Intensive rehabilitation may be more cost effective than surgical stabilization for chronic low back pain.

Question Is Tai Chi effective and safe as a treatment for people with rheumatoid arthritis (RA)? Design Systematic review of randomised controlled trials (RCT) or controlled trials (CCT). Setting/population Ambulatory adults with a diagnosis of RA. Interventions Exercise programs with Tai Chi instruction or incorporating principles of Tai Chi philosophy. Control groups received no therapy, sham therapy, or another type of therapy. Outcomes Outcome measures from OMERACT 1993 and safety assessed as withdrawals. Results Three RCTs and one CCT including 206 participants were included in the review. On a scale from 0 (worst) to 5 (best) the methodological quality of the studies were assessed as 0 in three studies and 1 in one study. Tai Chibased exercise programs had no clinically important or statistically significant effect on most outcomes of disease activity, which included activities of daily living, patient global overall rating, tenderness or number of swollen joints (WMD 2.45 joints, 95% CI –0.45 to 5.36). For range of motion, Tai Chi participants had statistically significant and clinically important improvements in ankle plantar flexion (WMD 24.00 degrees, 95% CI 3.34 to 44.66). There were statistically greater withdrawals from the control groups than from the Tai Chi groups (RR 0.97, 95% CI 0.19 to 0.72). One study found that compared to people who participated in traditional ROM exercise/rest programs those in a Tai Chi dance program reported a significantly higher level of participation in and enjoyment of exercise both immediately and four months after completion of the Tai Chi program. Conclusion The results suggest Tai Chi does not exacerbate symptoms of rheumatoid arthritis. In addition, Tai Chi has statistically significant benefits on lower extremity range of motion, in particular ankle range of motion, for people with RA. However, four studies of low methodological quality do not provide strong evidence and the results should be interpreted with caution.