CClinicalTrials.gg
CompletedNCT03299192Updated Apr 2, 2024Results posted

Tai Chi for Chronic Low Back Pain in Older Adults

An interventional study of Tai Chi and Health Education in Back Pain Lower Back Chronic, sponsored by Kaiser Permanente. Completed at 1 site in United States. Open to participants aged 65 Years and older. Per ClinicalTrials.gov, last updated 2024-04-02.

Sponsored by Kaiser Permanente · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
57
Allocation
Randomized
Ages
65 Years and older
Sex
All
01

Study summary

There is a major gap in knowledge about safe and effective treatment options for older adults with chronic low back pain. This project will determine the feasibility of conducting a full-scale trial evaluating Tai Chi, a promising "mind-body" intervention that seems particularly well-suited for older adults with chronic low back pain.

Read the detailed description

The ultimate goal of this project is to help fill the substantial gap in knowledge about safe and effective treatments for older adults with chronic low back pain. This deficiency is a particular problem because treatments that have been found safe and effective for younger adults may not be appropriate for an older population that is at higher risk of adverse effects and that may have different needs and treatment preferences. Tai Chi, which has been found effective for chronic back pain in younger adults, seems particularly well-suited for older adults with chronic low back pain because it includes multiple therapeutic elements, is gentle and has been found beneficial for a variety of health conditions more common to older adults. The goal of this project is to prepare the foundation for successfully conducting a full-scale trial evaluating the effectiveness of two doses of Tai Chi (Standard and Enhanced, which includes Standard + Maintenance Tai Chi) for improving chronic low back pain in older adults over the course of a year.

In the first phase of this study (Aim 1), the the Investigators will focus on finalization of a Standard Tai Chi protocol, development of the maintenance Tai Chi protocol and development of a credible attention control group. In the course of finalizing the feasibility trial documents, members of the research study team will work with patient partners (older adults with chronic low back pain) to adapt strategies for recruitment, adherence to Tai Chi, safety, and optimizing follow-up rates for this population and the Investigators will finalize the inclusion/exclusion criteria to maximize safety and generalizability.

After finalizing the key study components, the Investigators will conduct a randomized feasibility trial comparing Enhanced Tai Chi with Health Education and Usual Medical Care. Sixty-four older adults with cLBP - 65+ years of age will be randomized to the Enhanced (standard + maintenance) Tai Chi, to Health Education or to Usual Medical Care. Outcomes will be collected at 12, 26, and 52 weeks. The Investigators will evaluate the adequacy of key elements of the study developed in Aim 1 for inclusion in a full-scale trial. Finally, the research study team will conduct debriefing discussion groups with 30 trial participants to elicit their ideas for improving the procedures and protocols. This evaluation will address the overall feasibility of conducting a large trial and the value of including the Enhanced dose Tai Chi treatment arm.

If successful, this feasibility study will pave the way for conducting an adequately-powered randomized\ controlled trial evaluating the ability of Tai Chi to reduce the impact of chronic low back pain on older adults. In view of the absence of knowledge about clearly safe and effective treatments for this population, this line of research has the potential for substantially reducing the suffering of many Americans with back pain.

02

Conditions studied

  • Back Pain Lower Back Chronic
03

Who can participate

Ages eligible
65 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

    • Be men or women at least 65 years of age

      • Have low back pain that has persisted for at least three months
      • Have had back pain on at least half the days in the last 6 months
      • Have at least moderate intensity low back pain
      • Have some activity limitations due to back pain
      • Be members of Kaiser Permanente Washington integrative health care system or have a regular source of health care and health insurance
      • Have normal cognition or only mild cognitive impairment
      • Be capable of understanding the study procedures and complying with them for the entire study period.
      • Live close enough to the class site for attendance to be practical
      • Give informed consent

Exclusion criteria

Exclusion Criteria:

    • Have certain specific conditions of LBP

      • Prior lumbar spine surgery
      • Have sciatica, or scheduled visits to a neurosurgeon or orthopedic surgeon.
      • Receiving or seeking compensation for back pain
      • Red flags of serious underlying illness
      • Have practiced Tai Chi or yoga recently. Have other disabling conditions that might confound treatment effects
      • Conditions making consent or treatment difficult
      • Conditions making treatment unsafe or inappropriate
      • Unwillingness to give informed consent
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
57 participants (actual)

Study arms

  • Experimental
    Tai Chi

    twice weekly classes for 12 weeks and then weekly for 6 weeks, every other week for 6 weeks and monthly for 3 months

    Behavioral: Tai Chi · Other: Usual Medical Care

  • Active comparator
    Health Education

    twice weekly classes for 12 weeks

    Behavioral: Health Education · Other: Usual Medical Care

  • Active comparator
    Usual Medical Care

    the usual care to which participants are entitled by their health insurance

    Other: Usual Medical Care

Interventions

  • BehavioralTai Chi

    Yang Style Tai Chi

  • BehavioralHealth Education

    Comprehensive Health Education relevant for Healthy Aging in Patients with Chronic Back Pain

  • OtherUsual Medical Care

    Medications, PT, Complementary and Integrative Health and other miscellaneous treatments as appropriate.

