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Impact of Iyengar Yoga on Quality of Life in Young Women With Rheumatoid Arthritis
Abstract
Objective:
Rheumatoid arthritis (RA) is a chronic, disabling disease that can greatly compromise health-related quality of life (HRQoL). The aim of this study was to assess the impact of a 6-week twice/week Iyengar yoga program on HRQoL of young adults with RA compared with a usual-care waitlist control group.
Methods:
The program was designed to improve the primary outcome of HRQoL including pain and disability and psychological functioning in patients. Assessments were collected pretreatment, posttreatment, and at 2 months after treatment. Weekly ratings of anxiety, depression, pain, and sleep were also recorded. A total of 26 participants completed the intervention (yoga=11; usual-care waitlist=15). All participants were female (mean age=28 y).
Results:
Overall attrition was low at 15%. On average, women in the yoga group attended 96% of the yoga classes. No adverse events were reported. Relative to the usual-care waitlist, women assigned to the yoga program showed significantly greater improvement on standardized measures of HRQoL, pain disability, general health, mood, fatigue, acceptance of chronic pain, and self-efficacy regarding pain at posttreatment. Almost half of the yoga group reported clinically meaningful symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects showed improvements in HRQoL general health, pain disability, and weekly ratings of pain, anxiety, and depression were maintained at follow-up.
Conclusions:
The findings suggest that a brief Iyengar yoga intervention is a feasible and safe adjunctive treatment for young people with RA, leading to HRQoL, pain disability, fatigue, and mood benefits. Moreover, improvements in quality of life, pain disability, and mood persisted at the 2-month follow-up.
... The majority of the patients identified were female, which is an expected finding within autoimmune conditions. Of the 11 studies included in this review, five assessed the impact of yoga on stress levels in patients with autoimmune conditions [45,46,49,52,54], six assessed the impact of yoga on anxiety [41,47,48,49,51,52], three assessed the impact of yoga on self-efficacy [47][48][49], six assessed the impact of yoga on depression [45,48,50,52,54], and seven of the studies assessed the impact of yoga on emotional fatigue in autoimmune patients [41,[47][48][49][50]53,54]. Most of the studies looked at patients with multiple sclerosis (MS) [41,46,47,49,50,53,54], with two focusing on patients with rheumatoid arthritis (RA) [45,48], and one assessed irritable bowel disease [51]. ...
... The majority of the patients identified were female, which is an expected finding within autoimmune conditions. Of the 11 studies included in this review, five assessed the impact of yoga on stress levels in patients with autoimmune conditions [45,46,49,52,54], six assessed the impact of yoga on anxiety [41,47,48,49,51,52], three assessed the impact of yoga on self-efficacy [47][48][49], six assessed the impact of yoga on depression [45,48,50,52,54], and seven of the studies assessed the impact of yoga on emotional fatigue in autoimmune patients [41,[47][48][49][50]53,54]. Most of the studies looked at patients with multiple sclerosis (MS) [41,46,47,49,50,53,54], with two focusing on patients with rheumatoid arthritis (RA) [45,48], and one assessed irritable bowel disease [51]. ...
... The majority of the patients identified were female, which is an expected finding within autoimmune conditions. Of the 11 studies included in this review, five assessed the impact of yoga on stress levels in patients with autoimmune conditions [45,46,49,52,54], six assessed the impact of yoga on anxiety [41,47,48,49,51,52], three assessed the impact of yoga on self-efficacy [47][48][49], six assessed the impact of yoga on depression [45,48,50,52,54], and seven of the studies assessed the impact of yoga on emotional fatigue in autoimmune patients [41,[47][48][49][50]53,54]. Most of the studies looked at patients with multiple sclerosis (MS) [41,46,47,49,50,53,54], with two focusing on patients with rheumatoid arthritis (RA) [45,48], and one assessed irritable bowel disease [51]. ...
