BACKGROUND: Osteoarthritis is the third leading risk factor for disability in older adults. OBJECTIVE: To compare the efficacy of different traditional Chinese exercises on knee osteoarthritis by network meta-analysis, and to provide a reference basis for patients to choose the best method. METHODS: Seven databases, including Pubmed, Embase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang, and China Science and Technology Journal Database were searched for literature on traditional Chinese exercise to improve the symptoms of patients with knee osteoarthritis. The search period was from inception of the database until February 14, 2024. Literature screening and data extraction were carried out independently by 2 investigators, and the quality of the included studies was evaluated using the Cochrane Risk of Bias 2.0 assessment tool. R4.2.3 and Stata 15.0 were used for analysis. RESULTS: Forty-two studies involving 2843 patients were ultimately included, encompassing 4 kinds of traditional Chinese exercise. The surface under the cumulative ranking curve (SUCRA) showed that Baduanjin was the best traditional Chinese exercises for Western Ontario and McMaster University Osteoarthritis Index scores including pain score (SUCRA = 0.85), stiffness score (SUCRA = 0.87), physical function score (SUCRA = 0.88) and overall score (SUCRA = 0.83). For Visual Analog Scale pain score, the most effective traditional Chinese exercise was Tai Chi (SUCRA = 0.93). CONCLUSION: The efficacy of Tai Chi, Baduanjin, Yijinjing, and Wuqinxi on knee osteoarthritis patients is superior to that of usual care. Baduanjin had the best effect in improving stiffness, physical function and overall score, and both Baduanjin and Tai Chi were the best options for improving pain.
Background: The increasing global popularity of traditional Chinese exercise (TCE) provides substantial evidence of its significant efficacy in treating knee osteoarthritis (KOA). To assess the impact of different types of TCE and varying exercise durations on KOA patients, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) on this topic. Methods: Two investigators extensively searched four electronic databases (PubMed, Embase, Cochrane, and Web of Science) from their inception until December 16, 2023, to identify all relevant RCTs on the use of TCE for KOA treatment. The included studies were assessed for risk of bias using the Cochrane Collaboration Risk of Bias Tool (CCRBT), and data analysis was performed using Stata 15.0. Results: A total of 20 RCTs, involving 1367 patients with KOA, met the inclusion criteria. Compared to the control group, TCE demonstrated significant improvement in three subscale scores of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Pain (SMD = -0.44; P = .0001); Stiffness (SMD = -0.35; P = .001); Physical function (SMD = -0.52; P = .0001)] and two subscale scores of the 36-item Short-Form (SF-36) [Physical score (WMD = 2.76; P = .001); Mental score (WMD = 2.49; P = .0001)] in KOA patients. Subgroup analysis showed that both long-term habitual exercise (over 12 weeks) and short-term exercise (within 12 weeks) were more effective than the control group in improving pain, joint stiffness, and physical function in KOA patients. Tai Chi, among the four TCE modalities analyzed, demonstrated improvements in all indicators. Conclusion: Based on the results of our meta-analysis, it can be concluded that both long-term and short-term TCE interventions are effective in alleviating the main symptoms of KOA and improving patients' physical function. However, due to limited methodological quality and inconsistent outcome measures in the included RCTs, further high-quality RCTs with larger sample sizes and longer-term interventions are necessary to validate our findings before TCE can be recommended as a treatment for KOA.
Objectives. This systematic review aims to summarize the existing literature on Tai Chi randomized controlled trials (RCTs) and recommend Tai Chi exercise prescriptions for different diseases and populations. Methods. A systematic search for Tai Chi RCTs was conducted in five electronic databases (PubMed, Cochrane Library, EMBASE, EBSCO, and Web of Science) from their inception to December 2019. SPSS 20.0 software and Microsoft Excel 2019 were used to analyze the data, and the risk of bias tool in the RevMan 5.3.5 software was used to evaluate the methodological quality of RCTs. Results. A total of 139 articles were identified, including diseased populations (95, 68.3%) and healthy populations (44, 31.7%). The diseased populations included the following 10 disease types: musculoskeletal system or connective tissue diseases (34.7%), circulatory system diseases (23.2%), mental and behavioral disorders (12.6%), nervous system diseases (11.6%), respiratory system diseases (6.3%), endocrine, nutritional or metabolic diseases (5.3%), neoplasms (3.2%), injury, poisoning and certain other consequences of external causes (1.1%), genitourinary system diseases (1.1%), and diseases of the eye and adnexa (1.1%). Tai Chi exercise prescription was generally classified as moderate intensity. The most commonly applied Tai Chi style was Yang style (92, 66.2%), and the most frequently specified Tai Chi form was simplified 24-form Tai Chi (43, 30.9%). 12 weeks and 24 weeks, 2-3 times a week, and 60 min each time was the most commonly used cycle, frequency, and time of exercise in Tai Chi exercise prescriptions. Conclusions. We recommend the more commonly used Tai Chi exercise prescriptions for different diseases and populations based on clinical evidence of Tai Chi. Further clinical research on Tai Chi should be combined with principles of exercise prescription to conduct large-sample epidemiological studies and long-term prospective follow-up studies to provide more substantive clinical evidence for Tai Chi exercise prescriptions.
