People with knee osteoarthritis (OA) who took part in a 12-week online, unsupervised tai chi program showed significant improvements in both knee pain and function compared to controls.

Clinical guidelines for knee OA strongly endorse tai chi as a recommended exercise option, and systematic reviews have shown improvements in pain, function, stiffness, and mobility on par with other forms of exercise. However, “there’s a lot of accessibility barriers to in-person tai chi, especially for those in regional and remote areas where we know there’s a higher prevalence of people with arthritis,” said study author Julia Zhu, physiotherapist and PhD candidate at The University of Melbourne, Melbourne, Australia.

The study, published in JAMA Internal Medicine on October 27, enrolled 170 people aged 45 years or older who had frequent and significant activity-related knee joint pain that had persisted for at least 3 months.

Number Needed to Treat Only Four to See Clinically Important Benefit

Researchers randomly assigned the participants to take part either a 12-week video-based online program of Yang-style tai chi — including a recommendation to download an exercise messaging app designed to encourage adherence — or to access an educational website with information about OA and exercise.

At the end of the program, participants in the tai chi arm showed a significant 1.4-point greater improvement in knee pain during walking and a significant 5.6-point greater improvement in Western Ontario and McMaster Universities Osteoarthritis Index function than those in the control group. Nearly three quarters of people in the tai chi group (73%) achieved a minimal clinically important difference in walking pain compared to 47% of those in the control group, which meant that four was the number needed to treat with the intervention to achieve this improvement.

“We obviously were happy to see the difference that’s between the groups,” Zhu told Medscape Medical News. “We were also glad to see that the therapeutic effect can be achieved through our online therapy model instead of in-person.”

Zhu said there was indirect evidence that the slow and low-impact movements of tai chi could improve joint mobility, muscle strength, balance, and proprioception, and “those effects will improve the biomechanics of the lower limb and improve the loading on the knee.” She also pointed to tai chi’s benefits for mental well-being and mood. In addition, the study found greater improvements in secondary outcomes with the tai chi intervention, including all Knee Injury and Osteoarthritis Outcome Score subscales, balance confidence, and global overall knee improvement.

A total of 82% of participants did the exercises at least 2 days per week, and they reported being highly satisfied with the program and likely to recommend it to others. Zhu said many of the participants had never done tai chi before, and they appreciated the flexibility of the program; they could pause and rewind the videos to keep up with the instructor.

The app was also important in improving adherence, Zhu said, and it was able to provide messages tailored to participants’ unique concerns or barriers. “If they reported that they got pain so that they don’t want to continue, then we send a message just specifically targeting this particular thought or barrier, saying, ‘some pain is normal, but if you actually move more it will help you,’” she said.

Online Program May Serve a Very Important Need

Grace Hsiao-Wei Lo, MD, MS, rheumatologist and epidemiologist with Baylor College of Medicine in Houston, said this sort of online program for knee OA serves a very important need, particularly given many people’s reluctance to talk to their physician about OA.

“Finding strategies where people can learn to self-manage their osteoarthritis is actually probably a better strategy overall because the number of people who have it is so high, and the burden of the disease is very high,” Lo told Medscape Medical News.

The study was supported by the National Health and Medical Research Council. Zhu was supported by the Australian Government Research Training Program, and another author was supported by the University of Melbourne. Lo had no relevant conflicts of interest.