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Effects of Tai Chi versus Physical Therapy on Mindfulness in Knee Osteoarthritis

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Abstract

Tai Chi mind–body exercise is widely believed to improve mindfulness through incorporating meditative states into physical movements. A growing number of studies indicate that Tai Chi may improve health in knee osteoarthritis (OA), a chronic pain disease and a primary cause of global disability. However, little is known about the contribution of mindfulness to treatment effect of Tai Chi practice. Therefore, our purpose was to investigate the effect of Tai Chi mind–body practice compared to physical therapy (PT) on mindfulness in knee OA. Adults with radiographic-confirmed, symptomatic knee OA were randomized to 12 weeks (twice weekly) of either Tai Chi or PT. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ) before and after intervention along with commonly used patient-reported outcomes for pain, physical function, and other health-related outcomes. Among 86 participants (74% female, 48% white, mean age 60 years, 85% at least college educated), mean total FFMQ was 142 ± 17. Despite substantial improvements in pain, function, and other health-related outcomes, each treatment group’s total FFMQ did not significantly change from baseline (Tai Chi = 0.76, 95% CI −2.93, 4.45; PT = 1.80, 95% CI −2.33, 5.93). The difference in total FFMQ between Tai Chi and PT was not significant (−1.04 points, 95% CI −6.48, 4.39). Mindfulness did not change after Tai Chi or PT intervention in knee OA, which suggests that Tai Chi may not improve health in knee OA through cultivating mindfulness. Further study is needed to identify underlying mechanisms of effective mind–body interventions among people with knee OA.

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References

  • Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342. doi:10.1177/1073191107313003.

    Article  PubMed  Google Scholar 

  • Bawa, F. L. M., Mercer, S. W., Atherton, R. J., Clague, F., Keen, A., Scott, N. W., & Bond, C. M. (2015). Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. The British Journal of General Practice, 65(635), e387–e400. doi:10.3399/bjgp15X685297.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bellamy, N., Buchanan, W. W., Goldsmith, C. H., Campbell, J., & Stitt, L. W. (1988). Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. The Journal of Rheumatology, 15(12), 1833–1840 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3068365.

    PubMed  Google Scholar 

  • Bergomi, C., Tschacher, W., & Kupper, Z. (2013). The assessment of mindfulness with self-report measures: existing scales and open issues. Mindfulness, 4(3), 191–202. doi:10.1007/s12671-012-0110-9.

    Article  Google Scholar 

  • Brady, T. J. (2011). Measures of self-efficacy: arthritis self-efficacy scale (ASES), arthritis self-efficacy scale-8 item (ASES-8), children’s arthritis self-efficacy scale (CASE), chronic disease self-efficacy scale (CDSES), parent’s arthritis self-efficacy scale (PASE), an. Arthritis Care & Research, 63 Suppl 1, S473–S485. doi:10.1002/acr.20567.

    Article  Google Scholar 

  • Caldwell, K., Emery, L., Harrison, M., & Greeson, J. (2011). Changes in mindfulness, well-being, and sleep quality in college students through taijiquan courses: A cohort control study. Journal of Alternative and Complementary Medicine (New York, N.Y.), 17(10), 931–938. doi:10.1089/acm.2010.0645.

    Article  Google Scholar 

  • Chen, Y.-W., Hunt, M. A., Campbell, K. L., Peill, K., & Reid, W. D. (2015). The effect of tai Chi on four chronic conditions-cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: A systematic review and meta-analyses. British Journal of Sports Medicine. doi:10.1136/bjsports-2014-094388.

    Google Scholar 

  • Christopher, M. S., Rogers, B., Hunsinger, M., Colgan, D., Reiss, A. L., & Farwood, H. B. (2015). Distinguishing mindful process from outcome in the prediction of Global Health and perceived stress in a mindfulness-based stress reduction program. Mindfulness, 6(4), 693–699. doi:10.1007/s12671-014-0305-3.

    Article  Google Scholar 

  • Delgado, R., York, A., Lee, C., Crawford, C., Buckenmaier 3rd, C., Schoomaker, E., & Crawford, P. (2014). Assessing the quality, efficacy, and effectiveness of the current evidence base of active self-care complementary and integrative medicine therapies for the management of chronic pain: A rapid evidence assessment of the literature. Pain Medicine (Malden, Mass.), 15 Suppl 1, S9–20. doi:10.1111/pme.12412.

