Kaimen Rigor reviewed

Rigor-Reviewed Manuscript

Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial.

Name: Kaimen Rigor review — Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial.
Item: Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial.
Rating: 59
Author: Alpha1

Siu PM, Yu DJ, Yu AP, Recchia F, Li SX, Chan RN, Fong DY, Chan DK, Hui SS, Chung KF, Woo J, Wang C, Irwin MR

Paper source

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Kaimen Rigor review — 3.25★ (Adequate), 0 critical, 0 high issues for “Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial.”

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Alpha1 Editorial

This rigor review was examined and confirmed by Alpha1 Editorial · August 15, 2026

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Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial.

Siu PM, Yu DJ, Yu AP, Recchia F, Li SX, Chan RN, Fong DY, Chan DK, Hui SS, Chung KF, Woo J, Wang C, Irwin MR

Read full text (PMC)

DOI

10.1136/bmj-2025-084320

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Issued Aug 15, 2026Engine 7.39.0

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Kaimen Rigor reviewed

Rigor-Reviewed Manuscript

Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial.

Siu PM, Yu DJ, Yu AP, Recchia F, Li SX, Chan RN, Fong DY, Chan DK, Hui SS, Chung KF, Woo J, Wang C, Irwin MR

Paper source

Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial.

Read full text (PMC)

Embed this Rigor badge

Links back to this Kaimen Rigor review.

Alpha1 Editorial

This rigor review was examined and confirmed by Alpha1 Editorial · August 15, 2026

Kaimen Rigor review

Kaimen Rigor reviewed

3.25 / 5

Adequate — real issues to address

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

StatisticsStatistic did not reproduce−0.5★
ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★
StatisticsPrinted percentage does not match its own count (capped) ×7−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Not verified in this report

The numeric-impossibility checks (GRIM/GRIMMER/DEBIT/SPRITE) did not run: 36 reported means were read, and their group size is not stated where the values are printed (this source has no machine-readable table structure). These checks need the count the mean was averaged over, so none was performed.

Biggest issues

01Printed percentage does not match its own count
highArithmeticrecomputedFull detail
76.5% does not match the reported count 76/100
“76.5%”
Secondary outcomes
02Efficacy rests on an unvalidated surrogate endpoint
highOverreachreviewer-assessedFull detail
The primary outcome is the Insomnia Severity Index (ISI), a patient-reported questionnaire, which is a surrogate for clinical insomnia. The paper does not demonstrate target engagement at the tested dose (no PK/PD or dose-exposure data) and does not cite validated evidence linking ISI changes to hard clinical outcomes. Although the ISI is a validated instrument, the efficacy claim rests on this surrogate without establishing a link to clinical outcomes.
“The primary outcome was perceived insomnia severity measured using the Insomnia Severity Index (ISI) at month 3 and month 15.”
Find in source
03Treatment effect not shown to be clinically meaningful
highOverreachreviewer-assessedFull detail
The primary effect is a reduction in ISI score. At month 3, the tai chi group showed a reduction of 6.67 points, which is below the minimally important difference of 8 points. At month 15, the reduction was 9.51 points, which exceeds the MID, but the paper does not explicitly anchor this to clinical meaningfulness beyond stating it is non-inferior to CBT-I. The effect size is not explicitly anchored to clinical meaningfulness in the context of the primary claim.
“At month 3, the tai chi group showed a reduction of 6.67 (95% confidence interval 5.61 to 7.73) in Insomnia Severity Index scores, while the CBT-I group had a reduction of 11.19 (10.06 to 12.32), resulting in a between group difference of 4.52 (−∞ to 5.81).”
Find in source
04Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
56.1% does not match the reported count 56/100
“56.1%”
Secondary outcomes
05Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
83.3% does not match the reported count 83/100
“83.3%”
Secondary outcomes
06Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
63.4% does not match the reported count 63/100
“63.4%”
Secondary outcomes

4 further findings of this severity or below — every one is in the sections below, filed under its error type.

