Kinesitherapy for Knee Osteoarthritis Patients Physical and Psychological Health Based on “Traditional Chinese Exercise” Management Modalities: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Biao Tan, Yan Yan, Qiujun Zhou, Qiang Ran, Hong Chen, Shiyi Sun, Weizhong Lu, Weiheng Chen, Jiajun Wang
Kinesitherapy for Knee Osteoarthritis Patients Physical and Psychological Health Based on “Traditional Chinese Exercise” Management Modalities: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Traditional Chinese exercise (“TCE” management modalities), including but not limited to Tai Chi, Baduanjin, and Yijinjing, has a good effect on improving the physical function of patients with knee osteoarthritis, but less attention has been paid to the impact on the psychological health of patients, and currently there is insufficient evidence to support it. We conducted this study to provide a systematic synthesis of best evidence regarding the physical and mental health of patients with knee osteoarthritis treated by traditional Chinese exercise. Literature on the effectiveness of traditional Chinese exercise (Tai Chi, Baduanjin, Yijinjing, Qigong, etc.) versus conventional therapy (muscle-strength training of the lower extremity and aerobic training, wellness education, quadriceps strengthening exercises, etc.) on Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog scale (VAS), Short Form-36 (SF-36), Timed Up and Go Test (TUG), and Berg Balance Scale (BBS) in knee osteoarthritis (KOA) from Pubmed, Web of Science, Ovid Technologies, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang Database, and SinoMed were collected from their inception to April 2022. Thirty-three studies with 2621 cases were included in this study. The study's results indicated that compared with conventional therapy, traditional Chinese exercise had more advantages on patients' WOMAC score, significantly reducing patients' overall WOMAC score (SMD = -0.99; 95% CI: -1.38, -0.60; p < 0.00001) and relieving pain (SMD = -0.76; 95% CI: -1.11, -0.40; p < 0.0001) in patients with KOA. It also has advantages over conventional therapy in improving mental component score (MCS) (SMD = 0.32; 95% CI: -0.00, 0.65; p = 0.05) and physical component score (PCS) (SMD = 0.34; 95% CI: 0.05, 0.62; p = 0.02). Compared with conventional therapy, traditional Chinese exercise can significantly reduce the effect on timed up and go test (TUG) score (SMD = -0.30; 95% CI: -0.50, -0.11; p = 0.002), beck depression inventory (DBI) score (SMD = -0.62; 95% CI: -1.03, -0.22; p = 0.002), and increase the impact on Berg Balance Scale (BBS) score (SMD = 0.60; 95% CI: 0.37, 0.83; p < 0.00001). The findings of this study indicated that traditional Chinese exercise improved body function and mental health in patients with knee osteoarthritis significantly. More high-quality clinical evidence-based data was needed to confirm the therapeutic effect of traditional Chinese exercise on the physical and mental health in KOA patients.
Knee Osteoarthritis / Meta-analysis / Physical Health / Psychological Health / Traditional Chinese Exercise
[1] |
Bortoluzzi A, Furini F, Scirè CA. Osteoarthritis and its management-epidemiology, nutritional aspects and environmental factors. Autoimmun Rev. 2018;17:1097–1104.
|
[2] |
O'Neill TW, McCabe PS, McBeth J. Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best Pract Res Clin Rheumatol. 2018;32:312–326.
|
[3] |
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2197–2223.
|
[4] |
Safiri S, Kolahi AA, Smith E, Hill C, Bettampadi D, Mansournia MA, et al. Global, regional and national burden of osteoarthritis 1990–2017: a systematic analysis of the global burden of disease study 2017. Ann Rheum Dis. 2020;79:819–828.
|
[5] |
Lin KW. Treatment of knee osteoarthritis. Am Fam Physician. 2018;98:603–606.
|
[6] |
Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72:220–233.
|
[7] |
Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162:46–54.
|
[8] |
Lopa S, Colombini A, Moretti M, de Girolamo L. Injective mesenchymal stem cell-based treatments for knee osteoarthritis: from mechanisms of action to current clinical evidences. Knee Surg Sports Traumatol Arthrosc. 2019;27:2003–2020.
|
[9] |
Zhao J, Huang H, Liang G, Zeng LF, Yang W, Liu J. Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2020;21:224.
|
[10] |
Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold-Samsøe B, Dagfinrud H, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016;2016(3):CD005523.