Yoga has been explored as a health modality to maintain mental and physical health and as a complementary therapy for managing various medical conditions. It has been most recently researched for its ability to decrease inflammatory markers responsible for various ailments. This opens the door for its potential role as an adjunct therapy in inflammatory-led dysfunctions such as autoimmune disorders. Although there has been a robust amount of data on yoga and autoimmune conditions, previous reviews have mostly been limited to the physical improvements that patients experience rather than the mental health changes. This scoping review aims to address the role of yoga as an effective therapy choice in treatment and management options for the mental health symptoms associated with autoimmune disorders. The initial search revealed 211 relevant studies, but following an extensive review, 11 articles were included in the final analysis. Yoga interventions ranged from six weeks to up to six months and included Iyengar yoga, Hatha yoga, and generalized yoga practices that did not fit into a specific subtype. Eight articles analyzed patients with multiple sclerosis, two focused on rheumatoid arthritis and one assessed irritable bowel disease. Between the 11 studies included in this review, the key markers analyzed were stress level, anxiety, sleep, self-efficacy, depression, and emotional fatigue. Significant improvement was found in all these subtypes. Yoga is a viable, non-pharmaceutical treatment for both the physical and mental health components of patients with autoimmune disorders.
... Instead, the term "young adult", and in the exclusively female study, "young women" was used. Intervention fidelity was monitored to various degrees in all of the studies: weekly monitoring forms (58,59), weekly follow-up sessions (61), or about 1.5 months before the final assessment at 3 months (60). ...
... All of the studies had small samples focused on one pain type: rheumatoid arthritis (58), irritable bowel syndrome (59), neurofibromatosis type 1 (60), and tension-type headache (61). A variety of chronic pain definitions was used; three of them were clinical definitions for the specific diagnosis (58,59,61), while the other study relied on self-report of chronic pain to a nurse practitioner during a physical examination at their most recent visit to the clinic (60). ...
... Random assignment was used in three studies with waitlist treatment-as-usual control groups (58,59) or an active comparison condition (61). In the ACT study, comparisons were made to the baseline values of the outcome measures. ...
Background
Emerging adults, of whom significant numbers report chronic pain, are characterized as having unique needs and challenges. Psychological/behavioral treatments found to be beneficial for reducing pain outcomes in children and adults are understudied in emerging adults. Following a systematic review of the literature, our objective is to report on quantitative studies of psychological/behavioral interventions for chronic pain in emerging adults.
Method
We conducted a search of six databases (Cochrane Central Register of Controlled Trials, Google Scholar, ProQuest, PsycINFO, PubMed, and Web of Science) and reference sections in dissertations and systematic reviews to 4/29/2023. Keywords and phrases were search term combinations of “chronic/persistent pain”, “emerging/young adults,” and “intervention/treatment” using Boolean logic.
Results
Our review resulted in identifying 37 articles, of which 2 duplicates were removed, and 31 were further excluded by a screening process based on various inclusionary and exclusionary criteria. The search yielded four studies on psychological/behavioral interventions (yoga, acceptance and commitment therapy and relaxation), all of which positively affected the pain experience and/or pain-related outcomes. These studies presented issues in design such as not being blinded or randomized, having a small sample size, and potential confounds that were not reported or examined.
Discussion
The low number of studies reveals a large gap in the literature and is a call-to-action to further expand our understanding of effective and safer psychological/behavioral therapies for chronic pain in emerging adults. Successful pain management during this developmental phase may help young adults achieve positive trajectories for personal, occupational, relational, and health aspects of their lives.
... These studies were combined for the 177 analyses under "inactive control interventions". The comparators were described as either waitlist 178 (n=4) [62,82,86,90], standard/usual care (n=6) [58,65,70,74,83,88], no intervention 179 (n=10) [56,57,60,63,68,73,75,77,78,85], brief education and advice on the benefits of physical activity 180 (n=1) [80]. In eight studies, participants in the control group received an EPA intervention that differed 182 from the experimental intervention in either the mode of provision (n=4) [54,55,68,89] or content 183 (n=4) [69,71,79,81]. ...
