The Effects of Qigong and Tai Chi Exercises on Chronic Low Back Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Qigong and Tai Chi are mind-body exercises that may provide therapeutic benefits for individuals with chronic low back pain (CLBP), yet their efficacy remains uncertain. This systematic review and meta-analysis assessed their effects on pain and disability in individuals with CLBP. Randomized controlled trials (RCTs) evaluating Qigong or Tai Chi for CLBP were included. A systematic search was conducted in MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Physiotherapy Evidence Database (PEDro), and the Cochrane Library up to September 2023. Pain and disability were the primary outcomes. Risk of bias (RoB) was assessed independently by two reviewers using Cochrane's RoB 2 tool. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence. Eight RCTs (n = 729 adults, age range 31.5-73 years, intervention duration 4-24 weeks) were included. Meta-analysis was performed using a random-effects model, with heterogeneity quantified via I² statistics. Eight RCTs (n = 729 participants) were included. Qigong and Tai Chi significantly reduced pain intensity (standardized mean difference (SMD) = -1.07, 95%CI: -1.64 to -0.49, I² = 93%) and disability (SMD = -0.77, 95%CI: -1.39 to -0.15, I² = 93%) compared to control groups. Subgroup analyses suggested greater effect sizes against passive controls (SMD = -1.17, 95%CI: -1.91 to -0.43, I² = 90%) than against active controls (SMD = -0.98, 95%CI: -1.95 to -0.01, I² = 95%). Limitations include substantial heterogeneity among studies and imprecision in effect estimates. The certainty of evidence was rated moderate to high. Qigong and Tai Chi appear effective in reducing pain and disability in individuals with CLBP. However, substantial heterogeneity and the lack of direct comparisons with structured exercise programs necessitate further high-quality RCTs to confirm their long-term effectiveness.

Keywords: chronic low back pain (clbp); pain management; physiotherapy; qigong; systematic review and meta-analysis; taichi.

Figure 1. PRISMA flowchart showing study selection

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. Forest plot of SMD in pain intensity between Qigong/Tai Chi and control groups (active or passive)

Negative values indicate a reduction in pain favoring the intervention. Pain outcomes were measured using scales such as NPRS, VAS, and PPI SMD: Standardized Mean Difference, NPRS: Numeric Pain Rating Scale, VAS: Visual Analog Scale, PPI: Present Pain Intensity References: [23-30]

Figure 3. Forest plot of SMDs in pain intensity comparing Qigong and Tai Chi interventions with active or passive controls

Results are presented separately for Qigong and Tai Chi. Negative values indicate a reduction in pain favoring the intervention. Pain intensity was measured using scales such as the VAS, NPRS, and PPI. SMD: Standardized Mean Difference, NPRS: Numeric Pain Rating Scale, VAS: Visual Analog Scale, PPI: Present Pain Intensity References:  [23-30]

Figure 4. Forest plot of SMDs in pain intensity comparing Qigong and Tai Chi interventions with either active controls (e.g., exercise therapy) or passive controls (e.g., waitlist or no treatment).

Negative values indicate greater reductions in pain favoring the intervention. Pain intensity was measured using scales such as the VAS, NPRS, and PPI. A random-effects model was used. Heterogeneity was substantial in both subgroups (I² = 95% for active controls; I² = 90% for passive controls). The test for subgroup differences was not statistically significant (p = 0.77). SMD: Standardized Mean Difference, NPRS: Numeric Pain Rating Scale, VAS: Visual Analog Scale, PPI: Present Pain Intensity References: [23-30]

Figure 5. Forest plot of SMDs in pain intensity comparing Qigong interventions with either active controls (e.g., yoga, exercise) or passive controls (e.g., waitlist or no treatment).

Negative values indicate a reduction in pain favoring Qigong. Pain intensity was assessed using validated instruments such as the VAS, NPRS, and PPI. A random-effects model was used. SMD: Standardized Mean Difference, NPRS: Numeric Pain Rating Scale, VAS: Visual Analog Scale, PPI: Present Pain Intensity References: [24-26,28,30]

Figure 6. Forest plot of SMDs in pain intensity comparing Tai Chi interventions with passive controls (e.g., waitlist or no treatment)

Negative values indicate greater reductions in pain favoring Tai Chi. Pain intensity was measured using validated scales such as the VAS and NPRS. A random-effects model was used. SMD: Standardized Mean Difference, NPRS: Numeric Pain Rating Scale, VAS: Visual Analog Scale References: [23,27,29]

Figure 7. Forest plot of SMDs in disability comparing Qigong and Tai Chi interventions with active or passive controls

Negative values indicate reduced disability favoring the intervention. Disability was measured using instruments such as the RMDQ, ODI, and FFbHR. SMD: Standardized Mean Difference, RMDQ: Roland-Morris Disability Questionnaire, ODI: Oswestry Disability Index, FFbHR: Hannover Functional Ability Questionnaire References: [23-26,30]

Figure 8. Forest plot of SMDs in disability comparing Qigong interventions with active controls (e.g., yoga) and passive controls (e.g., waitlist or no treatment)

Negative values indicate reduced disability favoring Qigong. Disability was assessed using validated instruments such as the RMDQ, ODI, and FFbHR. A random-effects model was used. RMDQ: Roland-Morris Disability Questionnaire, ODI: Oswestry Disability Index, FFbHR: Hannover Functional Ability Questionnaire References: [24-26,30]

Figure 9. Risk of Bias per domain

Figure 10. Risk of Bias as percentage

Figure 11. Funnel plot for combined Qigong and TaiChi exercises vs active and passive controls

References: [23–30]

Figure 12. Funnel plot for subgroups Qigong or Tai Chi vs active and passive controls

References: [23–30]

Figure 13. Funnel Plot for combined Qigong and Tai Chi exercises vs active or passive controls

References: [24–26,28,30]

Figure 14. Funnel plot Qigong vs active or passive controls

References: [23,27,29]

Figure 15. Forest plot for Tai Chi vs passive controls

References: [23-26,30]

Figure 16. Funnel plot combined Qigong and Tai Chi exercises vs active and passive controls - Disability

References: [24–26,30]

Figure 17. Funnel plot for Qigong vs active or passive controls – Disability