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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.

ABSTRACT: BACKGROUND:Chronic low back pain (CLBP) is a common and often disabling musculoskeletal condition. Yoga has been proven to be an effective therapy for chronic low back pain. However, there are still controversies about the effects of yoga at different follow-up periods and compared with other physical therapy exercises. OBJECTIVE:To critically compare the effects of yoga for patients with chronic low back pain on pain, disability, quality of life with non-exercise (e.g. usual care, education), physical therapy exercise. METHODS:This study was registered in PROSPERO, and the registration number was CRD42020159865. Randomized controlled trials (RCTs) of online databases included PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase which evaluated effects of yoga for patients with chronic low back pain on pain, disability, and quality of life were searched from inception time to November 1, 2019. Studies were eligible if they assessed at least one important outcome, namely pain, back-specific disability, quality of life. The Cochrane risk of bias tool was used to assess the methodological quality of included randomized controlled trials. The continuous outcomes were analyzed by calculating the mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CI) according to whether combining outcomes measured on different scales or not. RESULTS:A total of 18 randomized controlled trials were included in this meta-analysis. Yoga could significantly reduce pain at 4 to 8 weeks (MD = -0.83, 95% CI = -1.19 to -0.48, p<0.00001, I2 = 0%), 3 months (MD = -0.43, 95% CI = -0.64 to -0.23, p<0.0001, I2 = 0%), 6 to 7 months (MD = -0.56, 95% CI = -1.02 to -0.11, p = 0.02, I2 = 50%), and was not significant in 12 months (MD = -0.52, 95% CI = -1.64 to 0.59, p = 0.36, I2 = 87%) compared with non-exercise. Yoga was better than non-exercise on disability at 4 to 8 weeks (SMD = -0.30, 95% CI = -0.51 to -0.10, p = 0.003, I2 = 0%), 3 months (SMD = -0.31, 95% CI = -0.45 to -0.18, p<0.00001, I2 = 30%), 6 months (SMD = -0.38, 95% CI = -0.53 to -0.23, p<0.00001, I2 = 0%), 12 months (SMD = -0.33, 95% CI = -0.54 to -0.12, p = 0.002, I2 = 9%). There was no significant difference on pain, disability compared with physical therapy exercise group. Furthermore, it suggested that there was a non-significant difference on physical and mental quality of life between yoga and any other interventions. CONCLUSION:This meta-analysis provided evidence from very low to moderate investigating the effectiveness of yoga for chronic low back pain patients at different time points. Yoga might decrease pain from short term to intermediate term and improve functional disability status from short term to long term compared with non-exercise (e.g. usual care, education). Yoga had the same effect on pain and disability as any other exercise or physical therapy. Yoga might not improve the physical and mental quality of life based on the result of a merging.

SUBMITTER: Zhu F

PROVIDER: S-EPMC7462307 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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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.

Zhu Feilong F Zhang Ming M Wang Dan D Hong Qianqin Q Zeng Cheng C Chen Wei W

PloS one 20200901 9

<h4>Background</h4>Chronic low back pain (CLBP) is a common and often disabling musculoskeletal condition. Yoga has been proven to be an effective therapy for chronic low back pain. However, there are still controversies about the effects of yoga at different follow-up periods and compared with other physical therapy exercises.<h4>Objective</h4>To critically compare the effects of yoga for patients with chronic low back pain on pain, disability, quality of life with non-exercise (e.g. usual care ...[more]

PMID: 32870936

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Project description:BACKGROUND:Back pain, one of the most prevalent conditions afflicting American adults, is the leading reason for using complementary and alternative medicine (CAM) therapies. Yoga is an increasingly popular "mind-body" CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition. This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits. METHODS/DESIGN:A total of 210 participants with low back pain lasting at least 3 months will be recruited from primary care clinics of a large healthcare system based in Seattle. They will be randomized in a 2:2:1 ratio to receive 12 weekly yoga classes, 12 weekly conventional therapeutic exercise classes of comparable physical exertion, or a self-care book. Interviewers masked to participants' treatment group will assess outcomes at baseline and 6, 12 and 26 weeks after randomization. Primary outcomes will be back-related dysfunction and symptom bothersomeness. In addition, data will be collected on physical measurements (e.g., flexion) at baseline and 12 weeks and saliva samples will be obtained at baseline, 6 and 12 weeks. Information will be collected on specific physical, psychological, and physiological factors to allow exploration of possible mechanisms of action through which yoga could relieve back pain and dysfunction. The effectiveness of yoga will be assessed using analysis of covariance (using general estimating equations - GEE) within an intention-to-treat context. If yoga is found effective, further analyses will explore whether yoga's benefits are attributable to physical, psychological and/or physiological factors. CONCLUSIONS:This study will provide the clearest evidence to date about the value of yoga as a therapeutic option for treating chronic back pain, and if the results are positive, will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.

