Tai Chi for Schizophrenia: A Systematic Review.

Author: Zheng W1, Li Q1, Lin J2, Xiang Y3, Guo T3, Chen Q4, Cai D5, Xiang Y6
1The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
2Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
3The National Clinical Research Center for Mental Disorders (Beijing Anding Hospital)& Department of Psychiatry, Capital Medical University & Center of Depression, Beijing Institute for Brain Disorders, China.
4Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
5Faculty of Traditional Chinese Medicine, the First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
6Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
Conference/Journal: Shanghai Arch Psychiatry.
Date published: 2016 Aug 25
Other: Volume ID: 28 , Issue ID: 4 , Pages: 185-194 , Special Notes: doi: 10.11919/j.issn.1002-0829.216051. , Word Count: 364

BACKGROUND: Tai Chi as a form of moderate aerobic exercise originating in China, could promote balance and healing of the mind-body. Furthermore, Tai Chi has been used as an adjunctive treatment for patients with schizophrenia. However, no meta-analysis or systematic review on adjunctive Tai Chi for patients with schizophrenia has yet been reported.

AIM: A systematic review and meta-analysis was conducted to examine the efficacy of Tai Chi as an adjunctive treatment for schizophrenia using randomized controlled trial (RCT) data.

METHOD: Two evaluators independently and systematically searched both English- and Chinese-language databases for RCTs of Tai Chi for schizophrenia patients, selected studies, extracted data, conducted quality assessment and data synthesis. Statistical analyses were performed using the Review Manager (version 5.3). The Cochrane Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to assess the strength of the evidence.

RESULTS: In 6 RCTs conducted in mainland China and Hong Kong, there were 483 participants including 215 subjects in the intervention group and 268 subjects in the control group. The trials lasted 16.0 (6.2) weeks. Compared to control group, we found significant differences regarding improvement of negative symptoms assessed by the Positive and Negative Syndrome Scale (PANSS) negative symptom sub-score (2 trials) and Scale for the Assessment of Negative Symptoms (SANS) (3 trials) over the study period in the intervention group (5 trials with 6 treatment arms, n=451, SMD: -0.87 (95%CI: -1.51, -0.24), p=0.007; I2=90%). Furthermore, there is no significant difference regarding improvement of positive symptoms assessed by the PANSS positive symptom sub-score (2 trials) and Scale for the Assessment of Positive Symptoms (SAPS) (2 trials) over the study period (4 trials with 5 treatment arms, n=391, SMD: -0.09 (95%CI: -0.44, 0.26), p=0.60; I2=65%). All included RCTs did not report side effects. Based on the GRADE, the strength of the evidence for primary outcome was 'very low'.

CONCLUSIONS: The data available on the effectiveness of adjunctive Tai Chi in patients with schizophrenia who are receiving antipsychotic is insufficient to arrive at a definitive conclusion about its efficacy. Furthermore, follow-up time in the available studies was relatively short, and all studies did not use blinded assessment of outcome measures. High-quality randomized trials are needed to inform clinical recommendations.

KEYWORDS: Tai Chi; antipsychotic; schizophrenia; systematic review

PMID: 28638191 PMCID: PMC5434269 DOI: 10.11919/j.issn.1002-0829.216051