... The quality of the reporting of adverse events was mostly poor with 17 of 36 (47%) included studies 356 not reporting on adverse events at all. Of the other 19 studies, eight studies reported that there were 357 no adverse events at all [62,65,69,[80][81][82]85,86]. 11 studies found minor adverse reactions, most 358 commonly short-term musculoskeletal pain (reported in ten studies [56][57][58]64,66,67,70,73,74,84]), in 359 a small subset of participants. ...
... 187 Outcomes 188 32 studies provided data on fatigue outcomes. Twelve studies provided data on sleep 189 parameters[56,61,62,65,67,70,71,79,80,82,84,87] but data from one study could not be used due to 190 insufficient detail[62].Objective sleep outcomes were sleep efficiency (SE), SL, TST, time awake after 191 sleep onset (WASO) and the percentage of time in the four different sleep stages during the total time 192 asleep (assessed via polysomnography). Self-reported sleep outcomes were SE, SL, TST, WASO, sleep 193 quality, sleep disturbances, sleep duration, sleep medication use, insomnia severity, daytime 194 symptoms and sleepiness. ...
This systematic review aimed to systematically investigate the literature on the effectiveness of exercise and physical activity programs on fatigue and sleep in people with arthritis. For that, seven databases were searched for relevant randomized controlled trials. After the searches, 36 studies investigating 2281 participants were included. Risk of bias assessments were done by two independent reviewers using the Cochrane Risk of Bias tool 2. Random-effects meta-analyses were performed, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to judge the certainty of evidence. The evidence on benefits of exercise and physical activity programs on fatigue and sleep parameters in people with osteoarthritis and psoriatic arthritis was either lacking or inconclusive. There was very low to low certainty evidence for a slight benefit of exercise and physical activity programs on fatigue at short-term in people with ankylosing spondylitis and rheumatoid arthritis. However, the evidence was very uncertain for the medium- and long-term as well as for any sleep parameters. The results indicate that exercise and physical activity programs may offer some benefits on fatigue for people with arthritis in the short-term, although the best type of exercise remains uncertain. The available evidence on improvements in sleep was insufficient to draw strong conclusions.
... In this review, 14/23 (61%) of the included studies applied yoga as an intervention. According to most studies, yoga interventions seemed to improve the quality of life (measured by SF-36, WHOQOL, or EQ-5D) of patients with RA, as evidenced by better the outcomes in vitality, general health, physical functioning, and self-efficacy [16][17][18][20][21][22][23][24][25]. One study saw a better physical-health-related QoL and vitality when measured with Short Form-36 (SF-36), but found no effect on physical functioning as measured with the Health Assessment Questionnaire (HAQ) [20]. ...
... Yoga has an as-yet-unclear effect on pain in patients with RA, as they showed improvements in pain scores, pain disability, pain intensity, acceptance of chronic pain, and self-efficacy regarding pain in four studies [17][18][19]21], although three studies found no change in pain levels [9,20,25]. Although multiple pain questionnaires were used (visual analog scales, the Simple Descriptive Pain Intensity Scale, the Pain Disability Index, and the Wellbeing Measurement Framework survey), no consistency could be traced. ...
... Although multiple pain questionnaires were used (visual analog scales, the Simple Descriptive Pain Intensity Scale, the Pain Disability Index, and the Wellbeing Measurement Framework survey), no consistency could be traced. Similarly, two studies showed improved fatigue scores [21,25], while two other studies did not find changes in fatigue scores [9,22]. ...
