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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2009

Open Access 01-12-2009 | Study protocol

A randomized controlled trial of tai chi for long-term low back pain (TAI CHI): Study rationale, design, and methods

Authors: Amanda M Hall, Chris G Maher, Jane Latimer, Manuela L Ferreira, Paul Lam

Published in: BMC Musculoskeletal Disorders | Issue 1/2009

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Abstract

Background

Low back pain persisting for longer than 3 months is a common and costly condition for which many current treatments have low-moderate success rates at best. Exercise is among the more successful treatments for this condition, however, the type and dosage of exercise that elicits the best results is not clearly defined. Tai chi is a gentle form of low intensity exercise that uses controlled movements in combination with relaxation techniques and is currently used as a safe form of exercise for people suffering from other chronic pain conditions such as arthritis. To date, there has been no scientific evaluation of tai chi as an intervention for people with back pain. Thus the aim of this study will be to examine the effects of a tai chi exercise program on pain and disability in people with long-term low back pain.

Methods and design

The study will recruit 160 healthy individuals from the community setting to be randomised to either a tai chi intervention group or a wait-list control group. Individuals in the tai chi group will attend 2 tai chi sessions (40 minutes)/week for 8 weeks followed by 1 tai chi session/week for 2 weeks. The wait-list control will continue their usual health care practices and have the opportunity to participate in the tai chi program once they have completed the follow-up assessments. The primary outcome will be bothersomeness of back symptoms measured with a 0–10 numerical rating scale. Secondary outcomes include, self-reports of pain-related disability, health-related quality of life and global perceived effect of treatment. Statistical analysis of primary and secondary outcomes will be based on the intention to treat principle. Linear mixed models will be used to test for the effect of treatment on outcome at 10 weeks follow up. This trial has received ethics approval from The University of Sydney Human Research Ethics Committee. HREC Approval No.10452

Discussion

This study will be the first trial in this area and the information on its effectiveness will allow patients, clinicians and treatment funders to make informed choices regarding this treatment.