BACKGROUND: Mild cognitive impairment (MCI) is the early phase of Alzheimer's disease (AD). The aim of early intervention for MCI is to decrease the rate of conversion from MCI to AD. However, the efficacy of multiple interventions in MCI, and the optimal methods of delivery, remain controversial. We aimed to compare and rank the treatment methods for MCI in AD, in order to find an optimal intervention for MCI and a way to prevent or delay the occurrence of AD. METHODS: Pair-wise and network meta-analysis were conducted to integrate the treatment effectiveness through direct and indirect evidence. Four English databases and three Chinese databases were searched for international registers of eligible published, single or double blind, randomized controlled trials up to September 31st 2019. We included nine comparative interventions: pharmacological therapies which incorporated cholinesterase inhibitors (ChEI), ginkgo, nimodipine, and Chinese medicine; non-pharmacological therapies comprising of acupuncture, music therapy, exercise therapy, and nutrition therapy; and a placebo group. The primary outcome was the Mini-Mental State Examination (MMSE) score. The secondary outcome was the AD Assessment Scale-cognitive subscale (ADAS-cog). RESULTS: Twenty-eight trials were eligible, including 6,863 participants. In the direct meta-analysis, as for the Mini-Mental State Examination scale, the ChEIs (MD: −0.38; 95% CI: −0.74, −0.01), Chinese medicine (MD: −0.31; 95% CI: −0.75, 0.13), exercise therapy (MD: −0.50; 95% CI: −0.65, −0.35), music therapy (MD: −1.71; 95% CI: −4.49, 1.07), were statistically more efficient than placebo. For AD Assessment Scalecognitive subscale outcome, ChEIs (MD: 1.20; 95% CI: 0.73, 1.68), Acupuncture (MD: 1.36; 95% CI: 1.28, 1.44), Chinese medicine (MD: 0.61; 95% CI: 0.49, 0.73) and exercise (MD: 0.61; 95% CI: 0.49, 0.73) were better than placebo. In the network meta-analysis, the MMSE outcome ranked music therapy (59%) as the best and Acupuncture (26%) as second. Nutrition and Ginkgo treatment had the lowest rank among all interventions. For ADAS-cog outcome, acupuncture (52) ranked the best. CONCLUSION: Among the nine treatments studied, music therapy appears to be the best treatment for MCI, followed by acupuncture. Our study provides new insights into potential clinical treatments for MCI due to AD, and may aid the development of guidelines for MCI in AD. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
The objective of this study is to construct an evidence synthesis to identify the types of land-based exercises most investigated in the current literature, the intervention duration, frequency of the programs and the exercises which are most frequently implemented. A search was performed on the reference list of included and excluded studies of one systematic review, on land-based exercises for knee osteoarthritis and, an updated search of The Cochrane Library, Embase, CINAHL and PEDro was completed. Two authors independently selected the studies and a third author was consulted for an additional opinion. The inclusion criteria were male or female with tibiofemoral knee osteoarthritis, land-based exercises, non-exercise control group and randomized clinical trials. The exclusion criteria were mixed diagnosis or comparison to other types of exercise. The data were extracted by two authors. Fifty-five full-text articles were included. Strengthening, proprioception and aerobic exercises resulted in significant pain reduction. The intervention durations which were significant for pain reduction were either the period of 8-11 weeks or 12-15 weeks. The frequency of three times per week was found significant in comparison to a non-exercise control group. The results, which formed an evidence synthesis, demonstrate that there is substantial evidence regarding the benefits of strengthening exercises to reduce pain in knee osteoarthritis patients. Based on the included studies analysis, exercises should be performed three times weekly for a duration of 8-11 or 12-15 weeks. Health professionals working with knee osteoarthritis patients can use this evidence synthesis as a fast and pragmatic instrument to obtain information about several effective types of exercises for pain reduction.