Objectives: Mind–body therapies (MBTs), including meditation, yoga, and mindfulness, create an interaction between the mind and body to enhance health. MBTs are perceived by both patients and healthcare professionals as valuable in the management of rheumatoid arthritis (RA), but the extent of this contribution is unclear, as are the patient subgroups who benefit most from MBTs. Therefore, this systematic literature review investigates the effects of meditation, mindfulness, and yoga in patients with RA. Methods: We searched four databases (PubMed, Embase, Web of Science (core collection, Chinese and Korean collection), and CINAHL). All studies were screened by two independent reviewers via the title/abstract/full text. The studies included any form of meditation/mindfulness/yoga as an intervention for RA. Animal studies, case reports, non-English articles, qualitative studies, conference abstracts, and articles without full-text access were excluded. Each study was assessed for its quality. Results: Out of 1527 potentially eligible records, 23 studies were included. All three MBTs showed various effects on patient-reported outcomes, such as vitality, functioning, and mental health, as well as on disease activity markers. Mindfulness-based interventions mainly reduced the subjective disease activity parameters (e.g., joint tenderness, morning stiffness, and pain), rather than the objective disease activity parameters (e.g., swollen joints and C-reactive protein (CRP)). RA patients with recurrent depression may benefit more from these non-pharmacological therapies than patients without recurrent depression. Discussion: This systematic literature review found that MBTs show added value in RA management, especially for patients with depressive symptoms. These non-pharmacological approaches, when used in addition to medication, might diminish polypharmacy in specific RA patient populations. Lay Summary: In recent decades, more attention has been given to the management of rheumatoid arthritis (RA) with options other than solely using medication. Such alternative options for patients to increase their quality of life are, for instance, meditation, yoga, and mindfulness. These examples of mind–body therapies (MBTs) are techniques that create an interaction between the mind and the bodily functions in order to obtain relaxation and enhance overall health. Although it is believed that these mind–body techniques are valuable in the management of RA, the extent of their contribution is still unclear, as is the question of if certain subgroups of patients benefit more from these complementary therapies. This systematic literature review investigated the effects of meditation, mindfulness, and yoga in patients with rheumatoid arthritis. A literature search was systematically performed within four different scientific databases by two independent reviewers. Out of 1527 potentially eligible articles, 23 studies were included. All three MBTs showed beneficial effects, which were mostly on the vitality, functioning, and mental health of patients with RA, but also on symptoms related to disease activity. RA patients with recurrent depression seemed to benefit more from these non-pharmacological therapies than patients without recurrent depression. Hence, we can conclude that MBTs show added value in the management of RA.
... Yoga is an ancient practice that originated in India about 5,000 years ago and is reported to improve health-related quality of life, including physical function, and inflammatory symptoms in RA patients (12). Evans et al. (13) reported that yoga reduced daily pain in RA patients, but no difference in physical function. Other studies conducted on RA patients reported improvements in physical function (14), disease activity (15), grip strength (16), and a drastic reduction in the expression of inflammatory cytokines (i.e., CRP, ESR, IL-6, and TNF-α) (17). ...
... The reasons for these excluded RCTs are shown in Supplementary Table 1. Finally, 10 RCTs reported on a total of 840 patients were included in the meta-analyses (13)(14)(15)(16)(17)(18)(22)(23)(24)(25). ...
... These studies were published from form 1994 to 2020. Among the 10 RCTs, four each were conducted in the United States (13,14,24,25) and India (16)(17)(18)23), and one each in England (22) and the United Arab Emirates (15). Of the 10 studies included, 840 patients with RA were analyzed. ...
Purpose: Rheumatoid arthritis (RA) is a pervasive inflammatory autoimmune disease that seriously impairs human health and requires more effective non-pharmacologic treatment approaches. This study aims to systematically review and evaluate the efficacy of yoga for patients with RA.
Methods: Medline (through PubMed), Cochrane Library, EMBASE (through SCOPUS), and Web of Science database were screened through for articles published until 20 July 2020. Randomized controlled trials (RCTs) of yoga in patients with RA were included. Outcomes measures were pain, physical function, disease activity, inflammatory cytokines, and grip strength. For each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.
Result: Ten trials including 840 patients with RA aged 30–70 years were identified, with 86% female participants. Meta-analysis revealed a statistically significant overall effect in favor of yoga for physical function (HAQ-DI) (5 RCTs; SMD = −0.32, 95% CI −0.58 to −0.05, I ² = 15%, P = 0.02), disease activity (DAS-28) (4 RCTs; SMD = −0.38, 95% CI −0.71 to −0.06, I ² = 41%, P = 0.02) and grip strength (2 RCTs; SMD = 1.30, 95% CI 0.47–2.13, I ² = 63%, P = 0.002). No effects were found for pain, tender joints, swollen joints count or inflammatory cytokines (i.e., CRP, ESR, IL-6, and TNF-α).
