Virtual Tai Chi for Chronic Low Back Pain (Spine 2027)

A Pragmatic Randomized Controlled Trial of Virtual Tai Chi for Chronic Low Back Pain: Effects on Disability, Pain, Quality of Life, and Healthcare Costs

This study tests whether a virtually delivered integrated tai chi, qigong, and meditation program, added to usual care, improves chronic low back pain, disability, quality of life, and healthcare costs compared with usual care alone. Adults with chronic low back pain are randomized to begin the program immediately (Tai Chi Now) or after a six-month period (Tai Chi Later). Outcomes are collected by online survey over twelve months.

Pragmatic randomized crossover design with delayed start. Participants are randomized 1:1 to Tai Chi Now (immediate program plus usual care) or Tai Chi Later (usual care for six months, then delayed access to the same twelve-month program). Delivery is entirely virtual by Zoom. The program is a three-month foundation phase (two 60-minute live classes per week) followed by nine months of monthly booster sessions and guided home practice. Co-primary clinical endpoints are change in pain (BPI-4) and disability (ODI) from baseline to three months, both required to reach significance. Secondary endpoints include EQ-5D-5L quality of life, healthcare costs, work productivity (WPAI), and cost-effectiveness. Participants and program staff are not blinded; the study statistician analyzes data blinded to group identity.

Inclusion Criteria:

• Age 18 years or older
• Current non-specific low back pain lasting 12 weeks or more, with average pain over the past 7 days rated 4 or higher on a 0 to 10 scale
• Understands written and spoken English
• Has consistent internet access and is able to participate in virtual sessions
• Agrees to appear on video during tai chi sessions, visible to the instructor and other participants
• Willing to participate in a 12-month study including a 3-month foundation training phase with two 60-minute virtual live tai chi classes per week, 10 minutes of daily home practice, monthly 60-minute booster sessions during months 4 through 12, and five online surveys over 12 months at months 0, 2, 3, 6, and 12
• Willing and able to provide informed consent

Exclusion Criteria:

• Currently pregnant
• Regular tai chi or qigong practice or research study participation in the past 5 years
• History of spine surgery within the past 6 months
• Severe psychiatric or medical comorbidities that, in the principal investigator's judgment, would make participation unsafe or not feasible

Note on the second exclusion bullet: the protocol wording leaves open whether "research study participation" means participation in any research study or only in tai chi or qigong research. That wording has been carried over exactly as approved rather than clarified here, because the registry record should match the protocol. If the ambiguity is worth resolving, it belongs in a future amendment and then in a record update, not in this response.