The effectiveness of tai chi for chronic musculoskeletal pain conditions: an updated systematic review and meta-analysis

Tai chi is recommended for musculoskeletal conditions, however, the evidence for its clinical effectiveness is uncertain.To determine whether tai chi is beneficial for clinical outcomes in people with musculoskeletal pain.Seven databases EMBASE, PEDro, AMED, MEDLINE, CINAHL, Sport Discus, and the Cochrane Central Register of Controlled Trials.Randomized controlled trials of tai chi for people with a chronic musculoskeletal condition were included.Two reviewers extracted data and rated risk of bias. Standardised mean differences and 95% confidence intervals (CI) were calculated for individual trials and pooled effect sizes were calculated using a random effects model.15 studies were identified including people with osteoarthritis (80%), back pain (13%) and headache (7%). Using the GRADE approach, we found moderate quality evidence that tai chi is more effective than no treatment or usual care at short term on pain (SMD -0.66 (-0.85, -0.48)) and disability (SMD -0.66 (-0.85, -0.46)). The evidence for other outcomes was of low or very low quality and there was little information regarding long-term effects. Thus, while the number of publications in this area has increased, the rigor has not, hindering our ability to provide reliable recommendations for clinical practice.The evidence provided in this review is limited by trials with small sample sizes, low methodological quality and lack of long-term assessment.In order for tai chi to be recommended as an effective intervention, more high quality trials with large sample sizes assessing tai chi versus other evidence-based treatments at short and long-term are needed