Determinants of Qigong, Tai Chi, and Yoga Use for Health Conditions: A Systematic Review Protocol

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Wexler , Christopher Joyce , Rocky Reichman , Cora Pereira , Emma Fanuele , Emily Hurstak , View ORCID Profile Lance Laird , View ORCID Profile Helen Lavretsky , Chenchen Wang , Rob Saper , View ORCID Profile Karen S. Alcorn , View ORCID Profile Brian S. Mittman , View ORCID Profile Eric J. Roseen doi: https://doi.org/10.1101/2025.03.18.25324204 Ryan S. Wexler 1 Helfgott Research Institute, National University of Natural Medicine , Portland, Oregon, United States 2 Oregon Center for Complementary & Alternative Medicine in Neurological Disorders, Department of Neurology, Oregon Health and Science University , Portland, Oregon, United States 3 Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School , Ann Arbor, MI, United States ND, MSCR Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: ryan.wexler{at}nunm.edu Christopher Joyce 4 School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences , Worcester, MA, United States DPT, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Rocky Reichman 6 Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center , Boston, Massachusetts, United States BA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Cora Pereira 7 Department of Family Medicine, Boston University Chobanian & Avedisian School of Medicine , Boston, Massachusetts, United States BS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Emma Fanuele 8 Bieler School of Environment, McGill University , Montreal, Quebec, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Emily Hurstak 6 Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center , Boston, Massachusetts, United States MD, MPH, MAS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Lance Laird 7 Department of Family Medicine, Boston University Chobanian & Avedisian School of Medicine , Boston, Massachusetts, United States ThD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Lance Laird Helen Lavretsky 9 UCLA Department of Psychiatry and Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles, California, United States MD, MS Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Helen Lavretsky Chenchen Wang 10 Tufts Medicine, Tufts Medical Center , Boston, MA, USA MD, MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site Rob Saper 12 Nancy J. and Michael F. Roizen Chair in Wellness, Department of Wellness and Preventive Medicine, Cleveland Clinic , Cleveland, Ohio, United States MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Karen S. Alcorn 5 Division of Library and Learning Resources, Massachusetts College of Pharmacy and Health Sciences , Worcester, MA, United States MLS Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Karen S. Alcorn Brian S. Mittman 11 Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California, United States PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Brian S. Mittman Eric J. Roseen 6 Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center , Boston, Massachusetts, United States DC, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Eric J. Roseen Abstract Full Text Info/History Metrics Data/Code Preview PDF ABSTRACT INTRODUCTION Mind-body movement interventions such as qi gong, tai chi, and yoga are recommended in clinical practice guidelines to improve outcomes for several health conditions. However, use of these interventions for health conditions, or the integration of these interventions within healthcare settings, is low. A systematic synthesis of implementation determinants (i.e., barriers and facilitators) is needed to increase adoption. Similarly, determinants may influence other implementation outcomes, such as scalability or sustainability of these interventions in a healthcare system or community organization. Thus, in conducting this review we aim to identify determinants of qi gong, tai chi, and yoga use for health conditions. The secondary aim is to evaluate whether barriers and facilitators differ by intervention type, health condition, implementation setting, or implementation outcome. METHODS AND ANALYSIS We conducted a comprehensive search of electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, PsycInfo) through May 2024 and a grey literature search (Google Scholar, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov , the WHO Clinical Trials database) through March 2025. We will include original research articles in English that identify barriers and facilitators to adoption of qi gong, tai chi, and yoga by adults with health conditions. Study quality will be assessed using the Mixed Methods Appraisal Tool. We will code each article using a codebook informed by the Consolidated Framework for Implementation Research (CFIR), a comprehensive taxonomy of implementation determinants. Findings will be presented as a narrative synthesis. We will report on how barriers and facilitators may relate to intervention type (qi gong, tai chi, yoga), health condition (e.g., low back pain, fall prevention), implementation settings (e.g., primary care clinic, community organization) or implementation outcome (e.g., adoption, sustainability). ETHICS AND DISSEMINATION Ethics approval will not be obtained for this review of published, publicly accessible data. The results from this systematic review will be disseminated through conference presentations and journal publications. STRENGTHS AND LIMITATIONS OF THIS STUDY There are no prior comprehensive reviews of the determinants (i.e., barriers and facilitators) of qi gong, tai chi and yoga use. This review will examine whether barriers and/or facilitators vary by type of mind-body movement intervention, health condition, implementation setting, or implementation outcome. Our search has been guided by librarians with expertise in systematic review methodology and informed by the PEER Review of Electronic Search Strategies (PRESS) guidelines. Reporting of results will be informed by the PRISMA-P checklist for systematic reviews. We will use the updated version of the Consolidated Framework for Implementation Research (CFIR, version 2.0) to report implementation factors using consistent concepts to facilitate use of the review by researchers, healthcare systems, and community organizations. Our findings will support the development of implementation strategies to increase the adoption of qi gong, tai chi, and yoga for health conditions. Due to the complex nature of describing implementation determinants and characterizing them within the Consolidated Framework for Implementation Research, our review is limited to papers written in English which may restrict the generalizability of our implementation findings to predominantly English-speaking healthcare settings. INTRODUCTION Qi gong, tai chi, and yoga are mind-body movement interventions that combine body positions or postures with mindful movement, controlled breathing, and meditation. 