To the best of our knowledge, this is the first randomized controlled trial assessing the efficacy of EQT for OA. This study is inconclusive, but highlights the methodological challenges in conducting trials of EQT, in that the two healers produced significantly different outcomes. EQT may be a safe and effective modality for knee OA, but all qigong healers are not the same; rigorous clinical studies are needed to identify the true healing capability of a qigong healer.
The placebo effect generated by a sham healer mimicking EQT movement worked well in this study. Assessment of quality of the blinding found no difference on guessing the treatment conditions between the two groups (except group by Healer 1). The control group with sham healer achieved quality blinding and the placebo (expectation) effect of 26% reduction in pain and 29% reduction in functionality after treatment. This magnitude of the placebo effect is similar to that achieved for sham acupuncture in a large study of knee OA [6
]. However, use of a sham procedure in such a trial may also underestimate the true treatment effect [32
The results of this study show that both EQT and placebo groups reported significant reduction in pain and functionality scores from baseline (p < .05) after intervention. Patients treated by Healer 2 reported greater reduction in pain and functional difficulty than those in control (p < .01). This improvement persisted 3 months later. However, those treated by Healer 1 reported no significant difference from those in the sham-treatment group. These were true with controlling for age, gender, BMI, and belief in CAM therapy. The results from secondary outcomes, such as MPQ and walking 15 meters, are also consistent with these findings.
A previous study of EQT reported significant reduction in anxiety [33
]. Our study found no significant change in anxiety or depression index in any treatment group.
We were cautious in selecting capable healers for this study since we knew that not all qigong masters produce measurable outcomes in a controlled study. We have worked with both healers in previous studies [23
], including some laboratory studies. Healer 1 demonstrated the capability to generate measurable outcomes in laboratory studies to inhibit tumor growth [34
]. In the previous uncontrolled pilot study, the average pain reduction in 6 patients treated by Healer 1 was about 70% after 3 treatments.[23
] However, in this study patients treated by Healer 1 reported improvement no better than those sham-treated patients. It is possible that Healer 1 may work more effectively in oncologic than with rheumatologic cases.
Some obvious limitations to this study include: 1) a small sample size with homogeneous
participants limits the study’s power for subgroup analysis and the generalizability of
results; 2) treatment is short (3 weeks)- OA is a chronic disease and this duration/dosage might
have been inadequate; 3) only two healers were tested in this study, and they are not the
average or representative healers in the field to represent EQT in general; and 4) although we asked the participants not to switch medication during the study period and to keep a diary on their use of medications and other therapies, only one third of them returned that diary so we could not reliably estimate if change in medication dosages had affected our results (point assessments gave use and type of medications only, no dosage information).
Due to the specific focus of this study, we did not take full advantage of qigong therapy, since we did not include a self-practice component as part of the treatment. Qigong is considered mostly as a self-care tool in health, and active self-practice is one of the key concepts of qigong therapy [15
]. EQT is an important beginning step, as a helping tool to assist the patient to restore qi
balance, or gain strength and confidence in qigong. Therefore, future studies should include patient self-practice (internal qigong) as part of the treatment procedure. It is important to verify the efficacy of EQT since EQT is said to be able to restore the balance of qi
in patients who cannot do so themselves. EQT is particularly important because not everyone is willing or able to commit to qigong practice daily. It may need scientific proof of the efficacy of EQT before patients will believe in qigong enough to commit to qigong practice [37
Little is known about the mechanism behind qigong therapy. TCM believes that open meridians (smooth qi
flow) support health, while qi
blockage is the source of many pains and diseases. It is assumed that qigong healer could use EQT to break the qi
blockage to get rid of the pain[14
]. Wang [38
] reported that qigong therapy – both self-practice and EQT -- increased the pain threshold for patients with various diseases. Zhang [39
] reported the analgesic effect of EQT in a placebo-controlled study, and found that EQT increased the human skin pain threshold as measured by the method of potassium-mediated pain. These findings may partially explain the therapeutic effect of EQT observed in this study. Future research should include in-depth studies of mechanisms of EQT, including psycho-physiological measures for both patients and healers during treatment, and X-ray or MRI examination for pathological changes after the treatment.
In short, the results of this study are inconclusive on efficacy of EQT. It would appear that for one of these healers, EQT might be an effective complementary treatment for OA with beneficial outcomes persisting for 3 months. However, treatment effects vary with utilization of different healers. Further study on a larger scale with multiple healers from the same qigong tradition is needed to confirm the preliminary findings, and to determine optimal treatment protocol, cost-effectiveness, and generalization to other patient groups. Given the limitation and potential adverse effects of pharmacological intervention for OA, qigong therapy might prove to be a valuable option as an adjunct to conventional modalities.