The authors of this review stated that there is sufficient evidence to support taiji as a beneficial component of health promotion and to support its use in cardiopulmonary practice. Although the review appears to highlight the potential of taiji, the methodological problems identified and the diversity of the participants and intervention styles render the authors' conclusions uncertain.

To explore the potential applications of taiji as a therapeutic exercise within physiotherapeutic cardiopulmonary clinical practice.

The authors searched MEDLINE and CINAHL in 2002 using keywords documented in the report. Ongoing monitoring of the literature (unspecified) continued up to July 2004. The studies were limited to the published in full in English.

Study designs of evaluations included in the review

To be eligible, studies needed to be randomised controlled trials (RCTs) or controlled trials (CCTs). However, it appears that one case-control study was also included.

Specific interventions included in the review

To be eligible, studies needed to investigate taiji in relation to health and wellness promotion or cardiopulmonary applications within the scope of physical therapy practice. A variety of styles and forms of taiji were used across the included studies. Comparator groups included those who were on a waiting list, following a home exercise programme, doing aerobic activities, doing no exercise, maintaining normal activities, brisk walking, or doing meditation and reading. Where stated, study duration ranged from a one-off session to daily sessions for between 8 and 15 weeks.

Participants included in the review

No inclusion criteria for the participants were pre-specified. In some of the studies the participants were unfamiliar with taiji, whilst in others they were already practising. Populations included elders living in the community, those who had recently had a coronary artery bypass graft, those who had recently had a myocardial infarction and a group of participants of Asian origin.

Outcomes assessed in the review

No inclusion criteria for the outcomes were pre-specified. The outcomes in the included studies were immune response, SF-36 score (physical functioning), activity tolerance, blood-pressure management, home exercise maintenance and level of stress.

How were decisions on the relevance of primary studies made?

The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.

The authors did not state that they assessed validity.

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction.

How were the studies combined?

The studies were combined in a narrative.

How were differences between studies investigated?

Study differences were documented in the text and tables of the report.

Seven studies with a total of 408 participants were included in the review. Five were RCTs (340 participants), one was a CCT (20 participants) and one was a prospective case-control study (48 participants).

There was evidence of physical and physiological benefits in all seven included studies, with no reports of adverse effects. Benefits were demonstrated for management of hypertension, activity tolerance, stress management and immune activity.

The authors stated that there is sufficient evidence to support taiji as a beneficial component of health and wellness promotion and to support its use in cardiopulmonary practice. There is preliminary evidence supporting its inclusion in cardiac rehabilitation.

The review question was broadly defined but no inclusion criteria for the participants or outcomes were specified. Study designs were pre-specified, but one study was included which did not meet the criteria. This, together with the fact that no details were reported on how studies were selected for the review, makes the introduction of bias a distinct possibility. Searching was based on two databases but no complementary medicine or Chinese language databases, where one might expect to find further studies, were searched. Furthermore, the review was limited to English language publications. There was no information on the data extraction process and it was unclear from the study details provided whether the results were statistically significant. The studies were not quality assessed so the influence of study quality on results could not be determined. For example, although in this type of study participants cannot be blinded, it would be important to assess blinding of those assessing the outcomes. Although the review appears to highlight the potential of taiji, the methodological problems identified together with the diversity of the participants and intervention styles render the authors' conclusions uncertain.

Practice: The authors stated that those interested in integrating taiji into their physical therapy practice would be advised to collaborate with taiji masters.

Research: The authors stated that research would be needed to answer the questions of who would deliver the taiji programme, was there a role for taiji instructors, and should physical therapists have a role as taiji instructors?

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.