|
[11] |
BennellK HR. Exercise as a treatment for osteoarthritis. Curr Opin Rheumatol. 2005;17:634–640.
|
[12] |
DeRogatis M, Anis HK, Sodhi N, Ehiorobo JO, Chughtai M, Bhave A, et al. Non-operative treatment options for knee osteoarthritis. Ann Transl Med. 2019;7:S245.
|
[13] |
Meiyappan KP, Cote MP, Bozic KJ, Halawi MJ. Adherence to the American academy of orthopaedic surgeons clinical practice guidelines for nonoperative management of knee osteoarthritis. J Arthroplasty. 2020;35:347–352.
|
[14] |
Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27:1578–1589.
|
[15] |
Zhang Y, Huang L, Su Y, Zhan Z, Li Y, Lai X. The effects of traditional Chinese exercise in treating knee osteoarthritis: a systematic review and meta-analysis. PloS One. 2017;12:e0170237.
|
[16] |
Wang X, Pi Y, Chen B, Chen P, Liu Y, Wang R, et al. Effect of traditional Chinese exercise on the quality of life and depression for chronic diseases: a meta-analysis of randomised trials. Sci Rep. 2015;5:15913.
|
[17] |
Palermi S, Sacco AM, Belviso I, Marino N, Gambardella F, Loiacono C, et al. Effectiveness of tai chi on balance improvement in type 2 diabetes patients: a systematic review and meta-analysis. J Aging Phys Act. 2020;3:1–11.
|
[18] |
Koh TC. Baduanjin-an ancient Chinese exercise. Am J Chin Med. 1982;10:14–21.
|
[19] |
Guo Y, Xu M, Wei Z, Hu Q, Chen Y, Yan J, et al. Beneficial effects of qigong Wuqinxi in the improvement of health condition, prevention, and treatment of chronic diseases: evidence from a systematic review. Evid Based Complement Alternat Med. 2018;2018:3235950.
|
[20] |
Zeng ZP, Liu YB, Fang J, Liu Y, Luo J, Yang M. Effects of Baduanjin exercise for knee osteoarthritis: a systematic review and meta-analysis. Complement Ther Med. 2020;48:102279.
|
[21] |
Zou L, Zhang Y, Sasaki JE, Yeung AS, Yang L, Loprinzi PD, et al. Wuqinxi Qigong as an alternative exercise for improving risk factors associated with metabolic syndrome: a meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2019;16:1396.
|
[22] |
Xiao CM, Li JJ, Kang Y, Zhuang YC. Follow-up of a Wuqinxi exercise at home programme to reduce pain and improve function for knee osteoarthritis in older people: a randomised controlled trial. Age Ageing. 2021;50:570–575.
|
[23] |
Wayne PM, Kaptchuk TJ. Challenges inherent to t'ai chi research: part I–t'ai chi as a complex multicomponent intervention. J Altern Complement Med. 2008;14:95–102.
|
[24] |
Li X, Geng J, Du X, Si H, Wang Z. Relationship between the practice of tai chi for more than 6 months with mental health and brain in university students: an exploratory study. Front Hum Neurosci. 2022;16:912276.
|
[25] |
Yao Y, Ge L, Yu Q, Du X, Zhang X, Taylor-Piliae R, et al. The effect of Tai Chi Chuan on emotional health: potential mechanisms and prefrontal cortex hypothesis. Evid Based Complement Alternat Med. 2021;2021:5549006.
|
[26] |
Hu L, Wang Y, Liu X, Ji X, Ma Y, Man S, et al. Tai Chi exercise can ameliorate physical and mental health of patients with knee osteoarthritis: systematic review and meta-analysis. Clin Rehabil. 2021;35:64–79.
|
[27] |
Lee HJ, Park HJ, Chae Y, Kim SY, Kim SN, Kim ST, et al. Tai Chi Qigong for the quality of life of patients with knee osteoarthritis: a pilot, randomized, waiting list controlled trial. Clin Rehabil. 2009;23:504–511.
|
[28] |
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.
|
[29] |
Ko PY, Li CY, Li CL, Kuo LC, Su WR, Jou IM, et al. Single injection of cross-linked hyaluronate in knee osteoarthritis: a 52-week double-blind randomized controlled trial. Pharmaceutics. 2022;14:1783.
|
[30] |
Ribeiro IC, Coimbra AMV, Costallat BL, Coimbra IB. Relationship between radiological severity and physical and mental health in elderly individuals with knee osteoarthritis. Arthritis Res Ther. 2020;22:187.
