BACKGROUND: Tai Chi is recommended for musculoskeletal conditions, however, the evidence for its clinical effectiveness is uncertain. PURPOSE: To determine whether Tai Chi is beneficial for clinical outcomes in people with musculoskeletal pain. DATA SOURCES: Seven databases Embase, PEDro, AMED, Medline, CINAHL, SPORTDiscus, and the Cochrane Central Register of Controlled Trials. STUDY SELECTION: Randomized controlled trials of Tai Chi for people with a chronic musculoskeletal condition were included. DATA EXTRACTION: Two reviewers extracted data and rated risk of bias. Standardised mean differences and 95% confidence intervals (CI) were calculated for individual trials and pooled effect sizes were calculated using a random effects model. DATA SYNTHESIS: 15 studies were identified including people with osteoarthritis (80%), back pain (13%) and headache (7%). Using the GRADE approach, we found moderate quality evidence that Tai Chi is more effective than no treatment or usual care at short term on pain (SMD -0.66 (-0.85 to -0.48)) and disability (SMD -0.66 (-0.85 to -0.46)). The evidence for other outcomes was of low or very low quality and there was little information regarding long-term effects. Thus, while the number of publications in this area has increased, the rigor has not, hindering our ability to provide reliable recommendations for clinical practice. LIMITATIONS: The evidence provided in this review is limited by trials with small sample sizes, low methodological quality and lack of long-term assessment. CONCLUSIONS: In order for Tai Chi to be recommended as an effective intervention, more high quality trials with large sample sizes assessing Tai Chi versus other evidence-based treatments at short and long-term are needed.

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