1 – 5 The practice of these mind-body movement interventions can lead to improved physical function, general health and better disease-specific outcomes. 6 – 13 For example, tai chi has been shown to improve balance and prevent falls, increase function in older adults with knee and hip osteoarthritis, and improve several patient reported outcomes among adults with neuropsychiatric and cognitive disorders. 6 – 8 , 14 – 17 Similarly, yoga has been shown to improve outcomes for adults with low back pain, diabetes and cancer-related symptoms. 18 – 22 Accordingly, qi gong, tai chi, and yoga are recommended in major clinical practice guidelines for several common adult health conditions as shown in Table 1 . 23 – 30 While it is estimated that 20% of adults in the United States practice these mind-body movement interventions, 31 and use of yoga has exponentially increased over time, 32 , 33 use is predominantly focused on mind-body movement practice as a form of exercise to support general wellbeing. 34 Thus, despite growing evidence that qi gong, tai chi, and yoga can improve outcomes and reduce morbidity in persons living with common health conditions, 9 , 23 – 30 , 35 utilization of these interventions for specific health conditions remains low. 34 View this table: View inline View popup Download powerpoint Table 1. Select clinical practice guidelines that recommend yoga, tai chi, and qi gong for specific health conditions In the healthcare context, implementation science involves the study of methods to promote the systematic uptake of evidence-based practices into routine clinical care. 36 Understanding the determinants (i.e., barriers and facilitators) of evidence-based clinical interventions is an important first step in developing effective implementation strategies that increase the use of these interventions. Furthermore, barriers to intervention use can occur at multiple socio-ecological levels. 37 – 42 For example, barriers of mind-body movement interventions in healthcare settings can occur at the level of the patient (e.g., high out-of-pocket costs), referring provider (e.g., low self-efficacy to describe or refer to tai chi), health system technology (e.g., referral to yoga not possible in electronic health record), or policy-maker (e.g., payers not reimbursing mind-body movement interventions). 43 – 49 Thus, identifying and prioritizing modifiable barriers is needed to design tailored implementation strategies that can increase the use of qi gong, tai chi and yoga for specific health conditions, as recommended by clinical practice guidelines. 50 The Consolidated Framework for Implementation Research (CFIR) was developed to guide the comprehensive and systematic assessment of implementation determinants. 51 CFIR includes 67 distinct constructs–providing a comprehensive taxonomy of implementation determinants–which are organized into five domains: Innovation (e.g., tai chi), Outer Setting (e.g., policy makers including insurers), Inner Setting (e.g., a health system or clinic), Individuals (e.g., clinicians that may refer to Qi Gong), and the Implementation Process. 51 The systematic assessment and mapping of determinants to these specific constructs can be used to develop tailored strategies to increase the use of evidence-based practices. 52 As clinical guidelines increasingly support the use of qi gong, tai chi, and yoga for specific health conditions, and healthcare systems or community organizations begin to implement these interventions, 53 – 56 there is a growing need to understand implementation determinants to increase the effectiveness and efficiency of these implementation efforts. 47 , 57 – 59 While the explicit use of implementation science theories or frameworks, like CFIR in implementation of mind-body movement interventions is just emerging, 47 , 60 there are lessons to learn from prior literature. However, we are unaware of systematic reviews that summarize the existing knowledge around implementation determinants of mind-body movement interventions. One reason for the absence of prior reviews may be the limited familiarity, awareness, or use of CFIR (or other evolving determinant frameworks 42 , 61 ) within the clinical research communities studying mind-body movement interventions. Yet, applying the common language codified in CFIR to code the existing literature may help synthesize and better document prior work, thus elucidating known barriers and informing future implementation efforts. It may also be that heterogeneity exists in the factors that influence the implementation of mind-body movement interventions (e.g., if barriers to implementing tai chi for knee osteoarthritis are different than the barriers that impede implementation of yoga in cancer care). Understanding these differences will aid the development of implementation strategies that are appropriately tailored to the intervention, health condition, implementation setting, or the relevant implementation outcomes. The purpose of this systematic review will be to: 1) apply CFIR constructs to identify and report barriers and facilitators to the use of qi gong, tai chi, and yoga in treating various health conditions, and 2) identify sources of heterogeneity in determinants of intervention use, including variation in barriers and facilitators by type of mind-body movement intervention, health condition, implementation setting, or implementation outcome. 62 METHODS Design We will conduct a systematic review with a qualitative meta-analysis of original studies to synthesize evidence on implementation barriers and facilitators. 62 To organize and present our findings in common language that subsequently informs the development of implementation strategies, we will use an a priori codebook, informed by CFIR 2.0, to code and organize data from the original studies. 51 During data extraction, we will code data from the included primary studies in order to organize all information into the CFIR domains and constructs (see Table 2 ). 62 We will also allow for emerging themes not captured by the CFIR constructs. View this table: View inline View popup Download powerpoint Table 2. Overview of Consolidated Framework for Implementation Research (CFIR) domains The protocol for this systematic review was registered with the international prospective register of systematic reviews (PROSPERO #CRD42024569493). Reporting of the review findings will be informed by the PRISMA guidelines study protocols (PRISMA-P). 