Project description:BackgroundYoga is effective for mild to moderate chronic low back pain (cLBP), but its comparative effectiveness with physical therapy (PT) is unknown. Moreover, little is known about yoga's effectiveness in underserved patients with more severe functional disability and pain.ObjectiveTo determine whether yoga is noninferior to PT for cLBP.Design12-week, single-blind, 3-group randomized noninferiority trial and subsequent 40-week maintenance phase. (ClinicalTrials.gov: NCT01343927).SettingAcademic safety-net hospital and 7 affiliated community health centers.Participants320 predominantly low-income, racially diverse adults with nonspecific cLBP.InterventionParticipants received 12 weekly yoga classes, 15 PT visits, or an educational book and newsletters. The maintenance phase compared yoga drop-in classes versus home practice and PT booster sessions versus home practice.MeasurementsPrimary outcomes were back-related function, measured by the Roland Morris Disability Questionnaire (RMDQ), and pain, measured by an 11-point scale, at 12 weeks. Prespecified noninferiority margins were 1.5 (RMDQ) and 1.0 (pain). Secondary outcomes included pain medication use, global improvement, satisfaction with intervention, and health-related quality of life.ResultsOne-sided 95% lower confidence limits were 0.83 (RMDQ) and 0.97 (pain), demonstrating noninferiority of yoga to PT. However, yoga was not superior to education for either outcome. Yoga and PT were similar for most secondary outcomes. Yoga and PT participants were 21 and 22 percentage points less likely, respectively, than education participants to use pain medication at 12 weeks. Improvements in yoga and PT groups were maintained at 1 year with no differences between maintenance strategies. Frequency of adverse events, mostly mild self-limited joint and back pain, did not differ between the yoga and PT groups.LimitationsParticipants were not blinded to treatment assignment. The PT group had disproportionate loss to follow-up.ConclusionA manualized yoga program for nonspecific cLBP was noninferior to PT for function and pain.Primary funding sourceNational Center for Complementary and Integrative Health of the National Institutes of Health.

Project description:BackgroundPoor sleep is common among adults with chronic low back pain (cLBP), but the influence of cLBP treatments, such as yoga and physical therapy (PT), on sleep quality is under studied.ObjectiveEvaluate the effectiveness of yoga and PT for improving sleep quality in adults with cLBP.DesignSecondary analysis of a randomized controlled trial.SettingAcademic safety-net hospital and 7 affiliated community health centers.ParticipantsA total of 320 adults with cLBP.InterventionTwelve weekly yoga classes, 1-on-1 PT sessions, or an educational book.Main measuresSleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) global score (0-21) at baseline, 12 weeks, and 52 weeks. Additionally, we also evaluated how the proportion of participants who achieved a clinically meaningful improvement in sleep quality (>?3-point reduction in PSQI) at 12 weeks varied by changes in pain and physical function at 6 weeks.Key resultsAmong participants (mean age?=?46.0, 64% female, 82% non-white), nearly all (92%) reported poor sleep quality (PSQI >?5) at baseline. At 12 weeks, modest improvements in sleep quality were observed among the yoga (PSQI mean difference [MD]?=?-?1.19, 95% confidence interval [CI] -?1.82, -?0.55) and PT (PSQI MD?=?-?0.91, 95% CI -?1.61, -?0.20) groups. Participants who reported a ??30% improvement in pain or physical function at 6 weeks, compared with those who improved <?10%, were more likely to be a sleep quality responder at 12 weeks (odds ratio [OR]?=?3.51, 95% CI 1.73, 7.11 and OR?=?2.16, 95% CI 1.18, 3.95, respectively). Results were similar at 52 weeks.ConclusionIn a sample of adults with cLBP, virtually all with poor sleep quality prior to intervention, modest but statistically significant improvements in sleep quality were observed with both yoga and PT. Irrespective of treatment, clinically important sleep improvements at the end of the intervention were associated with mid-intervention pain and physical function improvements.Trial registrationClinicalTrials.gov Identifier: NCT01343927.