Trial Registration

This trial has been registered with Australian New Zealand Clinical Trials Registry. ACTRN12608000270314
Appendix
Available only for authorised users
Literature
1.
Walker B, Muller R, Grant W: Low back pain in Australian adults. Health provider utilization and care seeking. Journal of Manipulative Physiology Therapy. 2004, 27: 327-235. 10.1016/j.jmpt.2004.04.006.CrossRef
2.
Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J: Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. British Medical Journal. 2008, 337 (7662):
3.
Pengel LHM, Herbert RD, Maher CG, Refshauge KM: Acute low back pain: systematic review of its prognosis. British Medical Journal. 2003, 327 (7410): 323-325. 10.1136/bmj.327.7410.323.CrossRefPubMedPubMedCentral
4.
Bogduk N: Management of chronic low back pain. Medical Journal of Australia. 2004, 180 (2): 79-83.PubMed
5.
ABS: National Health Survey. Summary of Results. 2002, Australian Bureau of Statistics: Canberra
6.
AIHW: Eighth Biennial Health Report of the Australian Institute of Health and Welfare. 2004, Australian Institute of Health and Welfare: Canberra
7.
8.
Nachemson A: Back Pain – causes, diagnosis and treatment. 1991, The Swedish Council of Technology Assessment in Health Care: Stolkholm
9.
Chou R, Huffman LH: Nonpharmacologic therapies for acute and chronic low back pain: A review of the evidence for an American pain Society/American college of physicians clinical practice guideline. Annals of Internal Medicine. 2007, 147 (7): 492-504.CrossRefPubMed
10.
Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD: Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial. Pain. 2007, 131 (1–2): 31-37. 10.1016/j.pain.2006.12.008.CrossRefPubMed
11.
Macedo L, Latimer J, Maher C, Hodges P, Nicholas M, Tonkin L: Motor Control or Graded activity exercises for chronic low back pain? A randomised controlled trial. BMC Musculoskeletal Disorders. 2008, 9 (65):
12.
Maher C, Latimer J, Hodges P, Refshauge K, Moseley L, Herbert RD: The effect of motor control exercise versus placebo in patients with chronic low back pain [ACTRN012605000262606]. BMC Musculoskeletal Disorders. 2005, 6 (54):
13.
Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K: Specific stabilisation exercise for spinal and pelvic pain: A systematic review. Australian Journal of Physiotherapy. 2006, 52 (2): 79-88.CrossRefPubMed
14.
CG Maher: Effective physical treatment for chronic low back pain. Orthopedic Clinics of North America. 2004, 35 (1): 57-10.1016/S0030-5898(03)00088-9.CrossRef
15.
Clare HA, Adams R, Maher CG: A systematic review of efficacy of McKenzie therapy for spinal pain. Australian Journal of Physiotherapy. 2004, 50 (4): 209-216.CrossRefPubMed
16.
Maher C, Latimer J, Refshauge K: Prescription of activity for low back pain: What works?. Australian Journal of Physiotherapy. 1999, 45 (2): 121-132.CrossRefPubMed
17.
Hayden JA, van Tulder MW, Malmivaara AV, Koes BW: Meta-analysis: Exercise therapy for nonspecific low back pain. Annals of Internal Medicine. 2005, 142 (9): 765-775.CrossRefPubMed
18.
Han A, Robinson V, Judd M, Taixiang W, Wells G, Tugwell P: Tai chi for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2004, 3: Art. No.:CD004849-PubMed
19.
Brismee JM, Paige RL, Chyu MC, Boatright JD, Hagar JM, McCaleb JA: Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Clinical Rehabilitation. 2007, 21 (2): 99-111. 10.1177/0269215506070505.CrossRefPubMed
20.
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. Journal of Rheumatology. 2003, 30 (9): 2039-2044.PubMed
21.
Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu TS: Reducing frailty and falls in older persons: An investigation of Tai Chi and computerized balance training. Journal of the American Geriatrics Society. 1996, 44 (5): 489-497.CrossRefPubMed
22.
Jin P: changes in heart-rate, noradrenaline, cortisol and mood during tai chi. Journal of Psychosomatic Research. 1989, 33 (2): 197-206. 10.1016/0022-3999(89)90047-0.CrossRefPubMed
23.
Jin PT: Efficacy of tai chi, brisk walking, meditation, and reading in reducing mental and emotional stress. Journal of Psychosomatic Research. 1992, 36 (4): 361-370. 10.1016/0022-3999(92)90072-A.CrossRefPubMed
24.
La Forge R: Mind-body fitness: encouraging prospects for primary and secondary prevention. Journal of Cardiovascular Nursing. 1997, 11 (3): 53-65.CrossRefPubMed
25.
Wang CC, Collet JP, Lau J: The effect of Tai Chi on health outcomes in patients with chronic conditions – A systematic review. Archives of Internal Medicine. 2004, 164 (5): 493-501. 10.1001/archinte.164.5.493.CrossRefPubMed
26.
ACSM, ed: ACSM's Guidelines for Exercise Testing and Prescription. 1995, Williams and Wilkins: Baltimore, 7th revised
27.
Hayden JA, van Tulder MW, Tomlinson G: Systematic review: Strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of Internal Medicine. 2005, 142 (9): 776-785.CrossRefPubMed
28.
Lam P, ed: Teaching Tai Chi Effectively. 2006, Tai Chi Productions: Narwee, 222-
29.
Stewart MJ, Maher CG, Refshauge KM, Herbert RD, Bogduk N, Nicholas M: Randomized controlled trial of exercise for chronic whiplash-associated disorders. Pain. 2007, 128 (1–2): 59-68. 10.1016/j.pain.2006.08.030.CrossRefPubMed
30.
Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA: Comparing yoga, exercise, and a self-care book for chronic low back pain – A randomized, controlled trial. Annals of Internal Medicine. 2005, 143 (12): 849-856.CrossRefPubMed
31.
Dunn KM, Croft PR: Classification of low back pain in primary care: Using "bothersomeness" to identify the most severe cases. Spine. 2005, 30 (16): 1887-1892. 10.1097/01.brs.0000173900.46863.02.CrossRefPubMed
32.
Deyo RA, Battie M, Beurskens A, Bombardier C, Croft P, Koes B: Outcome measures for low back pain research – A proposal for standardized use. Spine. 1998, 23 (18): 2003-2013. 10.1097/00007632-199809150-00018.CrossRefPubMed
33.
Tait RC, Chibnall JT, Krause S: The Pain Disability Index – Psychometric properties. Pain. 1990, 40 (2): 171-182. 10.1016/0304-3959(90)90068-O.CrossRefPubMed
34.
Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, Wood Dauphinee S, Lamping DL: The Quebec Back Pain Disability Scale: Conceptualization and development. Journal of Clinical Epidemiology. 1996, 49 (2): 151-161. 10.1016/0895-4356(96)00526-4.CrossRefPubMed
35.
Pengel LHM, Refshauge KM, Maher CG: Responsiveness of pain, disability, and physical impairment outcomes in patients with low back pain. Spine. 2004, 29 (8): 879-883. 10.1097/00007632-200404150-00011.CrossRefPubMed
36.
Scrimshaw SV, Maher C: Responsiveness of visual analogue and McGill pain scale measures. Journal of Manipulative and Physiological Therapeutics. 2001, 24 (8): 501-504. 10.1067/mmt.2001.118208.CrossRefPubMed
37.
Ware JE, Sherbourne CD: The MOS 36-item Short-Form Health Survey (SF-36).1. Conceptual-framework and item selection. Medical Care. 1992, 30 (6): 473-483. 10.1097/00005650-199206000-00002.CrossRefPubMed
38.
Rosenstiel AK, Keefe FJ: The use of coping strategies in chronic low-back pain patients – relationship to patient charateristics and current adjustment. Pain. 1983, 17 (1): 33-44. 10.1016/0304-3959(83)90125-2.CrossRefPubMed
39.
Morris R: A study of the natural-history of back pain.1. Development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983, 8 (2): 141-144. 10.1097/00007632-198303000-00004.CrossRefPubMed
40.
Chaory K, Fayad F, Rannou F, Lefevre-Colau MM, Fermanian J, Revel M: Validation of the French version of the Fear Avoidance Belief Questionnaire. Spine. 2004, 29 (8): 908-913. 10.1097/00007632-200404150-00018.CrossRefPubMed
41.
Bland M: An introduction to medical statistics. 2000, O.U. Press. New York, 3
42.
Brookes S, Whitley E, Peters T, Mulheran P, Egger M, Davey Smith G: Subgroup analyses in randomised controlled trials: quantifying the risks of false-positives and false-negatives. Health Technology Assessment. 2001, 5 (33): 1-56.CrossRefPubMed
43.
McGuirk B, King W, Govind J, Lowry J, Bogduk N: Safety, efficacy, and cost effectiveness of evidence-based guidelines for the management of acute low back pain in primary care. Spine. 2001, 26 (23): 2615-2622. 10.1097/00007632-200112010-00017.CrossRefPubMed
Metadata
Title
A randomized controlled trial of tai chi for long-term low back pain (TAI CHI): Study rationale, design, and methods
Authors
Amanda M Hall
Chris G Maher
Jane Latimer
Manuela L Ferreira
Paul Lam
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2009
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-10-55

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