，对照试验。患者将通过TAI CHI（2x/周）或标准PT（2倍/周（持续6周）随机分配12周的治疗，然后进行6周严格的监督家庭运动），并进行24和52周的随访。我们的目的是表明：1）与PT的标准方案（使用西部Ontario和McMaster University指数[WOMAC]疼痛分量表）相比，Tai Chi更有效地减轻了膝盖疼痛； 2）TAI CHI提高功能能力（WOMAC功能子量表和椅子姿势表现），肌肉力量，膝关节关节本体感受，与健康相关的生活质量（SF36）以及社会心理功能（情绪，压力，自我效能和社会支持措施）更有效，并且比PT更有效，并且更有效地延长；和3）太极汽车降低了医疗保健利用，因此与PT的标准方案相比，成本降低了。拟议的研究的成功完成将表明，太极拳是一种简单，廉价，有效，耐用的治疗方法，可用于具有巨大的社会和经济成本的主要残疾疾病。 公共卫生相关性：膝关节骨关节炎（膝盖OA）是世界上最常见的肌肉骨骼疾病，目前没有证明疾病的医疗疗法。 Tai Chi提供了一种新颖的，具有逻辑上可行的运动方案，并提供了一种互补的思维方式方法，可控制疼痛，增强膝关节OA患者的身心健康和健康。拟议的研究的成功完成将表明，太极拳是一种简单，廉价，有效，耐用的治疗方法，可用于具有巨大的社会和经济成本的主要残疾疾病。