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Background The chronic pain of patients with knee osteoarthritis (KOA) seriously affects their quality of life and leads to heavy social and economic burden. As a nondrug therapy in Traditional Chinese Medicine (TCM), Tuina is generally recognised as safe and effective for reducing the chronic pain of KOA. However, the underlying central mechanisms of Tuina for improving the pain of KOA are not fully understood. Methods/design This study will be a randomised controlled trial with a parallel-group design. A total of 60 eligible participants will be assigned to the Tuina group or healthcare education group (Education group) at 1:1 ratio using stratified randomisation with gender and age as factors. The interventions of both groups will last for 30 min per session and be conducted twice each week for 12 weeks. This study will primarily focus on pain evaluation assessed by detecting the changes in brain grey matter (GM) structure, white matter (WM) structure, and the cerebral functional connectivity (FC) elicited by Tuina treatment, e.g., thalamus, hippocampus, anterior cingulate gyrus, S1, insula, and periaqueductal grey subregions (PAG). The two groups of patients will be evaluated by clinical assessments and multimodal magnetic resonance imaging (MRI) to observe the alterations in the GM, WM, and FC of participants at the baseline and the end of 6 and 12 weeks’ treatment and still be evaluated by clinical assessments but not MRI for 48 weeks of follow-up. The visual analogue scale of current pain is the primary outcome. The Short-Form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, 36-Item Short Form Health Survey, Hamilton Depression Scale, and Hamilton Anxiety Scale will be used to evaluate the pain intensity, pain feeling, pain emotion, clinical symptoms, and quality of life, respectively. MRI assessments, clinical data evaluators, data managers, and statisticians will be blinded to the group allocation in the outcome evaluation procedure and data analysis to reduce the risk of bias. The repeated measures analysis of variance (2 groups × 6 time points ANOVA) will be used to analyse numerical variables of the clinical and neuroimaging data obtained in the study. P Discussion The results of this randomised controlled trial with clinical assessments and multimodal MRI will help reveal the influence of Tuina treatment on the potential morphological changes in cortical and subcortical brain structures, the white matter integrity, and the functional activities and connectivity of brain regions of patients with KOA, which may provide scientific evidence for the clinical application of Tuina in the management of KOA. Trial registration Chinese Clinical Trial Registry ChiCTR2000037966. Registered on Sep. 8, 2020. Dissemination The results will be published in peer-reviewed journals and disseminated through the study’s website, and conferences.

Objective. This meta-analysis aimed to evaluate the effects of manual therapy (MT) on cancer pain, so as to provide clinical evidence for application. Methods. Five English and Chinese databases were searched until February 29, 2020, for randomized controlled trials (RCTs) of MT for cancer pain. Articles published in the English or Chinese language were included. Two authors independently reviewed all articles and extracted the data, and any disagreements in the above process were discussed with other reviewers until the authors reached consensus. Review Manager 5.3 was used to calculate the effect size and 95% confidence intervals. This review was registered in PROSPERO, number CRD42020172053. Results. The intensity of cancer pain is our primary outcome measure, and compared with standard care, MT can significantly relieve the pain of patients with cancer (SMD, 0.63; 95% CI [0.18, 1.08]; P = 0.006 < 0.01 ); the effects of MT plus active activity were significantly different from AT alone (SMD, 0.79; 95% CI [0.28, 1.30]; P = 0.002 < 0.01 ); there was no statistical difference in the efficacy of MT and AT alone (SMD, -0.24; 95% CI [-1.09, 0.62]; P = 0.53 > 0.05 ). In other related symptoms, the above evidence cannot support that MT had a good effect on fatigue (SMD, 0.77; 95% CI [-0.09, 1.63]; P = 0.08 > 0.05 ), nausea (SMD, 0.24; 95% CI [-0.00, 0.48]; P = 0.05 ), anxiety (SMD, 0.76; 95 % CI [-0.32, 1.84]; P = 0.17 > 0.05 ), and depression (SMD, 0.67; 95 % CI [-0.28, 1.62]; P = 0.17 > 0.05 ); however, MT intervention can improve physical function (n = 271; SMD, 0.35; 95 % CI [-0.04, 0.74]; P = 0.04 < 0.05 ) and global well-being (SMD, 0.50; 95 % CI [0.02, 0.98]; P = 0.04 < 0.05 ). In addition, MT had a significant effect on pain relief (SMD, 0.52; 95% CI [0.03, 1.01]; P = 0.04 < 0.05 ) and improvement of physical function (SMD, 0.28; 95% CI [0.02, 0.53]; P = 0.03 < 0.05 ) even after a period of time after treatment. Conclusion. MT was an effective intervention, which may have immediate effect on cancer pain and may improve physical function and global well-being. In the view of follow-up effects, MT had good effects for the reduction of pain and the recovery of physical function. However, because of limitations, the seemingly promising results should be interpreted with caution.