63 Eligibility Criteria This systematic review will include original peer-reviewed empirical studies including cross-sectional and longitudinal observational studies, randomized and non-randomized clinical trials, and qualitative and mixed method evaluations of implementation or quality improvement programs. We will conduct reference list checking, as described by the Terminology, Application, and Reporting of Citation Search (TARCiS) statement, 64 from conference proceedings, commentaries, editorials, dissertations, letters, books, book chapters, and reviews, but will exclude these types of articles. Relevant systematic reviews, commentaries, and literature reviews will also be searched for original research references, but excluded from full text review and extraction Inclusion Criteria We will include qualitative or quantitative studies that examine determinants (barriers and facilitators) of implementation outcomes for qi gong, tai chi, or yoga in adults with health conditions. We will include studies of adults with a specific health condition or those considered “at-risk” for a given health condition and described by the authors as such (e.g., older adults at risk for falls, cancer survivors). We will also include studies of other key informants (e.g., clinicians, health system or community leaders, policy makers). For example, we will include studies of clinicians if the mind-body movement intervention is relevant to a health condition they manage (e.g., geriatricians may recommend tai chi for knee osteoarthritis or fall prevention). We will also include multicomponent interventions (e.g., combined acupuncture-yoga intervention, mindfulness-based stress reduction) if we can identify facilitators or barriers specific to the qi gong, tai chi, or yoga component of the program. 60 , 65 Clinical trials will be included if they provide data on barriers and facilitators to mind-body movement intervention use thought to be relevant outside the context of the clinical trial. For example, we would include a study of yoga which measures feasibility and gathers information about barriers and facilitators to practicing yoga via semi-structured interviews or questionnaires. By contrast, we will exclude clinical trials that only measure implementation outcomes (e.g., measuring feasibility without collecting information on barriers or facilitators) or studies identifying barriers or facilitators that may only be relevant to the conduct of clinical trials (e.g., barriers to recruitment of trial participants). Exclusion Criteria Healthy populations (i.e., those without a specified health condition or not designated as at-risk for a health condition); populations under the age of 18 years; conference proceedings, commentaries, editorials, dissertations, letters, books, book chapters, and reviews; and articles written in languages other than English will be excluded. We will exclude studies written in languages other than English because it may be difficult to accurately code translated text while maintaining a common language from the field of implementation science (i.e., CFIR constructs) where term homonymity, synonymy, and instability are major challenges. 66 – 68 Search Strategy A comprehensive search of studies was conducted from database inception until May 2024 using the electronic databases: MEDLINE (OVID platform), Embase (OVID platform), CINAHL, PsycInfo, and Web of Science. In addition, a grey literature search was conducted using Google Scholar, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov , and the WHO International Clinical Trials database in March of 2025. Search terms were variations on two concepts: qi gong, tai chi, or yoga AND barrier, facilitators, or implementation. Search strings varied slightly depending on the MESH and subject heading terms within each database. Truncation (*) was used to capture variations in terms. Results were limited to the English language. See Appendix 1 for full search strategies for each database. Endnote was used to remove duplicates and double-checked by librarians with expertise in systematic review methods. Additional duplicates were identified and removed in the systematic review software, Covidence (Veritas Health Innovation, Melbourne, Australia). Data Extraction Through team meetings and the use of exemplar articles, an extraction form was developed ( Appendix 2 ) to capture information on each study. We will extract the following information on general study characteristics: author(s), year, country where the study was conducted, study design, sample size, and data collection method (e.g., interviews, focus groups, surveys). We will collect information on the sample including participant demographic characteristic such as age, sex, race/ethnicity, and other characteristics that define the population of interest (e.g., military veterans, healthcare workers). We will identify what stakeholder perspectives(s) are being captured (e.g. patients, instructors of mind-body movement interventions, primary care providers, medical specialists, medical educators, hospital leadership, community leaders, policy makers). We will extract information on strength of evidence of the intervention for the specific health condition as justified by the original investigator. The authors rationale for implementation efforts will be characterized as: 1) the mind-body movement intervention is recommended for the specific health condition (e.g., a guideline recommending yoga for low back pain 9 ); 2) a component of the mind-body movement intervention is recommended for the specific health condition (e.g., a guideline recommending exercise or mindfulness for cardiovascular health 69 ); or 3) implementation is occurring without a clinical practice guideline supporting either the intervention or its components for the specific health condition. We will extract information on several potential sources of heterogeneity in our evaluation of implementation determinants for mind-body movement intervention use for health conditions. First, we will identify the intervention type (i.e., qi gong, tai chi, yoga) and intervention delivery method (e.g., in-person, virtual). Second, we will identify health conditions of interest (e.g., low back pain, knee osteoarthritis). Third, the implementation setting will be characterized by the location where implementation is occurring (e.g., primary care clinic, community organization). We will also document if practice of qi gong, yoga, or tai chi occurs elsewhere (e.g., if primary care providers refer to community-based interventions or when virtually delivered interventions are practiced at home). When possible, we will also identify the specific implementation outcome(s) of interest in each study, with implementation outcomes defined by Proctor et al shown in Table 3 . 