An Exploratory Three-Arm Randomized Controlled Trial: The Clinical Effects of Tai Chi, Baduanjin, and Health Education in the Management of Knee Osteoarthritis.
Zeng Tao T, Chen Zi-Liang ZL, Zhou Yao-Hui YH, Liu Wei-Qi WQ
This three-arm randomized controlled trial aimed to investigate the comparative clinical effects of Tai Chi (TC), Baduanjin(BDJ), and Health Education(HE) for controlling symptoms and restoring physical function in individuals diagnosed with knee osteoarthritis(KOA). This randomized controlled trial was conducted on patients with KOA, who were randomly allocated 1:1:1 to three groups (40 participants per group, total randomized n=120): TC, BDJ, or HE. The study lasted 48 weeks, comprising a 12-week intervention phase and a 36-week follow-up. The primary outcomes were the pain, stiffness, and physical function subscales of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included the Berg Balance Scale, 6-minute walk test, and the SF-36 quality-of-life assessment. All measures were evaluated at weeks 12, 24, and 48. The primary analysis utilized a linear mixed model based on the modified intention-to-treat (mITT) population (n=116; TC n=38, BDJ n=39, HE n=39), including six participants with partial post-baseline follow-up data. The per-protocol population (n=110) was used for sensitivity analysis. No statistically significant between-group differences in primary outcomes-WOMAC pain, stiffness, and physical function-were detected between the TC and BDJ groups across 12, 24 and 48week assessments (P> 0.05). Compared with HE, TC yielded a mean reduction in WOMAC pain of -3.22 points (95% CI -3.96 to -2.48; P < 0.001), and BDJ yielded a mean reduction of -3.04 points (95% CI -3.78 to -2.30; P < 0.001), indicating superior pain relief for both exercise interventions. Both TC and BDJ groups demonstrated significantly greater improvements compared to the HE group across all time points (P < 0.05). A similar trend was evident in the secondary outcomes. Regular TC and BDJ practice effectively improved the pain, stiffness, and physical function of older adults with KOA, enhanced their balance and walking endurance, and elevated their quality of life. Although no statistically significant difference was detected between TC and BDJ, both exercises showed greater clinical improvements relative to the HE control. These findings support the integration of TC and BDJ as effective, potentially low-cost, non-pharmacological therapies into clinical practice for the long-term management of KOA.The trial was registered in International Traditional Medicine Clinical Trial Registry (ITMCTR), http://itmctr.ccebtcm.org.cn/, identifier ITMCTR2025000409.