The aim of this review was to examine the effects of shoes and insoles on low back pain (LBP). Seven electronic databases were searched from their inception to May 2020. The methodological quality of the 14 included studies was assessed by PEDro scale. Quality of evidence was assessed using GRADE. Moderate evidence on the disability questionnaire score (SMD, 0.52; 95% CI, 0.28 to 0.77; P < 0.001) and pain score (SMD, 0.61; 95% CI, 0.36 to 0.85; P < 0.001) of the custom-made orthotics for chronic LBP compared with no orthotics/insoles intervention was found. Meta-analysis results also showed moderate evidence on the disability questionnaire score (SMD, 0.44; 95% CI, 0.05 to 0.82; P =0.03) in patients who wore unstable shoes compared with regular shoes. Pain and life quality scores showed low-quality evidence of unstable shoes for chronic LBP. Custom-made orthotics and unstable shoes can be recommended to patients as a management option of chronic LBP.

Low back pain (LBP) is one of the major concerns of the current health care. The guidelines for chronic LBP recommend traditional Chinese exercise as an effective treatment. As one of the representatives of traditional Chinese exercise, Wuqinxi has been famous in China for its effects on improving health and treating chronic diseases for thousands of years. The objectives of the study were to assess the effects of Wuqinxi in the patients with chronic LBP on pain intensity, trunk muscle strength, and quality of life. The primary outcome measure was assessed by the Short-Form McGill Pain Questionnaire (SF-MPQ), including the Visual Analog Scale (VAS) and Present Pain Intensity (PPI) as the subtables. The effects of Wuqinxi on the quality of life were also assessed by the Short-Form Health Survey (SF-36) and the Pittsburgh Sleep Quality Index (PSQI) from physical component summary (PCS), mental component summary (MCS), and sleep quality. Besides, the electrical activities of the rectus abdominis (RA), obliquus externus abdominis (OEA), lumbar erector spinae (ES), and multifidus (MF) were assessed by integrated electromyogram (iEMG) after the end of the intervention. Both the groups showed statistically significant improvement in SF-MPQ, SF-36, PSQI, and iEMG at 12 weeks and 24 weeks when compared with baseline (P<0.05). However, Wuqinxi demonstrated better effects in SF-MPQ and MCS after 24 weeks of intervention compared with the general exercise (P<0.05). The patients in the Wuqinxi group (WQXG) also showed a significantly higher iEMG on OEA than the general exercise group (GEG) in 30°/s and 90°/s (P<0.05). Our results showed that Wuqinxi had better effects on chronic LBP for a long time compared with general exercise, including pain intensity and quality of life. Thus, Wuqinxi should be recognized as a possible standalone therapy and self-management skill in chronic LBP, which is suitable for long-term practice.

Background Post-stroke depression (PSD) is a common complication after stroke which hinders functional recovery and return to social participation of stroke patients. Efficacy of conventional drug therapies for patients with PSD is still uncertain. Therefore, many patients prefer to use complementary and alternative therapies for PSD. Tuina (traditional Chinese manual manipulation) with herbal ointment is an integration of manual therapy, and ointment is an important part of traditional Chinese medicine (TCM) therapy. Preliminary experiments have shown that the Tuina with herbal ointment can improve the mental state of patients with PSD. The purpose of this study is to observe and verify the efficacy of Tuina combined with herbal ointment for patients with post-stroke depression, and to lay a foundation for further research on its mechanism of action. Methods/design In this study, a randomized controlled trial will be conducted in parallel, including two intervention groups: Tuina with herbal ointment group and herbal ointment for control group. A total of 84 eligible participants will be randomly assigned to the groups in a 1:1 ratio. All participants will receive conventional antidepressant venlafaxine treatment (75 mg QD), on which they received two different interventions. The interventions for both groups will be carried out 5 times each week for a period of 2 weeks. The primary outcome will be the Hamilton Rating Scale for Depression (HAMD). Secondary outcomes will include transcranial magnetic stimulation (TMS), as well as 36-item Short-Form Health Survey (SF-36) and Treatment Emergent Symptom Scale (TESS). They will be assessed at the baseline, at the end of the intervention (2 weeks), and during the 1 month and 3 months of follow-up by repeated measures analysis of variance. The significance level is 5%. Adverse events will be monitored at each visit to assess safety. All outcomes will be assessed and analyzed by researchers blinded to the treatment allocation. The purpose of this study will focus on observing the efficacy of Tuina with herbal ointment for patients with post-stroke depression, and to explore further the mechanisms of its effects. Discussion This study may evaluate clinical application value and safety of Tuina with herbal ointment in PSD patients, which can provide basis for clinical research and mechanism exploration of PSD. Trial registration Chinese Clinical Trial Registry ChiCTR2000033887. Registered on 15 June 2020. Dissemination The results will be published in peer-reviewed journals and disseminated through the study’s website and conferences.