05

What researchers measure

Primary outcomes

  1. Change in Roland Morris Disability Questionnaire Score

    The score of the Roland-Morris Disability Questionnaire (RDMQ) is the total number of items checked, from a minimum of 0 to a maximum of 24, with a higher score indicating a higher experience of disability from back pain. The timeframe of the RMDQ is how a person feels within the last 7 days. Change was calculated as the value of the time point (3, 6, or 12 months) minus baseline

    Time frame: Baseline, 3, 6, 12 months

06

Results

Posted Apr 2, 2024

Participant flow

Participant flow — Overall Study
MilestoneTai ChiHealth EducationUsual Medical Care
Started281217
Completed271016
Not completed121
Withdrew: Fell before classes started100
Withdrew: Other021

Outcome measures

PrimaryChange in Roland Morris Disability Questionnaire Score

The score of the Roland-Morris Disability Questionnaire (RDMQ) is the total number of items checked, from a minimum of 0 to a maximum of 24, with a higher score indicating a higher experience of disability from back pain. The timeframe of the RMDQ is how a person feels within the last 7 days. Change was calculated as the value of the time point (3, 6, or 12 months) minus baseline

Time frame:
Baseline, 3, 6, 12 months
Reported as:
Mean · units on a scale
Change in Roland Morris Disability Questionnaire Score
units on a scaleTai ChiHealth EducationUsual Medical Care
3 Months-4.38 (-5.81 to -2.96)-0.12 (-2.58 to 2.93)0.18 (-2.58 to 2.93)
6 Months-3.64 (-5.64 to -1.65)-1.92 (-3.73 to -0.11)-2.39 (-4.79 to 0.01)
12 Months-5.20 (-7.11 to -3.29)-0.82 (-3.04 to 1.40)-2.89 (-4.74 to -1.04)
Statistical analysis
  • Tai Chi vs Health Education vs Usual Medical Care · GEE with Ancova features · p = .001 (This feasibility study is small and not designed to look at outcome statistics)

Adverse events

Collected over Adverse event information was collected over a 1-year period post-enrollment.. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Tai Chi0/28 (0%)0/28 (0%)0/28 (0%)
Health Education0/12 (0%)0/12 (0%)0/12 (0%)
Usual Medical Care0/17 (0%)0/17 (0%)0/17 (0%)

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)Tai ChiHealth EducationUsual Medical CareTotal
<=18 years0000
Between 18 and 65 years0000
>=65 years28121757
Age, Continuous
Age, Continuous(Years)Tai ChiHealth EducationUsual Medical CareTotal
Mean73.2 ± 5.973.6 ± 5.571.8 ± 3.872.9 ± 5.2
Sex: Female, Male
Sex: Female, Male(Participants)Tai ChiHealth EducationUsual Medical CareTotal
Female1681135
Male124622
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Tai ChiHealth EducationUsual Medical CareTotal
American Indian or Alaska Native0000
Asian3036
Native Hawaiian or Other Pacific Islander0000
Black or African American4318
White2191141
More than one race0022
Unknown or Not Reported0000
Region of Enrollment
Region of Enrollment(participants)Tai ChiHealth EducationUsual Medical CareTotal
United States28121757
Roland-Morris Disability Measure Questionnaire
Roland-Morris Disability Measure Questionnaire(units on a scale)Tai ChiHealth EducationUsual Medical CareTotal
Mean11.4 ± 4.311.7 ± 3.79.4 ± 4.210.8 ± 4.2
07

Study locations

1 site
  • Kaiser Permanente Washington Health Research Institute
    Seattle, Washington 98101, United States
08

References and documents

Study documents

  • Study protocol · Jul 20, 2017
  • Statistical analysis plan · Feb 21, 2017
  • Informed consent form · Jul 18, 2017

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT03299192
Lead sponsor
Kaiser Permanente
Responsible party
Sponsor
First posted
Oct 3, 2017
Start date
May 1, 2016
Primary completion
Mar 31, 2019
Completion
Apr 30, 2020
Results posted
Apr 2, 2024
Last update
Apr 2, 2024

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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