Complementary medicine therapies are frequently used to treat pain conditions such as headaches and neck, back, and joint pain. Chronic pain, described as pain lasting longer than 3-6 months, can be a debilitating condition that has a significant socioeconomic impact. Pharmacologic approaches are often used for alleviating chronic pain, but recently there has been a reluctance to prescribe opioids for chronic noncancer pain because of concerns about tolerance, dependence, and addiction. As a result, there has been increased interest in integrative medicine strategies to help manage pain and to reduce reliance on prescription opioids to manage pain. This article offers a brief critical review of integrative medical therapies used to treat chronic pain, including nutritional supplements, yoga, relaxation, tai chi, massage, spinal manipulation, and acupuncture. The goal of this article is to identify those treatments that show evidence of efficacy and to identify gaps in the literature where additional studies and controlled trials are needed. An electronic search of the databases of PubMed, The Cochrane Library, EMBASE, PsycINFO, and Science Citation Index Expanded was conducted. Overall, weak positive evidence was found for yoga, relaxation, tai chi, massage, and manipulation. Strong evidence for acupuncture as a complementary treatment for chronic pain that has been shown to decrease the usage of opioids was found. Few studies were found in which integrative medicine approaches were used to address opioid misuse and abuse among chronic pain patients. Additional controlled trials to address the use of integrative medicine approaches in pain management are needed.
BACKGROUND: The purpose of this study was to conduct a meta-analysis and systematic review to assess the effect of exercise on cognitive function in people with chronic diseases.
METHODS: PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, PsycINFO, and three Chinese databases were electronically searched for papers that were published until September 2016. This meta-analysis and systematic review included randomized controlled trials that evaluated the effect of exercise on cognitive function compared with control group for people with chronic diseases.
RESULTS: Totally, 35 studies met the inclusion criteria, with 3,113 participants. The main analysis revealed a positive overall random effect of exercise intervention on cognitive function in patients with chronic diseases. The secondary analysis revealed that aerobic exercise interventions and aerobic included exercise interventions had a positive effect on cognition in patients with chronic diseases. The intervention offering low frequency had a positive effect on cognitive function in patients with chronic diseases. Finally, we found that interventions offered at both low exercise intensity and moderate exercise intensity had a positive effect on cognitive function in patients with chronic diseases. The secondary analysis also revealed that exercise interventions were beneficial in Alzheimer's disease patients when grouped by disease type.
CONCLUSION: This meta-analysis and systematic review suggests that exercise interventions positively influence cognitive function in patients with chronic diseases. Beneficial effect was independent of the type of disease, type of exercise, frequency, and the intensity of the exercise intervention.
Background. Tai chi is recommended for musculoskeletal conditions; however, the evidence for its clinical effectiveness is uncertain. Purpose. The aim of this study was to determine whether tai chi is beneficial for clinical outcomes in people with musculoskeletal pain. Data Sources. Seven databases were searched: Embase, PEDro, AMED, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Central Register of Controlled Trials. Study Selection. Randomized controlled trials of tai chi for people with a chronic musculoskeletal condition were included. Data Extraction. Two reviewers extracted data and rated risk of bias. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated for individual trials and pooled effect sizes were calculated using a random-effects model. Data Synthesis. Fifteen studies were identified; these studies included people with osteoarthritis (80%), back pain (13%), and headache (7%). Using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, moderate-quality evidence was found that tai chi was more effective than no treatment or usual care at short term on pain (SMD=-0.66 [95% CI=-0.85, -0.48]) and disability (SMD=-0.66 [95% CI= --0.85, --0.46]). The evidence for other outcomes was of low or very low quality and there was little information regarding long-term effects. Thus, although the number of publications in this area has increased, the rigor has not, hindering physical therapists' ability to provide reliable recommendations for clinical practice. Limitations. The evidence provided in this review is limited by trials with small sample sizes, low methodological quality, and lack of long-term assessment. Conclusions. In order for tai chi to be recommended as an effective intervention, more high-quality trials with large sample sizes assessing tai chi versus other evidence-based treatments at short term and at long term are needed.
OBJECTIVE: To identify effective mind-body exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning non-traditional land-based exercises for knee osteoarthritis. METHODS: A systematic search and adapted selection criteria included comparative controlled trials with mind-body exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, D-) was used, based on statistical significance (P < 0.5) and clinical importance (⩾15% improvement). RESULTS: The four high-quality studies identified demonstrated that various mind-body exercise programs are promising for improving the management of knee osteoarthritis. Hatha Yoga demonstrated significant improvement for pain relief (Grade B) and physical function (Grade C+). Tai Chi Qigong demonstrated significant improvement for quality of life (Grade B), pain relief (Grade C+) and physical function (Grade C+). Sun style Tai Chi gave significant improvement for pain relief (Grade B) and physical function (Grade B). CONCLUSION: Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis.
OBJECTIVES: To assess the evidence for the efficacy of the following interventions for improving clinical outcomes in adults with osteoarthritis (OA) of the knee: cell-based therapies; glucosamine, chondroitin, or glucosamine plus chondroitin; strength training, agility, or aerobic exercise (land or water based); balneotherapy, mud bath therapy; electrical stimulation techniques (including transcutaneous electrical stimulation [TENS], neuromuscular electrical stimulation, and pulsed electromagnetic field therapy [PEMF]); whole body vibration; heat, infrared, or ultrasound; orthoses (knee braces, shoe inserts, or specially designed shoes); weight loss diets; and home-based therapy or self-management.