Background In December 2019, pneumonia associated with the 2019 novel coronavirus (COVID-19) emerged in Wuhan, China. The number of cases has increased rapidly. Patients with severe disease have a poor prognosis, and there are no effective therapies for COVID-19. Only rapid advice guidelines for symptomatic supportive care have been used. A traditional Chinese medicine rehabilitation (TCMR) program consisting of acupressure therapy and Liu Zi Jue Qigong can be used as a complementary therapy for COVID-19. Hence, we designed a randomized trial to evaluate the efficacy and advantages of TCMR for treating patients with severe COVID-19. Methods/design This is a parallel-design, two-arm, analyst assessor-blinded, randomized controlled trial. A total of 128 patients with COVID-19 aged from 20 to 80 years will be recruited and assigned randomly into a guideline therapy group and a guideline therapy plus TCMR group at a 1:1 ratio. Patients in both groups will receive guideline therapy. The patients in the intervention group will perform acupressure therapy and Liu Zi Jue Qigong exercises in addition to conventional treatments twice a day and will be persistent from admission to discharge. The primary outcome will be measured with the Modified Medical Research Council Dyspnea Scale, and the secondary outcomes will include the Activities of Daily Living Barthel Index Scale, Patient Health Questionnaire-9 Scale, and the Respiratory Symptoms Scale. The assessments of the clinical scales will be performed at three points (before treatment, the 7th day during hospitalization, and the discharge day). Adverse events will be noted and recorded for the safety evaluation. Discussion This trial will provide high-quality evidence of the value of TCMR, which consists of acupressure therapy and Liu Zi Jue Qigong exercises, for treating patients with severe COVID-19. Trial registration Chinese Clinical Trial Registry ChiCTR2000029994. Registered on 18 February 2020

Objectives Efficacy of conventional treatment plus the complementary therapy Liu-zi-jue (a mind-body exercise) to treat patients with mild COVID-19. Trial design The study is a single-center 2 arm, randomized controlled trial with parallel-group design.

Background: Knee osteoarthritis (KOA) is a common disabling musculoskeletal disorder. Previous studies showed that Tuina manipulation and health care education were effective treatments for patients with KOA. However, there is no evidence to support the use of one intervention over the other. The purpose of this study is to evaluate the effectiveness of Tuina manipulation and health care education for the management of pain and dysfunction in patients with KOA.Methods/Design: This study is a single-centre, two-arm, open-label randomized controlled trial (RCT). A total of 170 eligible KOA patients will be randomly assigned to the Tuina manipulation group or the health education group in a 1:1 ratio. Patients in the Tuina manipulation group will receive a 30-minute 2-step treatment plan, including pain point assessment and manual therapy, which will be performed 12 times in 4 weeks. The health education group will receive 45 minutes of lecture and discussion three times a week for four weeks. The primary outcome is the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include the McGill Pain Questionnaire (MPQ) and 36-item Short-Form Health Survey (SF-36). The results of this study will help clarify the value of Tuina manipulation and health education as treatments for KOA and will highlight any differences in treatment outcomes.Discussion: The design and methodology of the trial is rigorous and allows the collection of valuable data to assess the efficacy of a specific Tuina regimen for the treatment of KOA. Therefore, the trial will provide a solid foundation for future clinical research on KOA and Tuina therapy.Trial registration: This trial was registered with the Chinese Clinical Trial Registry on 24 February 2020 (ChiCTR2000030154), http://www.chictr.org.cn/index.aspx

