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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

The effect of Tai Chi on psychosocial well-being: a systematic review of randomized controlled trials

WC Wang, AL Zhang, B Rasmussen, LW Lin, T Dunning, SW Kang, BJ Park, and SK Lo.

Review published: 2009.

CRD summary

The authors concluded that there were some indications that Tai Chi could lead to improved psychosocial well-being, but that, due to limited evidence, no firm conclusions could be made. Given the different populations, interventions, and outcomes evaluated in this review, and the apparent poor quality of the included trials, the authors' lack of firm conclusions appears appropriate.

Authors' objectives

To assess the effect of Tai Chi (traditional Chinese exercise) on psychosocial well-being.

Searching

MEDLINE, CINAHL, EMBASE, PsycINFO, CISCOM and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to August 2008; search terms were reported. Dissertations and conference proceedings were also searched. Non-English language studies were excluded from the review.

Study selection

Randomised controlled trials (RCTs) that compared Tai Chi with other forms of activities or no activity (i.e. waiting list), and that evaluated psychosocial outcomes such as depression, stress, anxiety and sleep disorder, were eligible for inclusion.

The conditions of the participants varied across included trials: chronic heart failure; back pain; depression; osteoarthritis; human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS); high blood pressure; rheumatoid arthritis; or older and/or sedentary healthy adults. Where reported, the mean age of the participants ranged from 36 to 72.6 years. The Tai Chi intervention was mainly a modified Yang style. Interventions ranged from three sessions three times per week (40/45 to 50 minutes), to two sessions per week (55/60 or 90 minutes), or one session per week. Trial duration ranged from six to 48 weeks. Control groups included no treatment, or activities such as health education, walking, meditation and reading. Outcomes measured included anxiety, depression, mood, stress, general mental health, anger, positive/negative effect, self-esteem, life satisfaction, social interaction, and self-rated health.

Two authors independently selected the studies, with any disagreements resolved by consensus or by discussion with a third author.

Assessment of study quality

The quality of included trials was assessed using the following criteria: randomisation, blinding, withdrawals/dropouts, inclusion/exclusion criteria, adverse effects and statistical analysis. Each quality criteria was given a score (using a modified Jadad scale), with combined scores of 3 or less representing 'non-high' quality trials, and scores of 4 to 8 representing high quality trials. The authors also reported on intention-to-treat analysis.

Two authors independently assessed quality, with any disagreements resolved by consensus or by discussion with a third author.

Data extraction

For each outcome reported within a trial, effect sizes with 95% confidence intervals (CI) were calculated.

The authors did not state how many reviewers performed the data extraction.

Methods of synthesis

The studies were combined in a narrative synthesis.

Results of the review

Fifteen RCTs (1,229 participants) were included in the review. Eight trials were considered to be of high quality.

Thirteen trials, including six high quality trials, showed statistically significant effects of Tai Chi, but only four trials found statistically significant between-group differences; of these only one was considered to be high quality.

The results varied across trials; between group differences or effect sizes were not reported in all of the trials. Some significant differences in favour of Tai Chi compared with control interventions were reported for depression, anxiety, and mood, but not for general mental health or stress outcomes.

Authors' conclusions

There were some indications that Tai Chi could lead to improved psychosocial well-being but, due to limited evidence, no firm conclusions could be made.

CRD commentary

The review addressed a clear question and was supported by appropriate inclusion criteria for study design, intervention, comparisons, and outcomes. Inclusion criteria regarding the participants were not defined. Attempts to identify all relevant studies were undertaken by searching a number of databases, and other sources, including dissertation and conference proceeding. The authors excluded non-English language studies, introducing the possibility of language bias into the review. However, as the authors discussed, much of the literature on Tai Chi may have been published in Asian language journals. At least two reviewers were involved in most aspects of review process, minimising the potential for reviewer bias.

Study quality was assessed using appropriate criteria, and the overall quality of the studies was considered in the analysis. Trial details were presented in tables, although data and between group statistical comparisons were not always presented, which made it difficult to independently assess the trial results. Due to heterogeneity, the trials were appropriately combined in a narrative synthesis. It was not clear if two trials (Chou 2004 and Chou 2008) contained results from the same study group, and should have been considered as one trial.

Given the different populations, interventions, and outcomes evaluated in this review, and the apparent poor quality of the included trials, the authors' lack of firm conclusions appears appropriate.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that further well-designed RCTs, with appropriate follow-up periods, that evaluate specific Tai Chi instructional technique and style on the mental health of homogeneous populations are required.

Funding

Not stated.

Bibliographic details

Wang WC, Zhang AL, Rasmussen B, Lin LW, Dunning T, Kang SW, Park BJ, Lo SK. The effect of Tai Chi on psychosocial well-being: a systematic review of randomized controlled trials. Journal of Acupuncture and Meridian Studies 2009; 2(3): 171-181. [PubMed: 20633489]

Indexing Status

Subject indexing assigned by NLM

MeSH

Humans; Mood Disorders /psychology /therapy; Randomized Controlled Trials as Topic; Tai Ji; Treatment Outcome

AccessionNumber

12009109799

Database entry date

19/01/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20633489

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