Hydrotherapy and Tai Chi each provide clinical improvements for older people with osteoarthritis

Abstract

Question

For people with osteoarthritis of the hip or knee, do hydrotherapy or Tai Chi give worthwhile improvements in pain and physical function?

Design

Randomised, 3-arm, parallel, controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.

Setting

Tertiary hospital, Sydney, Australia.

Participants

Adults aged 59–85 years, with osteoarthritis of the hip or knee meeting American College of Rheumatology criteria, recruited through advertisements, social clubs for older people, and referral from local general practitioners and rheumatologists. 55 participants were randomised to hydrotherapy, 56 to Tai Chi, and 41 to a control group.

Interventions

Participants in either of the two treatments groups were required to attend classes (max 15 participants) for one hour, twice per week for 12 weeks. Hydrotherapy involved lower limb exercise in waist-deep water, including walking, free-standing and bar work, running, and stairs. Tai Chi included a 10-minute warm-up followed by a modification of 24 forms of Sun style Tai Chi. Participants were allowed to purchase, if they desired, a Tai Chi video to assist with home practice. The control group were waitlisted for 12 weeks and then randomly allocated to one of the two treatments.

Outcomes

The primary outcomes were pain and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included the SF-12 general health status questionnaire; the Depression, Anxiety and Stress Scale of psychological well being; the participant's global assessment of treatment effectiveness and current status of the joint that had originally been the most painful; and physical performance measures (50-foot walk test, stair climb test, and Up and Go test). Outcomes were assessed at the end of the 12-week treatment period, and 12 weeks later.

Results

At the end of treatment, pain had improved by 6 points (95% CI 0 to 13) more in the hydrotherapy group than the control group. Similarly, physical function had improved by 10 points (95% CI 4 to 14) more in the hydrotherapy group and by 10 points (95%CI 3 to 17) more in the Tai Chi group. The hydrotherapy group also showed significant treatment benefits in the physical component summary of the SF-12 and the three physical performance measures. Twelve weeks later, comparisons with a no-treatment control group were not possible, but the outcomes that had improved significantly during treatment had mostly been maintained.

Conclusion

Older people with osteoarthritis of the hip or knee can obtain clinically worthwhile improvements in physical function from hydrotherapy or Tai Chi.