ImportancePsychological and health-restorative benefits of mind-body therapies have been investigated, but their impact on the immune system remain less defined.ObjectiveTo conduct the first comprehensive review of available controlled trial evidence to evaluate the effects of mind-body therapies on the immune system, focusing on markers of inflammation and anti-viral related immune responses.MethodsData sources included MEDLINE, CINAHL, SPORTDiscus, and PsycINFO through September 1, 2013. Randomized controlled trials published in English evaluating at least four weeks of Tai Chi, Qi Gong, meditation, or Yoga that reported immune outcome measures were selected. Studies were synthesized separately by inflammatory (n = 18), anti-viral related immunity (n = 7), and enumerative (n = 14) outcomes measures. We performed random-effects meta-analyses using standardized mean difference when appropriate.ResultsThirty-four studies published in 39 articles (total 2, 219 participants) met inclusion criteria. For inflammatory measures, after 7 to 16 weeks of mind-body intervention, there was a moderate effect on reduction of C-reactive protein (effect size [ES], 0.58; 95% confidence interval [CI], 0.04 to 1.12), a small but not statistically significant reduction of interleukin-6 (ES, 0.35; 95% CI, −0.04 to 0.75), and negligible effect on tumor necrosis factor-α (ES, 0.21; 95% CI, −0.15 to 0.58). For anti-viral related immune and enumerative measures, there were negligible effects on CD4 counts (ES, 0.15; 95% CI, −0.04 to 0.34) and natural killer cell counts (ES, 0.12, 95% CI −0.21 to 0.45). Some evidence indicated mind-body therapies increase immune responses to vaccination.ConclusionsMind-body therapies reduce markers of inflammation and influence virus-specific immune responses to vaccination despite minimal evidence suggesting effects on resting anti-viral or enumerative measures. These immunomodulatory effects, albeit incomplete, warrant further methodologically rigorous studies to determine the clinical implications of these findings for inflammatory and infectious disease outcomes.

BackgroundThe psychometric properties of Patient Reported Outcomes Measurement Information System (PROMIS) instruments have been explored in a number of general and clinical samples. No study, however, has evaluated the psychometric function of these measures in individuals with symptomatic knee osteoarthritis (KOA). The aim of this project was to evaluate the construct (structural) validity and floor/ceiling effects of four PROMIS measures in this population.MethodsWe conducted a secondary analysis of baseline data from a randomized trial comparing Tai Chi and physical therapy. Participants completed four PROMIS static short-form instruments (i.e., Anxiety, Depression, Physical Function, and Pain Interference) as well as six well-validated (legacy) measures that assess pain, function, and psychological health. We calculated descriptive statistics and percentages of participants scoring the minimum (floor) and maximum (ceiling) possible scores for PROMIS and legacy measures. We also estimated the association between PROMIS scores and scores on legacy measures using Spearman’s rank correlations coefficients.ResultsData from 204 participants were analyzed. Mean age of the sample was 60 years; 70 % were female. The PROMIS Anxiety and Depression had floor effects with 17 and 24 % of participants scoring the minimum, respectively. PROMIS Anxiety and Depression scores had strongest associations with general mental health, including stress (Perceived Stress Scale, r ≥ 0.65) and depression (Beck Depression Index-II, r = 0.70). PROMIS Pain Interference scores correlated most strongly with measures of whole body pain (Short-Form 36 Bodily Pain, r = −0.73) and physical health (Short-Form 36 Physical-Component Summary, r = −0.73); their correlations were lower with other legacy measures, including with the WOMAC knee-specific pain (r = 0.47). PROMIS Physical Function scores had stronger associations with scores on the Short-Form 36 Physical Function (r = 0.79) than with scores on other legacy measures.ConclusionThe four PROMIS static-short forms performed well among individuals with symptomatic knee osteoarthritis as evidenced in correlations with legacy measures. PROMIS Anxiety and Depression target general mental health (e.g., stress, depression), and PROMIS Pain Interference and Physical Function static-short forms target whole-body outcomes among participants with symptomatic knee osteoarthritis. Floor effects in the PROMIS Anxiety and Depression scores should be considered if needing to distinguish among patients with very low levels of these outcomes.Trial registrationClinicaltrials.gov NCT01258985. Registered 10 December 2010Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0715-y) contains supplementary material, which is available to authorized users.

