TCQ shows promise in addressing cancer-related symptoms and QOL in cancer survivors.

Purpose To systematically evaluate and quantify the effects of Tai Chi/Qigong (TCQ) on motor (UPDRS III, balance, falls, Timed-Up-and-Go, and 6-Minute Walk) and non-motor (depression and cognition) function, and quality of life (QOL) in patients with Parkinson’s disease (PD). Methods A systematic search on 7 electronic databases targeted clinical studies evaluating TCQ for individuals with PD published through August 2016. Meta-analysis was used to estimate effect sizes (Hedge’s g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed by two raters. Results Our search identified 21 studies, 15 of which were RCTs with a total of 755 subjects. For RCTs, comparison groups included no treatment (n=7, 47%) and active interventions (n=8, 53%). Duration of TCQ ranged from 2 to 6 months. Methodological bias was low in 6 studies, moderate in 7, and high in 2. Fixed-effect models showed that TCQ was associated with significant improvement on most motor outcomes (UPDRS III [ES=-0.444, p<.001], balance [ES=0.544, p<.001], Timed-Up-and-Go [ES=−0.341, p=.005], 6MW [ES=−0.293, p=.06]), falls [ES=−.403, p=.004], as well as depression [ES=−0.457, p=.008] and QOL [ES=−0.393, p<.001], but not cognition [ES= −0.225, p=.477]). I2 indicated limited heterogeneity. Funnel plots suggested some degree of publication bias. Conclusion Evidence to date supports a potential benefit of TCQ for improving motor function, depression and QOL for individuals with PD, and validates the need for additional large-scale trials.

ObjectivesTo assess the feasibility and inform design features of a fully powered randomized controlled trial (RCT) evaluating the effects of Tai Chi (TC) in Parkinson’s disease (PD) and to select outcomes most responsive to TC assessed during off-medication states.DesignTwo-arm, wait-list controlled RCT.SettingsTertiary care hospital.SubjectsThirty-two subjects aged 40–75 diagnosed with idiopathic PD within 10 years.InterventionsSix-month TC intervention added to usual care (UC) versus UC alone.Outcome MeasuresPrimary outcomes were feasibility-related (recruitment rate, adherence, and compliance). Change in dual-task (DT) gait stride-time variability (STV) from baseline to 6 months was defined, a priori, as the clinical outcome measure of primary interest. Other outcomes included: PD motor symptom progression (Unified Parkinson’s Disease Rating Scale [UPDRS]), PD-related quality of life (PDQ-39), executive function (Trail Making Test), balance confidence (Activity-Specific Balance Confidence Scale, ABC), and Timed Up and Go test (TUG). All clinical assessments were made in the off-state for PD medications.ResultsThirty-two subjects were enrolled into 3 sequential cohorts over 417 days at an average rate of 0.08 subjects per day. Seventy-five percent (12/16) in the TC group vs 94% (15/16) in the UC group completed the primary 6-month follow-up assessment. Mean TC exposure hours overall: 52. No AEs occurred during or as a direct result of TC exercise. Statistically nonsignificant improvements were observed in the TC group at 6 months in DT gait STV (TC [20.1%] vs UC [−0.1%] group [effect size 0.49; P = .47]), ABC, TUG, and PDQ-39. UPDRS progression was modest and very similar in TC and UC groups.ConclusionsConducting an RCT of TC for PD is feasible, though measures to improve recruitment and adherence rates are needed. DT gait STV is a sensitive and logical outcome for evaluating the combined cognitive-motor effects of TC in PD.

