Exercise - Tai chi move towards the mainstream

Research that’s relevant to physios: Janet Wright reports on the latest clinical news

Tai chi can do more for your health than just promote relaxation, say researchers.

Evidence for this traditional Chinese exercise system has been building over the past few years.

Originally developed from martial arts, tai chi is now usually practised as a gentle exercise, looking like a slow-motion dance.

Recent studies in mainstream medical journals show it can relieve back pain, promote mental health and reduce inflammation.

An Australian randomised controlled trial (RCT) published in the journal Arthritis Care & Research supports what enthusiasts have long claimed: that tai chi can ease lower back pain.

Amanda Hall and colleagues in Sydney recruited 160 adult volunteers under the age of 70, who had persistent nonspecific lower back pain.

Half of them took tai chi classes with a qualified instructor.

The control group continued with their usual care.

After 10 weeks, the tai chi group reported that, on a scale of 0-10, their symptoms were 1.7 points less bothersome and their pain was 1.3 points less intense.

‘This is the first pragmatic RCT of tai chi exercise for people with low back pain,’ the authors said.

‘It showed that a 10-week tai chi programme improved pain and disability outcomes and can be considered a safe and effective intervention for those experiencing long-term low back pain symptoms.’

Meanwhile, Helen Lavretsky of the University of California, Los Angeles, and colleagues tried a simplified modern form called tai chi chih to treat depression among older people.

The team recruited 73 depressed people aged over 60.

Those who did tai chi chih had more relief from depression, greater improvements in physical functioning and cognitive tests and lower levels of C-reactive protein, a marker of inflammation.

‘Complementary use of a mind-body exercise, such as tai chi chih, may provide additional improvements of clinical outcomes in the pharmacologic treatment of geriatric depression,’ the researchers concluded.

Hall AM et al. Tai chi exercise for treatment of pain and disability in people with persistent low back pain. Arthritis Care and Research 2011; 63: 1576-1583.

Lavretsky H et al. Complementary use of tai chi chih augments escitalopram treatment of geriatric depression. American Journal of Geriatric Psychiatry 2011; 19: 839-850.

Thanks to CSP member Ros Smith from Cumbria, for this information.

Online comments tell it like it is, say researchers

Feedback from patients posting comments online can be as useful as formal surveys, according to a study published last month in BMJ Quality and Safety.

So, far from fearing criticism, healthcare providers should promote online reporting and encourage patients to comment, say researchers who compared the two approaches.

Felix Greaves of Imperial College London and colleagues studied nearly 10,000 comments on the NHS Choices website. This lets patients rate their treatment on quality criteria including cleanliness, dignity, involvement in decision-making and whether staff worked well together.

The patients who commented had been treated at 146 English NHS hospitals in 2009 and 2010.

The team compared these comments with answers on 68,500 responses to the 2009-2010 Inpatient Survey, a paper-based survey of a random sample of patients.

The survey’s findings are used by England’s health and social care regulator, the Care Quality Commission, to assess performance.

The researchers then checked both online and survey comments against outcome statistics at each of the hospitals, covering deaths and emergency readmissions.

They found that the online ratings significantly matched those of the formal survey on all the quality criteria.

And the online ratings matched the statistical outcomes at least as strongly as the formal survey results. In each group, two thirds of patients said they would recommend the hospital to a friend – allaying some providers’ fears that online feedback would be mostly critical.

‘Although online feedback mechanisms should not replace patient surveys, they may provide information on hospital quality that is relevant, complementary to survey data and potentially useful for patients when making choices about their healthcare,’ say the authors.

Greaves F et al. Associations between internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study. BMJ Quality and Safety 2012; doi:10.1136/bmjqs-2012-000906

Janet Wright

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