|
[31] |
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
|
[32] |
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.
|
[33] |
Lee AC, Harvey WF, Wong JB, Price LL, Han X, Chung M, et al. Effects of tai chi versus physical therapy on mindfulness in knee osteoarthritis. Mindfulness. 2017;8:1195–1205.
|
[34] |
An B, Dai K, Zhu Z, Wang Y, Hao Y, Tang T, et al. Baduanjin alleviates the symptoms of knee osteoarthritis. J Altern Complement Med. 2008;14:167–174.
|
[35] |
Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, et al. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum. 2009;61:1545–1553.
|
[36] |
Wang C, Schmid CH, Iversen MD, Harvey WF, Fielding RA, Driban JB, et al. Comparative effectiveness of tai chi versus physical therapy for knee osteoarthritis: a randomized trial. Ann Intern Med. 2016;165:77–86.
|
[37] |
Chen FN, Wu WM, Le YM. Application of Baduanjin in functional exercise of elderly patients with chronic knee osteoarthritis and its effect on exercise capacity and self-management effectiveness. Chin J Health Manage Forum. 2020;14:556–559.
|
[38] |
Chen YD, Liu HG, Luo M, Jia HS, Guo YG, Zhong C. Rehabilitation effect and quality of life of Tai Chi combined with muscle strength training in patients with early and mid-stage knee osteoarthritis. Chin J Trauma and Disability Med. 2021;29:49–51.
|
[39] |
Xiao C, Zhuang Y, Kang Y. Effects of Wu Qin xi Qigong exercise on physical functioning in elderly people with knee osteoarthritis: a randomized controlled trial. Geriatr Gerontol Int. 2020;20:899–903.
|
[40] |
Wang F, Zhang X, Tong X, Zhang M, Xing F, Yang K, et al. The effects on pain, physical function, and quality of life of quadriceps strengthening exercises combined with Baduanjin qigong in older adults with knee osteoarthritis: a quasi-experimental study. BMC Musculoskelet Disord. 2021;22:313.
|
[41] |
Brismée JM, Paige RL, Chyu MC, Boatright JD, Hagar JM, McCaleb JA, et al. Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2007;21:99–111.
|
[42] |
Ye J, Simpson MW, Liu Y, Lin W, Zhong W, Cai S, et al. The effects of Baduanjin Qigong on postural stability, proprioception, and symptoms of patients with knee osteoarthritis: a randomized controlled trial. Front Med. 2020;6:307.
|
[43] |
Lü J, Huang L, Wu X, Fu W, Liu Y. Effect of Tai Ji Quan training on self-reported sleep quality in elderly Chinese women with knee osteoarthritis: a randomized controlled trail. Sleep Med. 2017;33:70–75.
|
[44] |
Chen KW, Perlman A, Liao JG, Lam A, Staller J, Sigal LH. Effects of external qigong therapy on osteoarthritis of the knee. A randomized controlled trial. Clin Rheumatol. 2008;27:1497–1505.
|
[45] |
Li JY, Cheng L. The effect of Taichi and resistance training on osteoarthritis symptoms of the elderly and exercise capacity. Chin J Rehabil Med. 2019;34:1304–1309.
|
[46] |
Li TJ, Li X, Zhong WH, Chen ZH, Zheng QK. Study on the mechanism of Yijinjing exercise in improving the syndrome of liver and kidney deficiency in senile degenerative knee osteoarthritis. Guangming J Chinese Med. 2018;33:3456–3459.
|
[47] |
Fransen M, Nairn L, Winstanley J, Lam P, Edmonds J. Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Rheum. 2007;57:407–414.
|
[48] |
Wortley M, Zhang S, Paquette M, Byrd E, Baumgartner L, Klipple G. Effects of resistance and Tai Ji training on mobility and symptoms in knee osteoarthritis patients. J Sport Health Sci. 2013;2:209–214.
|
[49] |
Nahayatbin M, Ghasemi M, Rahimi A, Khademi-Kalantari K, Zarein-Dolab S. The effects of routine physiotherapy alone and in combination with either tai chi or closed kinetic chain exercises on knee osteoarthritis: a comparative clinical trial study. Iran Red Crescent Med J. 2018;20:1–9.
