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Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial
In 90 breast-cancer survivors with insomnia, three months of Tai Chi Chih met the prespecified noninferiority margin versus cognitive behavioral therapy for insomnia for Pittsburgh Sleep Quality Index–defined treatment response at 15 months (with robust short-term improvements in both arms).
Design
- Randomized, partially blinded, noninferiority trial (Los Angeles community recruitment 2008–2012)
- N = 90 (45 CBT-I vs 45 Tai Chi Chih); 3-month interventions; follow-up through 15 months
- Primary endpoint: insomnia treatment response defined by PSQI thresholds at 15 months
Primary outcome (noninferiority)
- Responder rates at 15 months: 43.7% (CBT-I) vs 46.7% (Tai Chi Chih)
- Noninferiority: met at 15 months and also at 3 and 6 months by the trial’s prespecified margin (P = 0.02 at 15 months)
Secondary insomnia remission (clinician-assessed)
- Remission: 46.2% (CBT-I) vs 37.9% (Tai Chi Chih)
Evidence hygiene
- Single condition focus (breast cancer survivors)—do not generalise to all insomnia phenotypes without sleep-apnea screening where indicated.
- Comparator strength: CBT-I is an active evidence-based control; noninferiority here is a high bar for a movement practice.
Publication
Irwin MR, Olmstead R, Carrillo C, et al. J Clin Oncol. 2017 Aug 10;35(23):2656–2665. PMID 28489508.
Outcomes
- PSQI-defined insomnia treatment response at 15 months: 43.7% (CBT-I) vs 46.7% (Tai Chi Chih); noninferiority of Tai Chi Chih to CBT-I demonstrated (P=0.02 for margin test).
- Clinician-assessed insomnia remission: 46.2% with CBT-I vs 37.9% with Tai Chi Chih.