    Article  Google Scholar 

  • Deyle, G. D., Allison, S. C., Matekel, R. L., Ryder, M. G., Stang, J. M., Gohdes, D. D., et al. (2005). Physical therapy treatment effectiveness for osteoarthritis of the knee: A randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Physical Therapy, 85(12), 1301–1317.

    PubMed  Google Scholar 

  • Fransen, M., Mcconnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee. The Cochrane Database of Systematic Reviews, (1), CD004376. doi:10.1002/14651858.CD004376.pub3.

  • Gould, L. F., Mendelson, T., Dariotis, J. K., Ancona, M., Smith, A. S. R., Gonzalez, A. A., et al. (2014). Assessing fidelity of core components in a mindfulness and yoga intervention for urban youth: Applying the CORE process. New Directions for Youth Development, 2014(142), 59–81. doi:10.1002/yd.20097.

    Article  PubMed  Google Scholar 

  • Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12. doi:10.1016/j.cpr.2015.01.006.

    Article  PubMed  Google Scholar 

  • Holzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559. doi:10.1177/1745691611419671.

    Article  PubMed  Google Scholar 

  • Kabat-Zinn, J. (2015). Meditation—it’s not what you think. Mindfulness, 6(2), 393–395. doi:10.1007/s12671-015-0393-8.

    Article  Google Scholar 

  • Kabat-zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190.

    Article  PubMed  Google Scholar 

  • Kelley, G. A., & Kelley, K. S. (2015). Meditative movement therapies and health-related quality-of-life in adults: A systematic review of meta-analyses. PloS One, 10(6), e0129181. doi:10.1371/journal.pone.0129181.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kraus, V. B., Blanco, F. J., Englund, M., Karsdal, M. A., & Lohmander, L. S. (2015). Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarthritis and Cartilage, 23(8), 1233–1241. doi:10.1016/j.joca.2015.03.036.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lange, K., Gorbunova, A., & Christ, O. (2012). The influence of mindfulness on different aspects of pain perception and affective reactivity to pain—feasibility of a multimethodical approach. Mindfulness, 3, 209–217. doi:10.1007/s12671-012-0113-6.

    Article  Google Scholar 

  • Larkey, L., Jahnke, R., Etnier, J., & Gonzalez, J. (2009). Meditative movement as a category of exercise: Implications for research. Journal of Physical Activity & Health, 6(2), 230–238.

    Article  Google Scholar 

  • Lee, C., Crawford, C., & Hickey, A. (2014). Mind–body therapies for the self-management of chronic pain symptoms and active self-care therapies for pain (PACT) working group. Pain Medicine, 15, S21–S39.

    Article  PubMed  Google Scholar 

  • Ma, V. Y., Chan, L., & Carruthers, K. J. (2014). Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: Stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pa. Archives of Physical Medicine and Rehabilitation, 95(5), 986–995.e1. doi:10.1016/j.apmr.2013.10.032.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morone, N. E., & Greco, C. M. (2007). Mind–body interventions for chronic pain in older adults: A structured review. Pain Medicine, 8(4), 359–375. doi:10.1111/j.1526-4637.2007.00312.x.

    Article  PubMed  Google Scholar 

  • Morone, N. E., Greco, C. M., & Weiner, D. K. (2008). Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain, 134(3), 310–319. doi:10.1016/j.pain.2007.04.038.

    Article  PubMed  Google Scholar 

  • Morone, N. E., Rollman, B. L., Moore, C. G., Li, Q., & Weiner, D. K. (2009). A mind–body program for older adults with chronic low back pain: Results of a pilot study. Pain Medicine (Malden, Mass.), 10(8), 1395–1407. doi:10.1111/j.1526-4637.2009.00746.x.

    Article  Google Scholar 

  • National Center for Complementary and Integrative Health. (2015). Spotlight on a modality: Tai Chi. Retrieved July 1, 2016, from https://nccih.nih.gov/health/providers/digest/taichi.

  • Nedeljkovic, M., Wirtz, P., & Ausfeld-Hafter, B. (2012). Effects of Taiji practice on mindfulness and self-compassion in healthy participants—A randomized controlled trial. Mindfulness, 3(3), 200–208. doi:10.1007/s12671-012-0092-7.

    Article  Google Scholar 

  • Nordin, M., & Nordin, S. (2013). Psychometric evaluation and normative data of the Swedish version of the 10-item perceived stress scale. Scandinavian Journal of Psychology, 54(1996), 502–507. doi:10.1111/sjop.12071.