70 This will allow us to evaluate whether determinants vary by implementation outcome (e.g., was the determinant a barrier to adoption and/or sustainability?). Acceptability, appropriateness, and feasibility are considered pre-implementation outcomes, i.e., outcomes that can precede implementation efforts that can predict other implementation outcomes such as adoption or sustainability. 71 View this table: View inline View popup Download powerpoint Table 3. Definitions of Implementation Outcomes 70 Barriers and facilitators will be identified through coding of relevant quantitative data (e.g., surveys) and qualitative findings (e.g., themes) from the results section of each study using a codebook informed by CFIR version 2.0. 51 We have piloted this codebook in several prior and ongoing studies designed to inform the development of implementation strategies. 47 , 50 We will also allow for emerging determinants (i.e., those that are not captured by CFIR) to arise throughout the coding process. Two reviewers will independently extract data from each of the primary studies. Disagreements in data extraction will be resolved by senior reviewers and/or team consensus meetings. Data Synthesis and Qualitative Meta Analysis We will describe the frequency of identified barriers and facilitators and use heatmaps to illustrate high-density areas of CFIR. 72 We will explore whether barriers and facilitators differ based on intervention type (e.g., tai chi vs. yoga), health condition (e.g., back pain vs cancer symptom management), setting (e.g., primary care clinic vs. community organization), and implementation outcome (e.g., adoption vs sustainability). For health condition, we will explore whether barriers and facilitators differ when qi gong, tai chi, and yoga are being implemented for different clinical indications (e.g., fall prevention, osteoarthritis, or symptom management in cancer care). For setting, we will explore whether barriers/facilitators differ when qi gong, tai chi, and yoga are implemented in different contexts. Clinical settings may include primary care clinics, medical specialty clinics (e.g., pain medicine, rheumatology, orthopedics, physical medicine and rehabilitation, integrative medicine, sports medicine), community settings (e.g., nursing homes, community centers, parks, home-based programs), or other specific settings where qi gong, tai chi, or yoga may be delivered for health conditions. For implementation outcomes, we will explore whether barriers and facilitators differ when a specific implementation outcome is specified. We will characterize each study as having no specified implementation outcomes or one or more of the following implementation outcomes: acceptability, appropriateness, feasibility, adoption, fidelity, penetration, cost, and sustainability of intervention delivery. 70 Risk of Bias Assessment Study quality will be assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018. 73 The MMAT is a grading check list that can be used to assess the risk of bias in five types of study designs: 1) Qualitative, 2) Quantitative randomized controlled trials, 3) Quantitative non-randomized trials, 4) Quantitative descriptive, and 5) Mixed methods. Two reviewers will independently use the appropriate checklist to grade each included study. Discrepancies between the two reviewers will be discussed at team meetings and/or arbitrated by a third reviewer. DISCUSSION The benefits of qi gong, tai chi, and yoga have been established for several health conditions. Thus, we anticipate our systematic review will identify studies on barriers and facilitators to mind-body movement intervention use for specific health conditions where there is consensus that these interventions are helpful. For example, guidelines endorse one or more of these mind-body movement interventions for low back pain (American College of Physicians 9 ), osteoarthritis (American College of Rheumatology and the Osteoarthritis Research Society International guidelines 25 and the American College of Rheumatology and Arthritis Foundation 74 ), hypertension (International Society of Hypertension Global Hypertension 23 ), and fall prevention (United States Preventive Services Task Force among exercise interventions 24 ). While several studies have looked at barriers to implementation of a specific intervention or within a particular clinical context, we are unaware of any publications that have synthesized what is known about implementing qi gong, tai chi, or yoga across broad settings where people with health conditions receive services. Identifying barriers is essential for developing effective implementation strategies that can support their adoption in routine care settings. Implementation strategies that target specific known barriers may be more effective than general strategies. While developing implementation strategies that have multiple components is also thought to be effective, it is important to tailor resources to those strategies most likely to be successful within a specific context. 75 , 76 Thus, identifying a range of barriers and facilitators, and whether they are relevant to a range of contexts, is essential to inform future dissemination and implementation efforts in research and practice. 77 , 78 Our qualitative meta-analysis will help us to organize and interpret information on implementation determinants using the common set of terminology defined in CFIR domains and constructs. Data Availability All data produced in the present study are available upon reasonable request to the authors Patient and Public Involvement Patients and the public will not be involved in the study design, data extraction, or interpretation of results. Ethics and Dissemination Ethics approval will not be obtained for this review of published, publicly accessible data. The results from this systematic review will be disseminated through conference presentations and journal publications. Based on our preliminary search results, we anticipate a majority of the papers included in our review will reflect the patient perspective, i.e., patient-related barriers to use of mind-body interventions for health conditions. Due to this potential asymmetry in data on intervention barriers and facilitators among different stakeholder perspectives, we anticipate that findings from our systematic review and qualitative meta-analysis may be split into two reports, 1) patient perspectives and 2) provider, staff, and healthcare system leader perspectives. Additionally, this