Objective Previous studies suggest that higher mindfulness is associated with less pain and depression. However, the role of mindfulness has never been studied in knee osteoarthritis (OA). We evaluate the relationships between mindfulness and pain, psychological symptoms, and quality of life in knee OA. Method We performed a secondary analysis of baseline data from our randomized comparative trial in participants with knee OA. Mindfulness was assessed using the Five Facet Mindfulness Questionnaire. We measured pain, physical function, quality of life, depression, stress, and self-efficacy with commonly-used patient-reported measures. Simple and multivariable regression models were utilized to assess associations between mindfulness and health outcomes. We further tested whether mindfulness moderated the pain-psychological outcome associations. Results Eighty patients were enrolled (60.3±10.3 years;76.3% female, body mass index:33.0±7.1kg/m2). Total mindfulness score was associated with mental (beta=1.31,95% CI: 0.68,1.95) and physical (beta=0.69,95% CI:0.06,1.31) component quality of life, self-efficacy (beta=0.22,95% CI:0.07,0.37), depression (beta=-1.15,95% CI:-1.77,-0.54), and stress (beta=-1.07,95% CI:-1.53,-0.60). Of the five facets, the Describing, Acting-with-Awareness, and Non-judging mindfulness facets had the most associations with psychological health. No significant association was found between mindfulness and pain or function (P=0.08-0.24). However, we found that mindfulness moderated the effect of pain on stress (P=0.02). Conclusion Mindfulness is associated with depression, stress, self-efficacy, and quality of life among knee OA patients. Mindfulness also moderates the influence of pain on stress, which suggests that mindfulness may alter the way one copes with pain. Future studies examining the benefits of mind-body therapy, designed to increase mindfulness, for patients with OA are warranted.

Tai Chi mind-body exercise is widely believed to improve mindfulness through incorporating meditative states into physical movements. A growing number of studies indicate that Tai Chi may improve health in knee osteoarthritis (OA), a chronic pain disease and a primary cause of global disability. However, little is known about the contribution of mindfulness to treatment effect of Tai Chi practice. Therefore, our purpose was to investigate the effect of Tai Chi mind-body practice compared to physical therapy (PT) on mindfulness in knee OA. Adults with radiographic-confirmed, symptomatic knee OA were randomized to either 12 weeks (twice weekly) of Tai Chi or PT. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ) before and after intervention along with commonly-used patient-reported outcomes for pain, physical function, and other health-related outcomes. Among 86 participants (74% female, 48% white, mean age 60 years, 85% at least college educated), mean total FFMQ was 142±17. Despite substantial improvements in pain, function, and other health-related outcomes, each treatment group’s total FFMQ did not significantly change from baseline (Tai Chi= 0.76, 95% CI: −2.93, 4.45; PT= 1.80, 95% CI: −2.33, 5.93). The difference in total FFMQ between Tai Chi and PT was not significant (−1.04 points, 95% CI: −6.48, 4.39). Mindfulness did not change after Tai Chi or PT intervention in knee OA, which suggests that Tai Chi may not improve health in knee OA through cultivating mindfulness. Further study is needed to identify underlying mechanisms of effective mind-body interventions among people with knee OA.

(ORURGS)) recruited 3,561patients 24.9% of whom were assessed as mild, 52.0% moderate, and 23.1% severe; of these, 3332 (93.6%) had completed data for analysis. All physician-reported patient characteristics (demographics, pain rating, functionality rating, number of joints, analgesia level, symptoms ever suffered, concomitant condition), with the exception of patient gender, loss of movement, and number of autoimmune diseases, differed significantly between severity groups (p<.0001) at a univariate level. The multivariate model indicated that OSURGs (odds ratio 1.6, 95% Confidence interval 1.2 to 2.2) were more likely to perceive patients as more severe compared to PCPs and RHEUMs combined. The model also indicated that a greater age, body mass index (BMI), use of diagnostics [joint space narrowing based on X-ray, severity of pain symptom(s), impairment in the ability to function (e.g. walk, activities of daily living), severity of joint deterioration], and ever suffering from one or more of the symptoms (pain on movement, pain at rest, nocturnal wakening, loss of movement), are associated with greater severity. McFadden's Rsquared increased from 0.35 to 0.37. Conclusions: Patient age, BMI, reported symptoms, disability and radiographic grade influenced physicians' assessment of OA severity. Controlling for patient factors, OSURGs rated patient's severity as worse compared to RHEUMs and PCPS. Our results suggest that this effect could in part be due to a greater influence of radiographic findings on OA severity rating (potentially deemed more important by OSURGs in severity assessment). Further research is needed to understand other potential explanations for this difference.

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plus meniscal injury and osteochondral fracture as visualized on baseline MR images. Results: The mean age of the participants was 26 years, 27% were female and the mean BMI was 24kg/m2. Over the course of 5 years the change in curvature was statistically significant in each region of the knee. In each region the values for curvature decreased (Figure). Participants randomized to early surgery as opposed to rehabilitation plus optional delayed ACL reconstruction were more likely to have flatter curvature in the femur (P<.001), medial femoral condyle (p¼0.006) and trochlea (p¼0.003). Any meniscal injury (largely medial meniscus) was associated with a more flattened curvature in the femur (p¼0.001), trochlea (p¼0.011) and lateral femoral condyle (p¼0.038) and lateral tibia (p¼0.048). In contrast, a lateral tibial osteochondral fracture was associated with a more convex curvature in the lateral tibia (p¼0.017). Conclusions: This study demonstrates that ACL injury leads to significant changes in articulating bone curvatures. These changes are measurable within a short interval (3 months) of the injury. Increased body mass index, meniscal injury and randomization to surgery (as distinct from rehabilitation plus optional delayed ACL reconstruction) all lead to decreased curvature.

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