Project description:BackgroundYoga has been recommended as a muscle strengthening and balance activity in national and global physical activity guidelines. However, the evidence base establishing the effectiveness of yoga in improving physical function and health related quality of life (HRQoL) in an older adult population not recruited on the basis of any specific disease or condition, has not been systematically reviewed. The objective of this study was to synthesise existing evidence on the effects of yoga on physical function and HRQoL in older adults not characterised by any specific clinical condition.MethodsThe following databases were systematically searched in September 2017: MEDLINE, PsycInfo, CINAHL Plus, Scopus, Web of Science, Cochrane Library, EMBASE, SPORTDiscus, AMED and ProQuest Dissertations & Theses Global. Study inclusion criteria: Older adult participants with mean age of 60 years and above, not recruited on the basis of any specific disease or condition; yoga intervention compared with inactive controls (example: wait-list control, education booklets) or active controls (example: walking, chair aerobics); physical function and HRQoL outcomes; and randomised/cluster randomised controlled trials published in English. A vote counting analysis and meta-analysis with standardised effect sizes (Hedges' g) computed using random effects models were conducted.ResultsA total of 27 records from 22 RCTs were included (17 RCTs assessed physical function and 20 assessed HRQoL). The meta-analysis revealed significant effects (5% level of significance) favouring the yoga group for the following physical function outcomes compared with inactive controls: balance (effect size (ES) = 0.7), lower body flexibility (ES = 0.5), lower limb strength (ES = 0.45); compared with active controls: lower limb strength (ES = 0.49), lower body flexibility (ES = 0.28). For HRQoL, significant effects favouring yoga were found compared to inactive controls for: depression (ES = 0.64), perceived mental health (ES = 0.6), perceived physical health (ES = 0.61), sleep quality (ES = 0.65), and vitality (ES = 0.31); compared to active controls: depression (ES = 0.54).ConclusionThis review is the first to compare the effects of yoga with active and inactive controls in older adults not characterised by a specific clinical condition. Results indicate that yoga interventions improve multiple physical function and HRQoL outcomes in this population compared to both control conditions. This study provides robust evidence for promoting yoga in physical activity guidelines for older adults as a multimodal activity that improves aspects of fitness like strength, balance and flexibility, as well as mental wellbeing.Trial registrationPROSPERO registration number: CRD42016038052 .

Project description:Background contextThe STarT Back Screening Tool (SBST) categorizes risk of future disability in patients with low back pain (LBP). Previous studies evaluating the use of SBST in physical therapy (PT) populations do not reflect the ethnic and socioeconomic diversity occurring in clinical practice and lack statistical power to evaluate factors associated with outcomes within each SBST risk category.PurposeThe purpose of this study is to further refine SBST risk categorization for predicting improvements in functional disability with attention toward patient level factors that might guide SBST use in routine outpatient physical therapy practice.Study design/settingThis was a retrospective cohort study that took place within a large academic, tertiary-care health system.Patient sampleThe study cohort consisted of 1,169 patients with LBP who completed a course of outpatient physical therapy from June 1, 2014 to May 31, 2015 and who completed the patient-reported SBST and modified low back pain disability questionnaire (MDQ) questionnaires as part of standard of care.Outcome measuresImprovement in functional disability defined as decrease in 10 or more points in the MDQ.MethodsMultivariable logistic regression was performed to evaluate independent predictors of improvement after PT, which included SBST risk category, baseline MDQ, a two-way interaction term between SBST category and baseline MDQ, prior level of function (independent vs. required assistance), demographic characteristics, number of completed PT visits, and duration of PT episode of care. In exploratory analyses, additional two-way interaction terms between SBST category and the significant predictors were added to the regression model.ResultsMean age of patients in the study cohort was 55.1 years (SD 16.1); 657 (56.2%) were female, 117 (10.0%) were black race, 127 (10.9%) had Medicaid insurance, and 353 (30.2%) had previously received PT for back pain. In all, 35.8% (n=419) patients categorized as low risk SBST category, 40.7% (n=476) medium risk SBST category, and 23.4% (n=274) high risk SBST category. There was an interaction between baseline MDQ and SBST risk category and improvement with PT. For all three SBST categories, higher baseline MDQ was associated with higher probability of improvement, but the effect was less pronounced as SBST risk category increased. Additional factors independently associated with reduced odds of improvement after PT included black race (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.28-0.72), Medicaid insurance (OR=0.58, 95% CI 0.36-0.95), and prior PT (OR=0.48, 95% CI 0.34-0.67). In exploratory analyses, there was a significant interaction between insurance type and SBST risk category in predicting functional improvement after PT. Patients with Medicare and Medicaid insurance had similar rates of improvement in low and high risk SBST categories but different rates of improvement in the medium risk categories.ConclusionsThe SBST tool predicts outcomes of PT in a cohort of patients receiving outpatient PT for LBP. The odds of improvement varied according to baseline disability and SBST risk status. Race, insurance type, and history of previous PT influenced prediction independent of SBST risk status. Incorporating these variables and the interaction between SBST and baseline disability in outcome models has the potential to refine prediction of outcomes after PT.

Dataset Information

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.

Publications

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.

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