review will inform the implementation of tai chi in four large healthcare systems in the context of a multi-site embedded pragmatic trial funded by the National Center for Complementary and Integrative Health (NIH Grant #: UG3AT012413). We also anticipate our review will inform other implementation efforts of qi gong, tai chi and yoga for specific health conditions in health care systems or community organizations. Author Contributions Study concept and design: RSW, CJ, RR, CP, and EJR Acquisition, analysis, or interpretation of data: RSW, CJ, RR, CP, EM, EH HL, CW, RS, BM, KSA, JD, and EJR. Critical revision of the manuscript for important intellectual content: RSW, CJ, RR, CP, EM, EH, HL, CW, RS, BM, KSA, JD, and EJR. Statistical analysis: n/a Obtained funding: n/a Administrative, technical, or material support: CJ, EJR . Study supervision: EJR Funding Several authors (RR, HL, RS, CW, EJR, EH) were supported by the National Center for Complementary and Integrative Health (K24AT007323, K23-AT010487, and UG3AT012413). RSW receives funding from the grant K12NS130673 from the National Institute of Neurological Disorders and Stroke. This work was supported within the National Institutes of Health (NIH) Pragmatic Trials Collaboratory by cooperative agreements UG3 AT012413 and UH3 AT012413 from the National Center for Complementary and Integrative Health (NCCIH). This work also received logistical and technical support from the NIH Pragmatic Trials Collaboratory Coordinating Center through cooperative agreement U24 AT009676 from NCCIH, the National Institute of Allergy and Infectious Diseases (NIAID), the National Cancer Institute (NCI), the National Institute on Aging (NIA), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Nursing Research (NINR), the National Institute of Minority Health and Health Disparities (NIMHD), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the NIH Office of Behavioral and Social Sciences Research (OBSSR), and the NIH Office of Disease Prevention (ODP). The content is solely the responsibility of the authors and does not necessarily represent the official views of NCCIH, NIAID, NCI, NIA, NHLBI, NINR, NIMHD, NIAMS, OBSSR, or ODP, or the NIH. Conflicts of Interest The authors have no conflicts of interest to disclose. Funding for this review was provided by internal funds from Boston Medical Center. There was no study sponsor. Study Dates Work on the protocol began in February 2024. Screening began after the protocol was registered on PROSPERO and as the protocol was submitted for peer review. It is expected the study will be completed by June 2025. Acknowledgements We would like to acknowledge Joanne Doucette, an expert systematic review librarian who helped our team develop the search strategy for this review. Appendix 1. Detailed search strategy Database: MEDLINE(R) ALL Host: Ovid Data parameters: 1946-05/18/2024 Date of search: 05/18/2024 Results: 4347 Search Strategy: (Tai Ji/ OR Yoga/ OR Qigong/ OR (Tai Ji.tw. OR Tai-ji.tw. OR Tai Chi.tw. OR Taiji.tw. OR Taijiquan.tw. OR tai ji quan.tw. OR T’ai Chi.tw. OR tai chi chuan.tw. OR yoga.tw. OR yogic meditation.tw. OR qigong.tw. OR Qi Gong.tw. OR Ch’i kung.tw. OR Chi kung.tw.)) AND (barrier*.tw. OR obstacle*.tw. OR challeng*.tw. OR difficult*.tw. OR issue*.tw. OR problem*.tw. OR imped*.tw. OR limit*.tw. OR struggle*.tw. OR complexit*.tw. OR disadvantage*.tw. OR restriction*.tw. OR facilitat*.tw. OR motivat*.tw. OR enabl*.tw. OR accessib*.tw. OR determin*.tw. OR implement*.tw.) Limit to English Database: Embase Host: Ovid Data parameters: 1974-05/19/2024 Date of search: 05/19/2024 Results: 5957 Search Strategy: (Tai Chi/ OR Yoga/ OR Qigong/ OR (Tai Ji.tw. OR Tai-ji.tw. OR Tai Chi.tw. OR Taiji.tw. OR Taijiquan.tw. OR tai ji quan.tw. OR T’ai Chi.tw. OR tai chi chuan.tw. OR yoga.tw. OR yogic meditation.tw. OR qigong.tw. OR Qi Gong.tw. OR Ch’i kung.tw. OR Chi kung.tw.)) AND (barrier*.tw. OR obstacle*.tw. OR challeng*.tw. OR difficult*.tw. OR issue*.tw. OR problem*.tw. OR imped*.tw. OR limit*.tw. OR struggle*.tw. OR complexit*.tw. OR disadvantage*.tw. OR restriction*.tw. OR facilitat*.tw. OR motivat*.tw. OR enabl*.tw. OR accessib*.tw. OR determin*.tw. OR implement*.tw.) Limit to English Omitted conference abstracts, books, and pre-prints Database: CINAHL with Full Text Host: EBSCOhost Data parameters: 1981-05/18/2024 Date of search: 05/18/2024 Results: 2633 Search Strategy: ((MH “Tai Chi”) OR (MH “Yoga”) OR (MH “Qigong”) OR Tai Ji OR Tai-ji OR Tai Chi OR Taiji OR Taijiquan OR T’ai Chi OR yoga OR yogic meditation OR qigong OR Qi Gong OR Ch’i kung OR Chi kung)) AND (barrier* OR obstacle* OR challeng* OR difficult* OR issue* OR problem* OR imped* OR limit* OR struggle* OR complexit* OR disadvantage* OR restriction* OR facilitat* OR motivat* OR enabl* OR accessib* OR determin* OR implement*) Limit to English and Peer-review Database: APA PsycInfo Host: Ovid Data parameters: 1806-05/18/2024 Date of search: 05/18/2024 Results: 1441 Search Strategy: (Yoga/ OR (Tai Ji.tw. OR Tai-ji.tw. OR Tai Chi.tw. OR Taiji.tw. OR Taijiquan.tw. OR tai ji quan.tw. OR T’ai Chi.tw. OR tai chi chuan.tw. OR yoga.tw. OR yogic meditation.tw. OR qigong.tw. OR Qi Gong.tw. OR Ch’i kung.tw. OR Chi kung.tw.)) AND (barrier*.tw. OR obstacle*.tw. OR challeng*.tw. OR difficult*.tw. OR issue*.tw. OR problem*.tw. OR imped*.tw. OR limit*.tw. OR struggle*.tw. OR complexit*.tw. OR disadvantage*.tw. OR restriction*.tw. OR facilitat*.tw. OR motivat*.tw. OR enabl*.tw. OR accessib*.tw. OR determin*.tw. OR implement*.tw.) Limit to English, Peer-reviewed, no dissertations Database: Web of Science Host: Clarivate Data parameters: Core Collection, 1900-05/18/2024 Date of search: 05/18/2024 Results: 2931 Search Strategy: (TI=("Tai Ji" OR Tai-ji OR "Tai Chi" OR Taiji OR Taijiquan OR "T’ai Chi" OR yoga OR "yogic meditation" OR qigong OR "Qi Gong" OR "Ch’i kung" OR "Chi kung") OR AB=("Tai Ji" OR Tai-ji OR "Tai Chi" OR Taiji OR Taijiquan OR "T’ai Chi" OR yoga OR "yogic meditation" OR qigong OR "Qi Gong" OR "Ch’i kung" OR "Chi kung")) (TI=(barrier* OR obstacle* OR challeng* OR difficult* OR issue* OR problem* OR imped* OR limit* OR struggle* OR complexit* OR disadvantage* OR restriction* OR facilitat* OR motivat* OR enabl* OR accessib* OR determin* OR implement*) OR AB=(barrier* OR obstacle* OR challeng* OR difficult* OR issue* OR problem* OR imped* OR limit* OR struggle* OR complexit* OR disadvantage* OR restriction* OR facilitat* OR motivat* OR enabl* OR accessib* OR determin* OR implement*)) #1 AND #2 #1 AND #2 and English (Languages) Kept WOS records (omitted PDTA, Korean, SciELO, Medline) Database: Google Scholar Host: Google Data parameters: N/A Date of search: March 5, 