An unsupervised online Tai Chi program for people with knee osteoarthritis (“My Joint Tai Chi”): protocol for the RETREAT randomised controlled trial

Background Knee osteoarthritis (OA) is a leading contributor to global disability, with exercise proven to be an effective treatment. Tai Chi is a recommended type of exercise, but it is primarily done in person which imposes an accessibility issue, especially in regional/rural areas. To improve access, we rigorously developed an online unsupervised Tai Chi program for people with lower limb OA. This study aims to evaluate the effects of this unsupervised program, when provided with online educational information and exercise adherence support, on changes in knee pain during walking and patient-reported physical function at 12-weeks, when compared to online education control for people with knee OA. Methods A two-arm, superiority parallel-design, pragmatic randomised controlled trial will be conducted involving 178 people with a clinical diagnosis of knee OA. After completing baseline assessment, participants will be randomly assigned to either: i) “My Joint Education”, an education control website containing OA information only; or ii) “My Joint Tai Chi”, an intervention website containing the same information as the control, a 12-week unsupervised online Tai Chi program to be undertaken at home 3 times a week, and information about an exercise adherence support app. All participants will be reassessed at 12 weeks after randomisation. Primary outcomes are overall knee pain during walking using an 11-point numeric rating scale and physical function using the Western Ontario and McMaster Universities Osteoarthritis Index subscale. Secondary outcomes are other self-reported measure of pain, function in sport and recreation and knee-related quality of life; physical and mental well-being; global change in knee condition; fear of movement; pain self-efficacy; balance confidence; positive activated affect; sleep quality and use of oral pain medications. Discussion This randomised controlled trial will provide evidence about the effectiveness of the “My Joint Tai Chi” website that contains an unsupervised Tai Chi program and information about OA and an exercise adherence support app compared to online OA educational information alone on self-reported knee pain and physical function for people with knee OA at 12 weeks. Trial Registration Prospectively registered with the Australia New Zealand Clinical Trials Registry (ID: ACTRN12623000780651) on 18th July 2023. Date/version: 28 th Feb 2024, Version 1