Background The epidemic of 2019 novel coronavirus (2019-nCoV) pneumonia has become a focused public health event in world. The authorities have taken prompt medical action in China, which contained strict isolation measures and potential symptomatic supportive care. Dao Yin, a traditional Chinese exercise, combines limb movements and breathing exercises. Previous researches showed that it can activate the immune system and improve the lung function and the mental state of patients. Therefore, there may be a potential effect of Dao Yin on the physical and mental health of patients with 2019-nCoV. The aim of this trail is to verify whether conventional therapy plus Dao Yin could show better effects for 2019-nCoV than conventional therapy alone.Methods/design The study is a multicenter randomized controlled trial with parallel-group design including two intervention groups: a conventional therapy group and a conventional therapy plus Dao Yin group. A total of 186 eligible participants will be randomly assigned to the groups in a 1:1 ratio. The routine treatment of the two groups is performed daily according to guideline, and Dao Yin is performed once a day until the patient is out of the hospital. The primary outcome is the Length of Hospital Stay (LHS). Secondary outcomes include the vital signs, respiratory symptoms, questionnaire of mental health and the quantity of immune cells. The outcomes will be assessed at five points including the baseline, 3th, 6th, 9th day during hospitalization and the discharge day. The significance level is 5%. This study will focus on the value of a conventional therapy plus Dao Yin as the treatment for 2019-nCoV and will explore any potential connection among the outcomes.Discussion This study may evaluate the efficacy of conventional therapy plus Dao Yin for 2019-nCoV, which can contribute to provide a solid evidence of Dao Yin therapy for the nationwide emergence.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000029978 Registered on 18 February 2020.

Objective To determine the effects of Taijiquan practice on knee proprioception in patients with knee osteoarthritis (OA). Methods We conducted a randomized controlled trial comparing Taijiquan with a control condition (wellness education) in patients with knee OA. The patients participated in either a 60-min Taijiquan session three times weekly or a 60-min weekly educational session, for 24 consecutive weeks. The primary outcomes were changes in knee proprioception. Secondary outcomes were changes in the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Results After 24 weeks, compared with the control group, the Taijiquan group demonstrated better improvements in the joint position sense in knee flexion (left: −2.12°; right: −2.02°), and knee extension (left: −2.22°; right: −1.54°). In addition, the Taijiquan group showed significantly greater improvements in the WOMAC scores (P Conclusion A 24-week Taijiquan practice resulted in a significant improvement in knee proprioception in patients with knee OA. The present findings add increasing evidence regarding the clinical benefits of Taijiquan as a therapeutic modality for patients to improve the reflex protection of knee joints against potentially harmful forces.

Background Chronic neck pain (CNP) is a common and disabling musculoskeletal disorder in developing and developed countries. Previous studies have shown that tuina and traditional Chinese massage are effective treatments for patients with CNP. However, there is little evidence to support the use of one intervention over the other. The aim of this study is to compare the effects of tuina and traditional Chinese massage in the treatment of pain and disability in patients with CNP. Methods/design This is a multicenter, assessor- and analyst-blinded, randomized controlled trial with two parallel arms: a tuina group and a traditional Chinese massage group. A total of 356 eligible CNP patients will be randomly assigned to the groups in a 1:1 ratio. The intervention in the tuina group includes both structural and relaxation massage, while the traditional Chinese massage group will receive relaxation massage only. The interventions for both groups will last for 15 min and will be carried out three times a week for a period of 4 weeks. The primary outcome will be changes in the Northwick Park Neck Pain Questionnaire. Secondary outcomes will be measured by a visual analogue scale (VAS), the Neck Disability Index (NDI), and the 36-item Short-Form Health Survey (SF-36). The data will be analyzed at the baseline, at the end of the intervention, and during the 3 months of follow-up by repeated measures analysis of variance. The significance level is 5%. The safety of tuina and traditional Chinese massage will be evaluated after each treatment session. The results of this trial will help clarify the value of tuina and traditional Chinese massage as treatments for CNP and will highlight any differences in the efficacy of the treatments. Discussion The purpose of this trial is to determine whether tuina is more effective than traditional Chinese massage in adults with CNP. This trial will, therefore, contribute to providing a solid foundation for clinical treatment of CNP, as well as future research in massage therapy. Trial registration Chinese Clinical Trial Registry, ChiCTR-INR-17013763. Registered 8 December 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3096-3) contains supplementary material, which is available to authorized users.