2025 Results: The first 200 results were used Search Strategy: intitle:(tai chi OR qigong OR yoga) (barrier OR barriers OR facilitator OR facilitators) Database: Cochrane Central Register of Controlled Trials Host: Wiley Data parameters: Issue 2 of 12, February 2025 Date of search: March 5, 2025 Results: 375 Search Strategy: “tai chi” OR qigong OR yoga OR “Tai Ji” OR “Tai-ji” OR Taiji OR Taijiquan OR “T’ai Chi” OR “yogic meditation” OR “Qi Gong” OR “Ch’i kung” OR “Chi kung” in Title Abstract Keyword AND barrier OR facilitator in Title Abstract Keyword - (Word variations have been searched) Database: ClinicalTrials.gov Host: National Library of Medicine Data parameters: 200-03/06/2025 Date of search: March 6, 2025 Results: 43 Search Strategy: (tai chi OR qigong OR yoga OR Tai Ji OR Tai-ji OR Taiji OR Taijiquan OR T’ai Chi OR yogic meditation OR Qi Gong OR Ch’i kung OR Chi kung) AND (barrier OR barriers OR facilitator OR facilitators) Limited to completed studies only Database: WHO International Clinical Trials Database Host: World Health Organization / International Clinical Trials Registry Platform (ICTRP) Data parameters: 2006-03/06/2025 Date of search: March 6, 2025 Results: 20 Search Strategy: (“tai chi” OR qigong OR yoga) AND (barrier* OR facilitator*) Appendix 2. Extraction forms View this table: View inline View popup Footnotes christopher.joyce{at}mcphs.edu , jeffrey.reichman{at}bmc.org , coraep{at}bu.edu , emma.fanuele{at}gmail.com , Emily.hurstak{at}bmc.org ,, llaird{at}bu.edu , HLavretsky{at}mednet.ucla.edu , Chenchen.Wang{at}tuftsmedicine.org , saperr{at}ccf.org , karen.alcorn{at}mcphs.edu , Brian.S.Mittman{at}kp.org , eric.roseen{at}bmc.org REFERENCES 1. ↵ Wayne PM , Kaptchuk TJ . Challenges inherent to t’ai chi research: part I--t’ai chi as a complex multicomponent intervention . J Altern Complement Med . 2008 ; 14 ( 1 ): 95 – 102 . doi: 10.1089/acm.2007.7170a OpenUrl CrossRef PubMed Web of Science 2. Yoga for Health: What the Science Says . NCCIH . Accessed February 17, 2025 . https://www.nccih.nih.gov/health/providers/digest/yoga-for-health-science 3. Mind-Body Practices . International Association for the Study of Pain (IASP) . Accessed February 17, 2025 . https://www.iasp-pain.org/resources/fact-sheets/mind-body-practices/ 4. Mind and Body Practices . NCCIH . Accessed February 17, 2025 . https://www.nccih.nih.gov/health/mind-and-body-practices 5. ↵ Kaplan J , Somohano VC , Zaccari B , O’Neil ME . Randomized controlled trials of mind–body interventions for posttraumatic stress disorder: a systematic review . Front Psychol . 2024 ; 14 . doi: 10.3389/fpsyg.2023.1219296 OpenUrl CrossRef 6. ↵ Bagiartana KDA , Huriah T . A Systematic Review of the Effectiveness of Tai Chi Exercises for Improving Balance and Lower Limb Muscle Strength of the Elderly in the Community . Open Access Macedonian Journal of Medical Sciences . 2021 ; 9 ( T5 ): 6 – 12 . doi: 10.3889/oamjms.2021.7841 OpenUrl CrossRef 7. Fan X , Soh KG , Mun CY , Soh KL . Effects of different types of Tai Chi intervention on motor function in older adults: a systematic review . Aging Clin Exp Res . 2025 ; 37 ( 1 ): 32 . doi: 10.1007/s40520-024-02894-5 OpenUrl CrossRef PubMed 8. ↵ Ye Y , Liu A . The Effectiveness of Tai Chi for Knee Osteoarthritis: An Overview of Systematic Reviews . Int J Gen Med . 2023 ; 16 : 4499 – 4514 . doi: 10.2147/IJGM.S434800 OpenUrl CrossRef PubMed 9. ↵ Qaseem A , Wilt TJ , McLean RM , Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians . Ann Intern Med . 2017 ; 166 ( 7 ): 514 . doi: 10.7326/M16-2367 OpenUrl CrossRef PubMed 10. Rathore V , Singh S , Katiyar VK . Exploring the therapeutic effects of yoga on spine and shoulder mobility: A systematic review . J Bodyw Mov Ther . 2024 ; 40 : 586 – 596 . doi: 10.1016/j.jbmt.2024.04.029 OpenUrl CrossRef PubMed 11. Wieland LS , Skoetz N , Pilkington K , Harbin S , Vempati R , Berman BM . Yoga for chronic non-specific low back pain . Cochrane Database Syst Rev . 2022 ; 11 ( 11 ): CD010671 . doi: 10.1002/14651858.CD010671.pub3 OpenUrl CrossRef PubMed 12. Anheyer D , Haller H , Lauche R , Dobos G , Cramer H . Yoga for treating low back pain: a systematic review and meta-analysis . Pain . 2022 ; 163 ( 4 ): e504 – e517 . doi: 10.1097/j.pain.0000000000002416 OpenUrl CrossRef PubMed 13. ↵ Zhu F , Zhang M , Wang D , Hong Q , Zeng C , Chen W . Yoga compared to non-exercise or physical therapy exercise on pain, disability, and quality of life for patients with chronic low back pain: A systematic review and meta-analysis of randomized controlled trials . PLoS One . 2020 ; 15 ( 9 ): e0238544 . doi: 10.1371/journal.pone.0238544 OpenUrl CrossRef PubMed 14. ↵ Chen W , Li M , Li H , Lin Y , Feng Z . Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials . Front Public Health . 2023 ; 11 . doi: 10.3389/fpubh.2023.1236050 OpenUrl CrossRef 15. Sherrington C , Fairhall NJ , Wallbank GK , et al. Exercise for preventing falls in older people living in the community . Cochrane Database Syst Rev . 2019 ; 1 ( 1 ): CD012424 . doi: 10.1002/14651858.CD012424.pub2 OpenUrl CrossRef PubMed 16. Hempel S , Taylor SL , Solloway MR , et al. Evidence Map of Tai Chi . Department of Veterans Affairs (US) ; 2014 . Accessed October 7, 2024 . http://www.ncbi.nlm.nih.gov/books/NBK253200/ 17. ↵ Cui Z , Xiong J , Li Z , Yang C . Tai chi improves balance performance in healthy older adults: a systematic review and meta-analysis . Front Public Health . 2024 ; 12 : 1443168 . doi: 10.3389/fpubh.2024.1443168 OpenUrl CrossRef PubMed 18. ↵ Coeytaux RR , McDuffie J , Goode A , et al. Evidence Map of Yoga for High-Impact Conditions Affecting Veterans . Department of Veterans Affairs (US) ; 2014 . Accessed October 7, 2024 . http://www.ncbi.nlm.nih.gov/books/NBK242401/ 19. Krause-Sorio B , Siddarth P , Kilpatrick L , et al. Yoga Prevents Gray Matter Atrophy in Women at Risk for Alzheimer’s Disease: A Randomized Controlled Trial . J Alzheimers Dis . 2022 ; 87 ( 2 ): 569 – 581 . doi: 10.3233/JAD-215563 OpenUrl CrossRef PubMed 20. Nguyen SA , LAvretsky H. Emerging Complementary and Integrative Therapies for Geriatric Mental Health . Curr Treat Options Psychiatry . 2020 ; 7 ( 4 ): 447 – 470 . doi: 10.1007/s40501-020-00229-5 OpenUrl CrossRef PubMed 21. Thind H , Lantini R , Balletto BL , et al. The effects of yoga among adults with type 2 diabetes: A systematic review and meta-analysis . Prev Med . 2017 ; 105 : 116 – 126 . doi: 10.1016/j.ypmed.2017.08.017 OpenUrl CrossRef PubMed 22. ↵ Innes KE , Selfe TK . Yoga for Adults with Type 2 Diabetes: A Systematic Review of Controlled Trials . J Diabetes Res . 2016 ; 2016 : 6979370 . doi: 10.1155/2016/6979370 OpenUrl CrossRef PubMed 23. ↵ Unger T , Borghi C , Charchar F , et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines . Hypertension . 