- This single-site, open-label proof-of-concept study evaluated the feasibility and effects of an adapted Tai Chi program for patients who had irritable bowel syndrome with constipation (IBS-C)
- There was significant change on the IBS Symptom Severity Scale from baseline to the end of follow-up, four weeks after the last of eight weekly Tai Chi classes (-66.5 points; P=0.01)
- Participants also reported significant improvement on multiple secondary measures of IBS-C symptom severity and quality of life
- 82% of eligible individuals agreed to participate, 67% of participants attended seven or more of the eight classes, and 56% of participants completed ≥80% of daily diaries
- These data set the stage for a fully powered randomized, controlled trial to test the efficacy of Tai Chi for patients with IBS-C
Treatment dissatisfaction is prevalent among patients with irritable bowel syndrome with constipation (IBS-C), and many turn to complementary modalities.
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Tai Chi, an ancient mind–body Chinese medicine practice, has physical, psychosocial, spiritual and behavioral components. Several randomized trials of Tai Chi have demonstrated benefit for fibromyalgia, which is similar to IBS in that both psychosocial factors and chronic pain with central sensitization have important roles in disease presentation and quality of life.
Kyle D. Staller, MD, MPH, director of the Gastrointestinal Motility Laboratory in the Division of Gastroenterology at Massachusetts General Hospital, member of the Clinical and Translational Epidemiology Unit, and assistant professor of Medicine at Harvard Medical School, and Braden Kuo, MD, director of the Center for Neurointestinal Health and assistant professor of Medicine at Harvard Medical School, and colleagues developed a novel Tai Chi program targeting the needs of patients suffering from IBS-C. In Neurogastroenterology & Motility they report proof-of-concept data suggesting the program warrants evaluation in a randomized, controlled trial.
The researchers conducted a single-center, open study from July 20, 2020, to April 27, 2021. Eligible participants were ages 18 to 70 and met Rome IV criteria for IBS-C.
The adapted Tai Chi program focused on self-massage of the abdominal muscles and viscera, and movements that targeted the digestive tract. Eight weekly one-hour group lessons, limited to 10 participants, were led by a Tai Chi master on Zoom.
Of 38 individuals who met study criteria, 31 (82%) agreed to participate. They entered a two-week run-in period and were asked to complete daily symptom diaries. Four participants withdrew from the run-in period: one required an ED visit for prolonged constipation, and three cited the burden of symptom recording and future class attendance.
Of the 27 participants who began Tai Chi classes, seven did not complete the intervention: two said it caused more stress, three said it did not fit into their schedule, one said it was too time-consuming, and one was lost to follow-up.
Eighteen of the 27 participants (67%) attended seven or more of the eight classes, which was considered moderate program acceptability. 56% completed ≥80% of the daily diaries, and 55% practiced at home ≥80% of days. Satisfaction among participants who completed follow-up was excellent.
On the primary outcome measure, the IBS Symptom Severity Scale, there was significant change from baseline to the end of follow-up, four weeks after the last treatment session (−66.5 points; P=0.01).
Over the same period, there were also significant improvements on multiple self-report instruments:
- IBS Quality of Life Scale
- Gastrointestinal Symptom Rating Scale–IBS version: constipation, bloating, and satiety scales
- Visual analog scales for abdominal discomfort and bloating, completed daily
- Fear of Food Questionnaire: total score and scores for GI fears, food fears, and social impairment
Waist circumference, measured daily, decreased by an average of 6 cm and provided objective confirmation of the subjective reports of less bloating.
Participants were asked to monitor their bowel movement frequency daily during the eight weeks of treatment. There was no significant improvement from baseline.
Notes for a Clinical Trial
Most attrition occurred in the early phases of the study, but all withdrawing participants cited burdensome data collection as the primary reason. Fewer questionnaires would be needed in a randomized, controlled trial now that relevant parameters have been established.
Among the 14 subjects who participated in exit interviews, opinions about video-based training were split. Many subjects appreciated the convenience, but some said they found it difficult to follow a video and wanted in-person attention to their positioning and movement. One participant wanted more interaction with fellow group members.
An in-person option might improve participant retention, but virtual sessions make treatment more scalable and enable intervention delivery to locations beyond major urban areas and academic centers.
Learn about the Center for Neurointestinal Health
Refer a patient to the Division of Gastroenterology