Background/Purpose: As a recommended intervention for knee Osteoarthritis (OA) according to current guidelines, Tai Chi, a multi-dimensional exercise has exhibited clinically significant improvements in knee OA pain. Previous studies suggest that Tai Chi may work through multiple pathways to achieve clinical improvement. However, most of previous findings are detected on in-person Tai Chi. Few studies have investigated the modulation effects of remotely delivered mind-body interventions for Knee OA during the COVID-19 pandemic.

This study examines how brain function / oscillations (as measured by amplitude of low-frequency fluctuations (ALFF)) and brain morphometry (as measured by voxel-based morphometry (VBM)) change in response to remote-delivered Tai Chi mind-body exercise versus wellness education over time.

Methods: Adults ≥ 50 years of age who met the American College of Rheumatology criteria for symptomatic Knee OA were randomized to either a Tai Chi or Wellness Education group and attended 12 weeks of biweekly remote sessions. The clinical outcomes included the Western Ontario and McMaster Universities (WOMAC), Patient Global Assessment, Hospital Anxiety and Depression scale, the Arthritis self-efficacy and quality of life at 12 weeks. Resting state Functional magnetic resonance imaging (fMRI, using simultaneously multi-slice sequences) and high-resolution structure MRI scans were applied with a 3.0T Siemens scanner at baseline and after intervention.

We applied CONN toolbox for ALFF analysis and Computational Anatomy Toolbox – CAT12 for VBM analysis. A threshold of p < 0.001 voxel-wise and p < 0.05 Family-Wise Error (FWE corrected) at cluster level was used for ALFF and VBM whole brain analysis. In addition, brain regions that showed significant difference in ALFF analysis were used as region of interest (ROI) in VBM analysis (small volume correction applied for ROIs).

Results: Thirty-four patients were randomized to the remote delivery interventions and 31 completed pre- and post- MRI scan. The mean participant age was 66 years, with 65% female. At 12 weeks, compared to wellness education, a significantly greater improvement in the Tai Chi group was found in the WOMAC pain subscale score (p < 0.05). No significant differences between groups were found for other clinical outcomes.

Brain imaging (ALFF and VBM) analysis showed that compared to remote-delivered wellness education, 12-week remote-delivered Tai Chi significantly increased 1) the ALFF in bilateral lateral / ventral prefrontal cortex, anterior insula, anterior cingulate cortex (ACC) / medical prefrontal cortex (MPFC) and left pre-motor cortex, and 2) grey matter volume at left ACC / MPFC.

Conclusion: Our results suggest that remote-delivered Tai Chi can not only relieve knee pain, but also modulate the brain function and structure of key regions involved in multiple function / pathways, i.e. descending pain modulation system and default mode network (MPFC / ACC), cognitive control of movement (bilateral prefrontal cortex), and interoceptive attention (anterior insula). Our findings demonstrated the potential of remote-delivered Tai Chi for musculoskeletal pain management.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/neurobiological-mechanisms-of-a-remote-delivered-mind-body-intervention-for-knee-osteoarthritis/