2020 ; 75 ( 6 ): 1334 – 1357 . doi: 10.1161/HYPERTENSIONAHA.120.15026 OpenUrl CrossRef PubMed 24. ↵ US Preventive Services Task Force , Nicholson WK , Silverstein M , et al. Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement . JAMA . 2024 ; 332 ( 1 ): 51 . doi: 10.1001/jama.2024.8481 OpenUrl CrossRef PubMed 25. ↵ Bannuru RR , Osani MC , Vaysbrot EE , et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis . Osteoarthritis Cartilage . 2019 ; 27 ( 11 ): 1578 – 1589 . doi: 10.1016/j.joca.2019.06.011 OpenUrl CrossRef PubMed 26. Hauk L. Low Back Pain: American College of Physicians Practice Guideline on Noninvasive Treatments . afp . 2017 ; 96 ( 6 ): 407 – 408 . OpenUrl 27. Kolasinski SL , Neogi T , Hochberg MC , et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand , Hip, and Knee. Arthritis & Rheumatology . 2020 ; 72 ( 2 ): 220 – 233 . doi: 10.1002/art.41142 OpenUrl CrossRef PubMed 28. Mao JJ , Ismaila N , Bao T , et al. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology–ASCO Guideline . JCO . 2022 ; 40 ( 34 ): 3998 – 4024 . doi: 10.1200/JCO.22.01357 OpenUrl CrossRef PubMed 29. American Diabetes Association Professional Practice Committee. 5 . Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2024 . Diabetes Care . 2023 ; 47 ( Supplement_1 ): S77 – S110 . doi: 10.2337/dc24-S005 OpenUrl CrossRef 30. ↵ England BR , Smith BJ , Baker NA , et al. 2022 American College of Rheumatology (ACR) Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis . Accessed February 20, 2025 . https://stacks.cdc.gov/view/cdc/151745 31. ↵ Bhattacharyya KK , Hueluer G , Meng H , Hyer K . Mind-body practices in U . S. adults: Prevalence and correlates. Complement Ther Med . 2020 ; 52 : 102501 . doi: 10.1016/j.ctim.2020.102501 OpenUrl CrossRef PubMed 32. ↵ Clarke TC , Stussman BJ. Use of Yoga, Meditation, and Chiropractors Among U.S. Adults Aged 18 and Over . 2018 ;( 325 ): 8 . 33. ↵ Wang C (Chunyun) , Li K , Gaylord A. S. Trends and characteristics of Tai Chi and Qi Gong use among U.S. adults: Results from the 2007–2017 National Health Interview Survey . Complementary Therapies in Medicine . 2022 ; 71 : 102890 . doi: 10.1016/j.ctim.2022.102890 OpenUrl CrossRef PubMed 34. ↵ Wang CC , Li K , Choudhury A , Gaylord S . Trends in Yoga, Tai Chi, and Qigong Use Among US Adults, 2002-2017 . Am J Public Health . 2019 ; 109 ( 5 ): 755 – 761 . doi: 10.2105/AJPH.2019.304998 OpenUrl CrossRef PubMed 35. ↵ Connor J , Buring JE , Eisenberg DM , Osypiuk K , Davis RB , Wayne PM . Patient Disclosure of Complementary and Integrative Health Approaches in an Academic Health Center . Glob Adv Health Med . 2020 ; 9 : 2164956120912730 . doi: 10.1177/2164956120912730 OpenUrl CrossRef PubMed 36. ↵ Eccles MP , Mittman BS . Welcome to Implementation Science . Implementation Science . 2006 ; 1 ( 1 ): 1 . doi: 10.1186/1748-5908-1-1 OpenUrl CrossRef 37. ↵ Bronfenbrenner U . Toward an experimental ecology of human development . American Psychologist . 1977 ; 32 ( 7 ): 513 – 531 . doi: 10.1037/0003-066X.32.7.513 OpenUrl CrossRef Web of Science 38. Sallis JF , Owen NG . Ecological Models of Health Behaviour . Vol 3rd Edition . Jossey-Bass ; 2002 : 462 – 484 . Accessed February 17, 2025 . https://espace.library.uq.edu.au/view/UQ:68927 39. McLeroy KR , Bibeau D , Steckler A , Glanz K . An ecological perspective on health promotion programs . Health Educ Q . 1988 ; 15 ( 4 ): 351 – 377 . doi: 10.1177/109019818801500401 OpenUrl CrossRef 40. Wold B , Mittelmark MB . Health-promotion research over three decades: The social-ecological model and challenges in implementation of interventions . Scand J Public Health . 2018 ; 46 ( 20_suppl ): 20 – 26 . doi: 10.1177/1403494817743893 OpenUrl CrossRef PubMed 41. Caperon L , Saville F , Ahern S . Developing a socio-ecological model for community engagement in a health programme in an underserved urban area . PLoS One . 2022 ; 17 ( 9 ): e0275092 . doi: 10.1371/journal.pone.0275092 OpenUrl CrossRef PubMed 42. ↵ Nilsen P . Making sense of implementation theories, models and frameworks . Implementation Science . 2015 ; 10 ( 1 ): 53 . doi: 10.1186/s13012-015-0242-0 OpenUrl CrossRef PubMed 43. ↵ McGuire C , Gabison J , Kligler B . Facilitators and Barriers to the Integration of Mind-Body Medicine into Primary Care . J Altern Complement Med . 2016 ; 22 ( 6 ): 437 – 442 . doi: 10.1089/acm.2016.0043 OpenUrl CrossRef PubMed 44. Bransteter I , McVoy M , Miller DW , et al. Barriers and Facilitators to Incorporating an Integrative Mind–Body Intervention in Youth With Type 2 Diabetes . JAACAP Open . 2024 ; 0 ( 0 ). doi: 10.1016/j.jaacop.2024.01.005 OpenUrl CrossRef 45. Spadola CE , Rottapel R , Khandpur N , et al. Enhancing Yoga Participation: A Qualitative Investigation of Barriers and Facilitators to Yoga among Predominantly Racial/Ethnic Minority, Low-Income Adults . Complement Ther Clin Pract . 2017 ; 29 : 97 – 104 . doi: 10.1016/j.ctcp.2017.09.001 OpenUrl CrossRef PubMed 46. Du Y , Roberts P , Liu W . Facilitators and Barriers of Tai Chi Practice in Community-Dwelling Older Adults: Qualitative Study . Asian Pac Isl Nurs J . 2023 ; 7 : e42195 . doi: 10.2196/42195 OpenUrl CrossRef 47. ↵ Roseen EJ , Joyce C , Winbush S , et al. Primary care barriers and facilitators to nonpharmacologic treatments for low back pain: A qualitative pilot study . PM R. Published online May 2 , 2024 . doi: 10.1002/pmrj.13183 OpenUrl CrossRef 48. Huston P , MacGuigan D . What Do Academic Physicians Think of Tai Chi? A Qualitative Study . J Altern Complement Med . 2021 ; 27 ( 5 ): 434 – 441 . doi: 10.1089/acm.2020.0418 OpenUrl CrossRef PubMed 49. ↵ Grasser LR , Marusak H. Strong Mind, Strong Body: The Promise of Mind-Body Interventions to Address Growing Mental Health Needs Among Youth . Mental Health Sci . 2023 ; 1 ( 2 ): 58 – 66 . doi: 10.1002/mhs2.16 OpenUrl CrossRef PubMed 50. ↵ Roseen EJ , Natrakul A , Kim B , Broder-Fingert S . Process mapping with failure mode and effects analysis to identify determinants of implementation in healthcare settings: a guide . Implementation Science Communications . 2024 ; 5 ( 1 ): 110 . doi: 10.1186/s43058-024-00642-4 OpenUrl CrossRef PubMed 51. ↵ Damschroder LJ , Reardon CM , Widerquist MAO , Lowery J . The updated Consolidated Framework for Implementation Research based on user feedback . Implementation Science . 2022 ; 17 ( 1 ): 75 . doi: 10.1186/s13012-022-01245-0 OpenUrl CrossRef PubMed 52. ↵ Fernandez ME , Ten Hoor GA , van Lieshout S , et al. Implementation Mapping: Using Intervention Mapping to Develop Implementation Strategies . Front Public Health . 