Findings by category

201ArithmeticNumerical inconsistencies 202OverreachOverstated conclusions 03AuthenticityNone found 04DisclosureNone found 05AvailabilityNone found 06Copyedit2 minor suggestions

This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted and transparently reported randomised non-inferiority trial. The methods are rigorous, ethical approvals are documented, and data/code are openly available. Minor reporting polish (e.g., exact p-values for primary outcome, CONSORT flow details) would enhance completeness.

Both reviewers classified the study as interventional and agreed on all dimensions; no divergence. The statistics component could only verify a subset of tests (1 of 9 machine-verifiable), so the statistical analysis is not fully independently confirmed. Non-applicable criteria (e.g., animal housing, cell lines) were excluded.

Numerical inconsistencies

2 findings · worst high

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Summary statistic impossible for the stated N (GRIM/GRIMMER)Recomputed
Printed percentage does not match its own countRecomputed

Recomputed 1 test: 1 consistent, 0 inconsistent; 1 via agent-written checks. 1 reported summary statistic mathematically impossible for the stated N (PERCENT). 7 printed percentages that do not match their own count.

Overstated conclusions

2 findings · worst high

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Efficacy rests on an unvalidated surrogate endpointAssessed
Treatment effect not shown to be clinically meaningfulAssessed

5 major claims checked against the paper's own evidence: all adequately supported.

Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.

Data authenticity concerns

None found

An adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.

Checked — nothing surfaced.

Reporting gaps

None found

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Checked — nothing surfaced.

Eight Dimensions8 pass

The introduction cites prevalence, burden, and limitations of CBT-I, and reviews prior tai chi trials, noting the lack of direct comparisons with first-line treatments. The rationale for non-inferiority is clearly stated, and the hypothesis follows logically. Limitations of prior research (e.g., passive control designs) are explicitly acknowledged.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise with extensive prior work and a logical rationale for the non-inferiority hypothesis.

Evidence

“Previous clinical trials and meta-analyses support the beneficial effects of tai chi in middle aged and older adults with insomnia, with improvements that can be sustained for up to 24 months. However, most studies used passive control designs (eg, stretching) or compared it with other exercise modalities (eg, aerobic exercise), while direct comparisons with first line insomnia treatments (eg, CBT-I) in middle aged and older adults with primary chronic insomnia are currently lacking.”

Introduction ¶4Find in source

“To validate the use of tai chi as an alternative approach to manage chronic insomnia in middle aged and older adults, this study aimed to examine whether a three month tai chi intervention (experimental treatment) is non-inferior to a three month CBT-I intervention (first line treatment for chronic insomnia) for treating insomnia; and whether tai chi is non-inferior to CBT-I in sustaining beneficial improvements 12 months after the intervention.”

Introduction ¶5Find in source

PASSReviewer 2· 90% conf

The paper establishes a clear scientific premise with extensive prior work and a logical rationale for the non-inferiority hypothesis.

Evidence

Introduction ¶4Find in source

“We hypothesised that tai chi is non-inferior to CBT-I for treating insomnia in middle aged and older adults, and sustaining the sleep improvements 12 months after the intervention.”

IntroductionFind in source

Randomization used an online random generator with block sizes, allocation concealment via sealed envelopes, and independent researchers. Outcome assessors were blinded; participants and instructors were not, which is expected for behavioral interventions. Sample size was calculated with explicit parameters. Inclusion/exclusion criteria were detailed. Missing data handling (per protocol, ITT, LOCF, multiple imputation) is described, addressing outlier/missing-data concerns. No independent replication is reported, but this is not required for a single pivotal trial.

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

The trial design is rigorous with adequate randomization, blinding of outcome assessors, sample size calculation, and pre-specified inclusion/exclusion criteria.

Evidence

“Randomisation was conducted using an online random generator ( https://www.sealedenvelope.com/ ) with block sizes of four to six. The computer generated randomised allocation sequence was securely placed in sealed opaque envelopes and kept by an independent researcher who did not interact with the participants during recruitment or during the interventions.”

Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial.

Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial.

Numerical inconsistencies

Overstated conclusions

Data authenticity concerns

Reporting gaps

Broken references and links

Copyediting

Numerical inconsistencies

Overstated conclusions

Data authenticity concerns

Reporting gaps

Broken references and links

Copyediting