    Article  PubMed  Google Scholar 

  • Olsson, L., & Swedberg, K. (2005). Six minute walk test. European Heart Journal, 26(20), 2209–2209. doi:10.1093/eurheartj/ehi452.

    Article  PubMed  Google Scholar 

  • Park, T., Reilly-Spong, M., & Gross, C. R. (2013). Mindfulness: A systematic review of instruments to measure an emergent patient-reported outcome (PRO). Quality of Life Research, 22(10), 2639–2659. doi:10.1007/s11136-013-0395-8.

    Article  PubMed  Google Scholar 

  • Petersen, M., & la Cour, P. (2016). Mindfulness—what works for whom? Referral, feasibility, and user perspectives regarding patients with mixed chronic pain. Journal of Alternative and Complementary Medicine (New York, N.Y.), 22(4), 298–305. doi:10.1089/acm.2015.0310.

    Article  Google Scholar 

  • Phillips, K., & Clauw, D. J. (2011). Central pain mechanisms in chronic pain states—maybe it is all in their head. Best Practice & Research. Clinical Rheumatology, 25(2), 141–154. doi:10.1016/j.berh.2011.02.005.

    PubMed  PubMed Central  Google Scholar 

  • Posadzki, P., & Jacques, S. (2009). Tai Chi and meditation. Journal of Holistic Nursing, 27(2), 103–114. doi:10.1177/0898010108330807.

    Article  PubMed  Google Scholar 

  • R Development Core Team. (2012). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing.

    Google Scholar 

  • Schmidt, S., Grossman, P., Schwarzer, B., Jena, S., Naumann, J., & Walach, H. (2011). Treating fibromyalgia with mindfulness-based stress reduction: Results from a 3-armed randomized controlled trial. Pain, 152(2), 361–369. doi:10.1016/j.pain.2010.10.043.

    Article  PubMed  Google Scholar 

  • Sharon, H., Maron-Katz, A., Ben Simon, E., Flusser, Y., Hendler, T., Tarrasch, R., & Brill, S. (2016). Mindfulness meditation modulates pain through endogenous opioids. The American Journal of Medicine. doi:10.1016/j.amjmed.2016.03.002.

    Google Scholar 

  • Steer, R. A., Ball, R., Ranieri, W. F., & Beck, A. T. (1999). Dimensions of the Beck depression inventory-II in clinically depressed outpatients. Journal of Clinical Psychology, 55(1), 117–128.

    Article  PubMed  Google Scholar 

  • Tsafou, K., Lacroix, J. P. W., Ee, R. V., Vinkers, C. D. W., & De Ridder, D. T. D. (2016). The relation of trait and state mindfulness with satisfaction and physical activity: A cross-sectional study in 305 Dutch participants. Journal of Health Psychology. doi:10.1177/1359105315624748.

    Google Scholar 

  • Visted, E., Vollestad, J., Nielsen, M. B., & Nielsen, G. H. (2015). The impact of group-based mindfulness training on self-reported mindfulness: A systematic review and meta-analysis. Mindfulness, 6(3), 501–522. doi:10.1007/s12671-014-0283-5.

    Article  Google Scholar 

  • Wang, C. (2012). Role of Tai Chi in the treatment of rheumatologic diseases. Current Rheumatology Reports, 14(6), 598–603. doi:10.1007/s11926-012-0294-y.

    Article  PubMed  Google Scholar 

  • Wang, C., Collet, J. P., & Lau, J. (2004). The effect of Tai Chi on health outcomes in patients with chronic conditions: A systematic review. Archives of Internal Medicine, 164(5), 493–501. doi:10.1001/archinte.164.5.493.

    Article  PubMed  Google Scholar 

  • Wang, C., Iversen, M. D., McAlindon, T., Harvey, W. F., Wong, J. B., Fielding, R. A., et al. (2014). Assessing the comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: Design and rationale for a randomized trial. BMC Complementary and Alternative Medicine, 14(1), 333. doi:10.1186/1472-6882-14-333.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang, C., Schmid, C. H., Iversen, M. D., Harvey, W. F., Fielding, R. A., Driban, J. B., et al. (2016). Comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: A randomized trial. Annals of Internal Medicine. doi:10.7326/M15-2143.

    Google Scholar 

  • Ware Jr., J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473–483.