2019 ; 7 : 158 . doi: 10.3389/fpubh.2019.00158 OpenUrl CrossRef PubMed 53. ↵ Li F , Harmer P , Stock R , et al. Implementing an evidence-based fall prevention program in an outpatient clinical setting . J Am Geriatr Soc . 2013 ; 61 ( 12 ): 2142 – 2149 . doi: 10.1111/jgs.12509 OpenUrl CrossRef PubMed 54. Smith ML , Durrett NK , Schneider EC , et al. Examination of sustainability indicators for fall prevention strategies in three states . Eval Program Plann . 2018 ; 68 : 194 – 201 . doi: 10.1016/j.evalprogplan.2018.02.001 OpenUrl CrossRef PubMed 55. Chewning B , Hallisy KM , Mahoney JE , Wilson D , Sangasubana N , Gangnon R . Disseminating Tai Chi in the Community: Promoting Home Practice and Improving Balance . Gerontologist . 2020 ; 60 ( 4 ): 765 – 775 . doi: 10.1093/geront/gnz006 OpenUrl CrossRef PubMed 56. ↵ Li F , Harmer P , Glasgow R , et al. Translation of an Effective Tai Chi Intervention Into a Community-Based Falls-Prevention Program . Am J Public Health . 2008 ; 98 ( 7 ): 1195 – 1198 . doi: 10.2105/AJPH.2007.120402 OpenUrl CrossRef PubMed Web of Science 57. ↵ Implementation Science for Complementary and Integrative Health. NCCIH . Accessed May 11, 2023 . https://www.nccih.nih.gov/about/nccih-strategic-plan-2021-2025/top-scientific-priorities/implementation-science-for-complementary-and-integrative-health 58. Clark D , Edwards E , Murray P , Langevin H . Implementation Science Methodologies for Complementary and Integrative Health Research . J Altern Complement Med . 2021 ; 27 ( Suppl 1 ): S-7 – S-13 . doi: 10.1089/acm.2020.0446 OpenUrl CrossRef 59. ↵ Dw M , Ej R , Jam S , et al. Incorporating Acupuncture Into American Healthcare: Initiating a Discussion on Implementation Science, the Status of the Field, and Stakeholder Considerations . Global advances in health and medicine . 2021 ; 10 . doi: 10.1177/21649561211042574 OpenUrl CrossRef 60. ↵ Anderson BJ , Meissner P , Mah DM , et al. Barriers and Facilitators to Implementing Bundled Acupuncture and Yoga Therapy to Treat Chronic Pain in Community Healthcare Settings: A Feasibility Pilot . J Altern Complement Med . 2021 ; 27 ( 6 ): 496 – 505 . doi: 10.1089/acm.2020.0394 OpenUrl CrossRef PubMed 61. ↵ Nilsen P , Bernhardsson S . Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes . BMC Health Serv Res . 2019 ; 19 ( 1 ): 189 . doi: 10.1186/s12913-019-4015-3 OpenUrl CrossRef PubMed 62. ↵ Levitt HM . How to conduct a qualitative meta-analysis: Tailoring methods to enhance methodological integrity . Psychother Res . 2018 ; 28 ( 3 ): 367 – 378 . doi: 10.1080/10503307.2018.1447708 OpenUrl CrossRef PubMed 63. ↵ Shamseer L , Moher D , Clarke M , et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation . BMJ . 2015 ; 349 ( jan02 1 ): g7647 – g7647 . doi: 10.1136/bmj.g7647 OpenUrl Abstract / FREE Full Text 64. ↵ Hirt J , Nordhausen T , Fuerst T , Ewald H , Appenzeller-Herzog C . Guidance on terminology, application, and reporting of citation searching: the TARCiS statement . Published online May 9 , 2024 . doi: 10.1136/bmj-2023-078384 OpenUrl FREE Full Text 65. ↵ Ee C , Singleton AC , de Manincor M , et al. A Qualitative Study Exploring Feasibility and Acceptability of Acupuncture, Yoga, and Mindfulness Meditation for Managing Weight After Breast Cancer . Integr Cancer Ther . 2022 ; 21 : 15347354221099540 . doi: 10.1177/15347354221099540 OpenUrl CrossRef PubMed 66. ↵ Lewis CC , Mettert KD , Dorsey CN , et al. An updated protocol for a systematic review of implementation-related measures . Systematic Reviews . 2018 ; 7 ( 1 ): 66 . doi: 10.1186/s13643-018-0728-3 OpenUrl CrossRef PubMed 67. McKibbon KA , Lokker C , Wilczynski NL , et al. A cross-sectional study of the number and frequency of terms used to refer to knowledge translation in a body of health literature in 2006: a Tower of Babel? Implement Sci . 2010 ; 5 : 16 . doi: 10.1186/1748-5908-5-16 OpenUrl CrossRef PubMed 68. ↵ Tabak RG , Khoong EC , Chambers DA , Brownson RC . Bridging research and practice: models for dissemination and implementation research . Am J Prev Med . 2012 ; 43 ( 3 ): 337 – 350 . doi: 10.1016/j.amepre.2012.05.024 OpenUrl CrossRef PubMed 69. ↵ Virani SS , Newby LK , Arnold SV , et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines . Circulation . 2023 ; 148 ( 9 ): e9 - e119 . doi: 10.1161/CIR.0000000000001168 OpenUrl CrossRef PubMed 70. ↵ Proctor E , Silmere H , Raghavan R , et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda . Adm Policy Ment Health . 2011 ; 38 ( 2 ): 65 – 76 . doi: 10.1007/s10488-010-0319-7 OpenUrl CrossRef PubMed 71. ↵ Weiner BJ , Lewis CC , Stanick C , et al. Psychometric assessment of three newly developed implementation outcome measures . Implementation Science . 2017 ; 12 ( 1 ): 108 . doi: 10.1186/s13012-017-0635-3 OpenUrl CrossRef PubMed 72. ↵ Kinney AR , Stearns-Yoder KA , Hoffberg AS , et al. Barriers and Facilitators to the Adoption of Evidence-Based Interventions for Adults Within Occupational and Physical Therapy Practice Settings: A Systematic Review . Arch Phys Med Rehabil . 2023 ; 104 ( 7 ): 1132 – 1151 . doi: 10.1016/j.apmr.2023.03.005 OpenUrl CrossRef PubMed 73. ↵ Hong QN , Gonzalez-Reyes A , Pluye P . Improving the usefulness of a tool for appraising the quality of qualitative, quantitative and mixed methods studies, the Mixed Methods Appraisal Tool (MMAT) . J Eval Clin Pract . 2018 ; 24 ( 3 ): 459 – 467 . doi: 10.1111/jep.12884 OpenUrl CrossRef PubMed 74. ↵ Buelt A , Narducci DM. Osteoarthritis Management: Updated Guidelines from the American College of Rheumatology and Arthritis Foundation . afp . 2021 ; 103 ( 2 ): 120 – 121 . OpenUrl 75. ↵ Mechanic D . Improving the quality of health care in the United States of America: the need for a multi-level approach . J Health Serv Res Policy . 2002 ; 7 Suppl 1 : S35 – 39 . doi: 10.1258/135581902320176359 OpenUrl CrossRef PubMed 76. ↵ Chaudoir SR , Dugan AG , Barr CH . Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures . Implementation Science . 2013 ; 8 ( 1 ): 22 . doi: 10.1186/1748-5908-8-22 OpenUrl CrossRef PubMed 77. ↵ Roseen EJ , Purtle J , Zhang W , et al. The Intersection of Dissemination Research and Acupuncture: Applications for Chronic Low Back Pain . Glob Adv Health Med . 2021 ; 10 : 2164956120980694 . doi: 10.1177/2164956120980694 OpenUrl CrossRef PubMed 78. ↵ Miller DW , Roseen EJ , Stone JAM , et al. Incorporating Acupuncture Into American Healthcare: Initiating a Discussion on Implementation Science, the Status of the Field, and Stakeholder Considerations . Glob Adv Health Med . 2021 ; 10 : 21649561211042574 . doi: 10.1177/21649561211042574 OpenUrl CrossRef View the discussion thread. Back to top Previous Next Posted March 21, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. 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