Purpose: To assess the feasibility, safety, and preliminary effectiveness of a 12-week multimodal Qigong Mind-Body Exercise (QMBE) program for breast cancer survivors with persistent post-surgical pain (PPSP). Methods: This was a single-arm mixed-methods pilot study. Primary outcome measures were feasibility (recruitment, adherence) and safety. Validated self-report questionnaires were used to evaluate a constellation of interdependent symptoms, including pain, fatigue, mood, exercise, interoceptive awareness, and health-related quality of life at baseline and 12 weeks. A subset of the instruments was administered 6 months postintervention. Shoulder range of motion and grip strength were objectively assessed at baseline and 12 weeks. Qualitative interviews were conducted at baseline and 12 weeks. Results: Twenty-one participants were enrolled; 18 and 17 participants, respectively, completed the 12-week and 6-month outcome assessment. No serious adverse events were reported. Statistically significant improvements were observed at 12 weeks in pain severity and interference, fatigue, anxiety, depression, perceived stress, self-esteem, pain catastrophizing, and several subdomains of quality of life, interoceptive awareness, and shoulder range of motion. Changes in pain, fatigue, pain catastrophizing, anxiety, depression, and quality of life were clinically meaningful. Postintervention effects were sustained at 6 months. Conclusions: QMBE is a safe and gentle multimodal intervention that shows promise in conferring a broad range of psychosocial and physical benefits for breast cancer survivors with PPSP. Results support the value of future studies evaluating the impact of QMBE on multiple outcomes relevant to breast cancer survivors with PPSP.

Background Several small studies have suggested that spinal manipulation may be an effective treatment for reducing migraine pain and disability. We performed a systematic review and meta‐analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability. Methods PubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine‐related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta‐analytic methods were employed to estimate the effect sizes (Hedges’ g) and heterogeneity (I2) for migraine days, pain, and disability. The methodological quality of retrieved studies was examined following the Cochrane Risk of Bias Tool. Results Our search identified 6 RCTs (pooled n = 677; range of n = 42‐218) eligible for meta‐analysis. Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability. Methodological quality varied across the studies. For example, some studies received high or unclear bias scores for methodological features such as compliance, blinding, and completeness of outcome data. Due to high levels of heterogeneity when all 6 studies were included in the meta‐analysis, the 1 RCT performed only among chronic migraineurs was excluded. Heterogeneity across the remaining studies was low. We observed that spinal manipulation reduced migraine days with an overall small effect size (Hedges’ g = −0.35, 95% CI: −0.53, −0.16, P < .001) as well as migraine pain/intensity. Conclusions Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta‐analysis, we consider these results to be preliminary. Methodologically rigorous, large‐scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.

Dynamic and static body postures are a defining characteristic of mind-body practices such as Tai Chi and Qigong (TCQ). A growing body of evidence supports the hypothesis that TCQ may be beneficial for psychological health, including management and prevention of depression and anxiety. Although a variety of causal factors have been identified as potential mediators of such health benefits, physical posture, despite its visible prominence, has been largely overlooked. We hypothesize that body posture while standing and/or moving may be a key therapeutic element mediating the influence of TCQ on psychological health. In the present paper, we summarize existing experimental and observational evidence that suggests a bi-directional relationship between body posture and mental states. Drawing from embodied cognitive science, we provide a theoretical framework for further investigation into this interrelationship. We discuss the challenges involved in such an investigation and propose suggestions for future studies. Despite theoretical and practical challenges, we propose that the role of posture in mind-body exercises such as TCQ should be considered in future research.

“Integrative medicine” (IM) refers to the combination of conventional and “complementary” medical services (e.g. chiropractic, acupuncture, massage, mindfulness training). More than half of all medical schools in the United States and Canada have programs in IM and more than 30 academic health centers currently deliver multi-disciplinary IM care. What remains unclear, however, is the ideal delivery model (or models) whereby individuals can responsibly access IM care safely, effectively and reproducibly in a coordinated and cost-effective way. Current models of IM across existing clinical centers vary tremendously in their: 1) Organizational settings, principal clinical focus and services provided; 2) Practitioner team composition and training; 3) Incorporation of research activities and educational programs; and 4) Administrative organization, e.g. reporting structure, use of medical records, scope of clinical practice as well as financial strategies, i.e. specific business plans and models for sustainability. In this Perspective, the authors address these important strategic issues by sharing lessons learned from the design and implementation of an IM facility within an academic teaching hospital, i.e. the Brigham and Women's Hospital at Harvard Medical School; and, review alternative options considered based on information about IM centers across the United States. The authors conclude that there is currently no consensus as to how integrative care models should be optimally organized, implemented, replicated, assessed and funded. The time may be right for prospective research in “best practices” across emerging models of IM care nationally in an effort to standardize, refine and replicate them in preparation for rigorous cost-effectiveness evaluations.

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