CrossRef
Google scholar
|
[50] |
Pan XY, Huang LY, Lv JJ, Wu X, Niu WX, Liu Y. Effects of innovative Tai Chi on the lower-extremity muscle strength and dynamic balance of the elderly women with knee osteoarthritis. Sport Sci Res. 2017;38:68–71.
|
[51] |
Chen PY, Song CY, Yen HY, Lin PC, Chen SR, Lu LH, et al. Impacts of tai chi exercise on functional fitness in community-dwelling older adults with mild degenerative knee osteoarthritis: a randomized controlled clinical trial. BMC Geriatr. 2021;21:449.
|
[52] |
Song R, Lee EO, Lam P, Bae SC. Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. J Rheumatol. 2003;30:2039–2044.
|
[53] |
Zhang S, Guo G, Li X, Yao F, Wu Z, Zhu Q, et al. The effectiveness of traditional Chinese Yijinjing qigong exercise for the patients with knee osteoarthritis on the pain, dysfunction, and mood disorder: a pilot randomized controlled trial. Front Med. 2022;8:792436.
|
[54] |
Wang CM, Meng LG. Clinical study on the intervention of Baduanjin in elderly knee osteoarthritis. Chin J Integr Med. 2016;4:158.
|
[55] |
Xu L, Tang XZ. Effects of 24-style simplified Tai Chi on joint function of elderly patients with knee osteoarthritis. J Nurs. 2016;21:51–53.
|
[56] |
Yang CJ, Gao XX, Zhan YW, Yuan YT, Wang YW. Effect of new horizontal Baduanjin characteristic training on elderly patients with knee osteoarthritis. Chinese Manipulation and Rehabilitation Medicine. 2021;12:27–29.
|
[57] |
Ye JJ, Wang LS. The effects of Tai Chi on balance and proprioception in elderly with knee osteoarthritis: a randomized controlled study. J Nanjing Sport Institute (Nat Sci). 2017;16:12–16.
|
[58] |
Ye YY, Niu XM, Qiu ZW, Zhong WH, Huang CW, Chen J, et al. Effect of Yijinjing on knee joint function in patients with knee osteoarthritis. Rheumatism and Arthritis. 2019;8:19–23.
|
[59] |
Zhao YY, Mi YQ, Gang JH, Wang HM, Chen YQ. Clinical study on Yi Jin Jing exercises combined with articular injection for early-to-mid osteoarthritis. Chin New Med J. 2020;52:72–75.
|
[60] |
Zheng YZ, Zhou SB, Li MF. Observation on the therapeutic effect and mechanism of Tai Chi on patients with early knee osteoarthritis. J Tradit Chin Med. 2019;31:970–973.
|
[61] |
Xiao Z, Li G. The effect of Wuqinxi exercises on the balance function and subjective quality of life in elderly, female knee osteoarthritis patients. Am J Transl Res. 2021;13:6710–6716.
|
[62] |
Zhou ZF. The effect of Tai Chi on influence in patients with osteoarthritis of the knee. Chin J Geriatric Care. 2019;17:15–17.
|
[63] |
Zhu Q, Huang L, Wu X, Zhang Y, Min F, Li J, et al. Effect of Taijiquan practice versus wellness education on knee proprioception in patients with knee osteoarthritis: a randomized controlled trial. J Tradit Chin Med. 2017;37:774–781.
|
[64] |
Oo WM, Liu X, Hunter DJ. Pharmacodynamics, efficacy, safety and administration of intra-articular therapies for knee osteoarthritis. Expert Opin Drug Metab Toxicol. 2019;15:1021–1032.
|
[65] |
Liu B, Fan Z, Wang Z, Li M, Lu T. The efficacy and safety of Health Qigong for ankylosing spondylitis: protocol for a systematic review and meta-analysis. Medicine. 2020;99:e18734.
|
[66] |
Li R, Chen H, Feng J, Xiao Y, Zhang H, Lam CW, et al. Effectiveness of traditional Chinese exercise for symptoms of knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2020;17:7873.
|
[67] |
Guo J, Peng C, Hu Z, Guo L, Dai R, Li Y. Effect of Wu Qin Xi exercises on pain and function in people with knee osteoarthritis: a systematic review and meta-analysis. Front Med. 2022;9:979207.
|
[68] |
Zhang S, Huang R, Guo G, Kong L, Li J, Zhu Q, et al. Efficacy of traditional Chinese exercise for the treatment of pain and disability on knee osteoarthritis patients: a systematic review and meta-analysis of randomized controlled trials. Front Public Health. 2023;11:1168167.
|
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