    Article  PubMed  Google Scholar 

  • Wayne, P. M., & Kaptchuk, T. J. (2008). Challenges inherent to T’ai Chi research: Part I—T’ai Chi as a complex multicomponent intervention. The Journal of Alternative and Complementary Medicine, 14(1), 95–102. doi:10.1089/acm.2007.7170A.

    Article  PubMed  Google Scholar 

  • Woolf, C. J. (2012). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3 Supplemental), 1–31. doi:10.1016/j.pain.2010.09.030.Central.

    Google Scholar 

  • Yan, J.-H., Gu, W.-J., Sun, J., Zhang, W.-X., Li, B.-W., & Pan, L. (2013). Efficacy of Tai Chi on pain, stiffness and function in patients with osteoarthritis: A meta-analysis. PloS One, 8(4), e61672. doi:10.1371/journal.pone.0061672.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ye, J., Cai, S., Zhong, W., Cai, S., & Zheng, Q. (2014). Effects of Tai Chi for patients with knee osteoarthritis: A systematic review. Journal of Physical Therapy Science, 26(7), 1133–1137. doi:10.1589/jpts.26.1133.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yu, M., & Clark, M. (2015). Investigating mindfulness, borderline personality traits, and well-being in a nonclinical population. Psychology, 6(6), 1232–1248. doi:10.4236/psych.2015.610121.

    Article  Google Scholar 

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Acknowledgements

The authors gratefully appreciate Ramel Rones, Dorri Li and Brian Muccio for their expertise in teaching the Tai Chi groups; Maura Iversen, Megan Whitmore, Marie Boneparth and Jane Lucas for their expert physical therapy instruction; Stephanie Hyon and Sun Yu for their feedback on the written manuscript; and the study participants, whose cooperation, encouragement, and enthusiasm are an inspiration.

Author’s Contributions

AL designed and executed the study, assisted with the data acquisition and analyses, interpreted the data and wrote the paper. WF collaborated with the design; data acquisition and interpretation, writing and editing of the study. JW collaborated with the design; data interpretation and writing and editing of the study. LLP acquired and analyzed the data and collaborated with the design, data interpretation and editing of the study. XH assisted with the acquisition and analysis of data, design and editing of the study. MC collaborated on the analysis and interpretation of the data and assisted with the design and editing of the study. JD collaborated with the design, data interpretation and the writing and editing of the study. LM wrote portions of the methods and discussion and collaborated with the design, data interpretation and editing of the study. NM wrote portions of the methods, assisted with data acquisition and collaborated with the design and editing of the study. CW collaborated with the design; data acquisition and interpretation, writing, and editing of the study.

Study conception and design: Lee, Price, Harvey, Wong, Chung, Han, Driban, Morgan L, Morgan N and Wang.

Acquisition of data: Lee, Price, Harvey, Wong, Chung, Han, Driban, Morgan L, Morgan N and Wang

Analysis and interpretation of data: Lee, Price, Harvey, Wong, Chung, Han, Driban, Morgan L, Morgan N and Wang

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Authors and Affiliations

  1. Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA

    Augustine C. Lee, William F. Harvey, Jeffrey B. Driban, Nani L. Morgan & Chenchen Wang

  2. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA

    Lori Lyn Price

  3. Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA

    Lori Lyn Price

  4. Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, MA, USA

    John B. Wong

  5. Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA

    Xingyi Han & Mei Chung

  6. I Ola Lahui Rural Hawaiʻi Behavioral Health, Honolulu, HI, USA

    Lucas P. K. Morgan

  7. Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA

    Nani L. Morgan

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  1. Augustine C. Lee
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  2. William F. Harvey
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  3. John B. Wong
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  4. Lori Lyn Price
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  8. Lucas P. K. Morgan
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  9. Nani L. Morgan
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  10. Chenchen Wang
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Correspondence to Augustine C. Lee.

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Conflict of Interests

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Funding

This study is supported by the National Center for Complementary and Integrative Health (R01AT005521 and K24AT007323) and the National Center for Advancing Translational Sciences (UL1TR001064) at the National Institutes of Health. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. The investigators are solely responsible for the content of the manuscript and the decision to submit for publication. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Lee, A.C., Harvey, W.F., Wong, J.B. et al. Effects of Tai Chi versus Physical Therapy on Mindfulness in Knee Osteoarthritis. Mindfulness 8, 1195–1205 (2017). https://doi.org/10.1007/s12671-017-0692-3

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