TAICHIKNEE trial: protocol for an embedded pragmatic, individually randomised group-treatment trial of remotely delivered Tai Chi for knee osteoarthritis across US healthcare systems

Introduction: Symptomatic knee osteoarthritis (OA) is a leading cause of chronic pain and disability and is associated with substantial healthcare utilisation and costs. In-person Tai Chi, a multidimensional mind-body exercise, is recommended as a non-pharmacological therapy for knee OA; however, delivery through in-person classes may limit scalability across US healthcare systems. Remote delivery may reduce logistical barriers and facilitate integration into routine care, but evidence regarding its effectiveness and implementation in real-world healthcare settings remains limited. We describe the protocol for TAICHIKNEE, an embedded pragmatic trial evaluating remotely delivered group Tai Chi plus routine care vs routine care alone for adults with symptomatic knee OA.