DATA SOURCES: PubMed®, Embase®, the Cochrane Collection, Web of Science, and the Physiotherapy Evidence Database (PEDRO) from 2006 to September 2016, and ClinicalTrials.gov and the proceedings from the 2015 American College of Rheumatology annual meetings.
REVIEW METHODS: We included randomized controlled trials conducted in adults 18 years or over diagnosed with OA of the knee, comparing any of the interventions of interest with placebo (sham) or any other intervention of interest that reported a clinical outcome (including pain, function, and quality of life). We also included single-arm and prospective observational studies that analyzed the effects of weight loss in individuals with OA of the knee on a clinical outcome. Standard methods were used for data abstraction and analysis, assessment of study quality, and assessment of the quality of the evidence, according to the Agency for Healthcare Research and Quality Methods Guide. Findings were stratified according to duration of interventions and outcomes: short term (4–12 weeks), medium term (12–26 weeks), and long term (>26 weeks).
RESULTS: Evidence was insufficient to draw conclusions about the effectiveness of many interventions, largely due to heterogeneous and poor-quality study design, which limited the number of studies that met inclusion criteria and could be pooled. Interventions that show beneficial effects on short-term outcomes of interest include TENS for pain (moderate strength of evidence [SoE]); strength and resistance training on Western Ontario and McMaster University Arthritis Index (WOMAC) total scores; tai chi on pain and function; and agility training, home-based programs, and PEMF on pain (low SoE). Interventions that show beneficial effects on medium-term outcomes include weight loss for pain (moderate SoE) and function, intra-articular platelet-rich plasma on pain and quality of life, glucosamine plus chondroitin on pain and function, chondroitin sulfate alone on pain, general exercise programs on pain and function, tai chi on pain and function, whole-body vibration on function, and home-based programs on pain and function (low SoE). Interventions that show beneficial long-term effects include agility training and general exercise programs for pain and function, and manual therapy and weight loss for pain (low SoE). Moderate SoE supports a lack of long-term benefit of glucosamine-chondroitin on pain or function, and glucosamine or chondroitin sulfate alone on pain. No consistent serious adverse effects were reported for any intervention. Almost no studies conducted subgroup analysis to assess the participant characteristics associated with better outcomes, and few studies systematically compared interventions head to head. Additional limitations included lack of blinding and sham controls in studies of physical interventions and the potentially limited applicability of study results to patients seen in nonacademic health care settings.
CONCLUSIONS: A variety of interventions assessed for their efficacy in treating OA of the knee in this review demonstrate shorter term beneficial effects on pain and function. With the exception of weight loss, agility training, and general exercise programs, few have been tested for or show long-term benefits. Larger randomized controlled trials are needed, with more attention to appropriate comparison groups and longer duration, to assess newer therapies and to determine which types of interventions are most effective for which patients.
Osteoarthritis is the third leading risk factor for disability in older adults.
OBJECTIVE:
To compare the efficacy of different traditional Chinese exercises on knee osteoarthritis by network meta-analysis, and to provide a reference basis for patients to choose the best method.
METHODS:
Seven databases, including Pubmed, Embase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang, and China Science and Technology Journal Database were searched for literature on traditional Chinese exercise to improve the symptoms of patients with knee osteoarthritis. The search period was from inception of the database until February 14, 2024. Literature screening and data extraction were carried out independently by 2 investigators, and the quality of the included studies was evaluated using the Cochrane Risk of Bias 2.0 assessment tool. R4.2.3 and Stata 15.0 were used for analysis.
RESULTS:
Forty-two studies involving 2843 patients were ultimately included, encompassing 4 kinds of traditional Chinese exercise. The surface under the cumulative ranking curve (SUCRA) showed that Baduanjin was the best traditional Chinese exercises for Western Ontario and McMaster University Osteoarthritis Index scores including pain score (SUCRA = 0.85), stiffness score (SUCRA = 0.87), physical function score (SUCRA = 0.88) and overall score (SUCRA = 0.83). For Visual Analog Scale pain score, the most effective traditional Chinese exercise was Tai Chi (SUCRA = 0.93).
CONCLUSION:
The efficacy of Tai Chi, Baduanjin, Yijinjing, and Wuqinxi on knee osteoarthritis patients is superior to that of usual care. Baduanjin had the best effect in improving stiffness, physical function and overall score, and both Baduanjin and Tai Chi were the best options for improving pain.
Systematic Review Question»Systematic review of interventions