OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Chad Krueger, MD, in response to an Annals of Internal Medicine study investigating the effectiveness of tai chi for treating knee osteoarthritis (OA).
We have put men on the moon, but we still have no cure for the osteoarthritis that affects millions of Americans. We try a variety of injections and other conservative measures to help slow the progression of the disease, but at some point arthritis wins. Undaunted, we search for new modalities of easing the disability the disease brings to our patients in hopes of offering an effective treatment.
That is why I read with interest the recent study “Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis” in the Annals of Internal Medicine. I have many patients with debilitating knee arthritis who are not quite ready to embark on a joint replacement until they feel they have exhausted all other options. I have never referred a patient to tai chi, so would this provide another avenue for those patients to explore?
In this trial, 200 patients were randomized to either 24 total tai chi classes or standard physical therapy sessions (12 sessions at the PT office followed by six weeks of monitored home exercise). The primary outcome measure was the WOMAC score. After following the patients for a year, the researchers found that both groups had substantial improvements in their WOMAC scores, along with improvements in four secondary outcome measures: physical function, quality of life, depression, and medication usage. The one notable between-group difference was that the tai chi group had significantly greater improvements in depression and quality of life.
It’s clear that increasing physical activity, within reasonable bounds, helps patients with knee arthritis in many ways. Whether that extra activity comes from a tai chi class or a structured physical therapy program may not matter. However, it is possible that the tai chi classes (and other group-based physical activity programs) have social benefits that standard physical therapy does not—and that the patients in the tai chi classes may have benefited substantially from that social connection. Many studies, including those of the Lower Extremity Assessment Project (LEAP) cohort, have shown the power that social and psychological factors can have on a patient’s outcome. It’s not surprising that similarly positive social effects would be found in patients with knee osteoarthritis.
Still, not everyone with knee osteoarthritis will want or be able to attend a group class, so such a treatment option is not universally applicable. However, these findings should provoke orthopaedic surgeons and payers to consider seriously the social and emotional aspects of OA treatments. Tai chi is certainly not a “moonshot” solution to knee osteoarthritis, but then again, what is?
Chad Krueger, MD is a military orthopaedic surgeon at Womack Army Medical Center in Fort Bragg, NC.
