|The effects of qigong on anxiety, depression, and psychological well-being: a systematic review and meta-analysis
|Wang F, Man JK, Lee EK, Wu T, Benson H, Fricchione GL, Wang W, Yeung A
The review concluded that Qigong may have positive effects on psychological well-being among patients with chronic illnesses, but the studies generally had significant methodological limitations so better quality studies were needed. These conclusions appear justified for type II diabetes patients, but their relevance to patients with other chronic illnesses is more uncertain.
To investigate the effects of Qigong on anxiety, depression and psychological well-being.
MEDLINE, PubMed, PsycINFO, Ovid, EBSCOhost and unspecified Cochrane databases were searched for studies in English from 2003 to 2011; search terms were reported. Wan Fang Med Online, China National Knowledge Infrastructure (CNKI) and VMIS were searched for studies in Chinese from 2000 to 2011. Local library journals were also searched.
Randomised controlled trials or quasi-experimental studies of Qigong versus any comparator were eligible for inclusion. Mixed interventions were excluded. The primary outcomes evaluated were based on mood, anxiety, depression, self-efficacy and quality of life.
Some studies were of healthy patients, but in most studies patients had chronic conditions such as diabetes, cancer, depression or hypertension. Patients ranged in age from college students to 86 year-olds. Most studies were conducted in China. Treatment durations ranged from 70 minutes to four months. The types of Qigong given varied across studies ("Eight section brocade exercise" was the most common). Control interventions also varied widely, with "treatment as usual" or "waiting list" being used most frequently.
Two reviewers independently selected studies in English, with disagreements resolved by discussion. One reviewer selected studies in Chinese.
Assessment of study quality
Two reviewers independently assessed trial quality using the following criteria: sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other potential biases (compliance assessment, similarity of groups at baseline, and appropriateness of the statistical analyses. Reviewer disagreements were resolved by discussion. The quality of the evidence was also evaluated using The Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Two reviewers independently extracted means and standard deviations for outcomes in each treatment group, with disagreements resolved by discussion. In studies of more than two groups, some groups were combined. Authors were contacted for missing data when necessary.
Methods of synthesis
When studies were deemed to be sufficiently similar, meta-analyses were performed to calculate pooled standardised mean differences with 95% confidence intervals, using a random-effects model. Heterogeneity was assessed using Ι² and Χ². When heterogeneity was high (Ι²>50%) the potential sources were investigated. Funnel plots were used to assess for publication bias. A basic narrative of the remaining studies was also presented, with tabulated results.
Results of the review
Fifteen studies were included (1,154 participants; range 20 to 162). The reporting of details to inform the study quality criteria was generally unclear, especially for allocation concealment, blinding and selective reporting. Only two studies clearly reported both adequate sequence generation and allocation concealment. Group baseline imbalance was apparent in two studies. The quality of the evidence was deemed to be low, using GRADE.
Meta-analyses of patients with type II diabetes suggested that Qigong was more effective than treatment as usual in reducing symptoms of the Symptom Checklist 90 (SCL-90), including depression (SMD -0.29, 95% CI -0.58 to 0.00; three studies) and anxiety (SMD -0.37, 95% CI -0.66 to -0.08; three studies), and in improving psychological well-being measured by Diabetes Specific Quality of Life Scale (SMD -0.58, 95% CI -0.91 to -0.25; two studies). Similar statistically significant results were also reported for other SCL-90 symptoms. There was no evidence of statistical heterogeneity.
Seven studies found that Qigong decreased depressive symptoms. Five studies found that Qigong reduced anxiety Three studies reported improvements in somatic symptoms (lowered stress and pain intensity). Following Qigong therapy, six studies reported a benefit in overall quality of life, and two studies showed a benefit in the ability to handle stress or novel experiences.
Qigong may have positive effects on psychological well-being among patients with chronic illnesses, but the studies generally had significant methodological limitations so better quality studies were needed.
The review addressed a clear question and was supported by reproducible eligibility criteria. Attempts to identify relevant studies in English and Chinese were undertaken by searching electronic databases. However, the limited search dates (and, to a lesser extent, languages) meant it was likely that some relevant studies were not identified. Suitable methods were employed to reduce the risks of reviewer error and bias throughout the review (except for the single-screening of Chinese language studies).
Risk of bias was assessed and was used when interpreting the results of the review. The risk of bias was generally unclear, particularly with regard to blinding. The overall quality of the evidence was judged to be low. Study details were provided but very little result detail was presented for the studies which were not suitable for meta-analysis, making interpretation difficult.
The authors' conclusions are likely to be reliable with respect to patients with type II diabetes, but their relevance to patients with other chronic illnesses is more uncertain, due to the the review's limited reporting.
Implications of the review for practice and research
Practice: The authors did not state any implications for practice.
Research: The authors stated a need for higher quality studies, with a particular emphasis placed on the need for appropriate blinding methods.
United States Centers for Disease Control and Prevention; The Ministry of Science and Technology of the People's Republic of China.
Wang F, Man JK, Lee EK, Wu T, Benson H, Fricchione GL, Wang W, Yeung A. The effects of qigong on anxiety, depression, and psychological well-being: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine 2013; 2013: 152738
Subject indexing assigned by CRD
Anxiety Disorders; Breathing Exercises; Depression; Humans; Mental Health; Stress, Psychological
Date bibliographic record published
Date abstract record published
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.