Summary: The findings of this meta-analysis indicate that yoga may be beneficial for improving physical function, disease activity, and grip strength in patients with RA. However, the balance of evidence showed that yoga had no significant effect in improving pain, tender joints, swollen joints count, and inflammatory cytokines in patients suffering from RA. Considering methodological limitations, small sample size, and low-quality, we draw a very cautious conclusion in the results of the estimate of the effect. High-quality and large-scale RCTs are urgently needed in the future, and the real result may be substantially different.
... Moreover, there is evidence citing the use of this practice as an interest of the scientific community as a form of prevention, maintenance, and recovery of health. 28 Although there is evidence on the positive effects of yoga on depression, sleep, anxiety, and pain 25,[29][30][31][32] In a published systematic review that analyzed experimental studies on the effects of yoga in patients with rheumatic diseases, only eight studies were found. 33 In addition, the review presented limitations in relation to the search strategy and the number of analyses used, which precludes an in-depth view of the studies found. ...
... The objective of the present review was to verify the effects of yoga on the QOL of patients with RD. After the analysis of the 23 studies found, a total 1430 patients with RD were evaluated, and most of the studies were conducted in patients with OA, 24,25,32,[46][47][48][49][50][51][52][53][54] followed by studies with RA patients, 30,31,55,56 and FM (17.4%). [57][58][59][60] The RD with the lowest number of studies was CFS, 61 and no studies were found in patients with SLE. ...
... Improvement was found in some areas of QOL (i.e., functional capacity, physical aspects, emotional aspects, general health, and limitations due to social aspects). 29,30,53 These results are important, showing that, in general, interventions with Yoga can bring significant improvements in the QOL of the patients, aiding in the treatment and combat of the disease. ...
Aim
To analyze the effects of yoga on the quality of life of patients with rheumatic diseases through a systematic review with meta-analysis.
Methods
This systematic review with meta-analysis was conducted following the recommendations of the Declaration of PRISMA. The searches were carried out on the databases PubMed, Web of Science, EBSCO, Scopus, and Cochrane until August 2018. Experimental studies evaluating the effect of yoga on the quality of life in patients with rheumatic diseases were included.
Results
After data searches, 483 studies were found, 23 of which were included in our analysis. We found that yoga improves the overall quality of life (d= −0.64; 95% CI: −0.91 to 0.038) of patients with rheumatic diseases, as well as the following domains: functional capacity (d = 16.43; 95% CI: 13.37–19.49), physical aspects (d = 27.11; 95% CI: 19.40–34.83), emotional aspects (d = 26.00; 95% CI: 18.87–33.13), general health (d = 16.61; 95% CI: 12.66–20.55), and social aspects (d = 7.01 ; 95% CI: 5.57–9.45).
Conclusion
Evidence suggests weak recommendations can be made for the use of yoga in the management of RD patients.
... The most common reason people withdrew was time/schedule conflicts. Others (37,38) have also reported higher rates of adherence to yoga than studies with clinical populations where <50% continue exercising by 3 months.(39) Reducing inactivity is an important public health challenge, especially in arthritis, where only 1 in 4 are meeting activity guidelines. ...
... Indeed, in yoga, 16/44 (36%) improved one category or more on the SF36 self-rating of health. We noted a trend toward improved physical function with yoga at week 8, as have some (37,(40)(41)(42), though not all (43). When we pooled data from all yoga completers, there were significant improvements in all HRQL scales except Role Emotional which was already close to population norms at baseline. ...
... Pain, one of the most widely studied outcomes in yoga, improved significantly with yoga. Some (37,41,42,44,46) though not all (42,43,49) have reported similar results. Yoga was associated with positive affect and fewer depressive symptoms, findings also reported by some (37,40,44) though not all (42,50). ...
Objective—To evaluate the impact of Integral-based hatha yoga in sedentary people with arthritis.Methods—75 sedentary adults aged 18+ with rheumatoid arthritis (RA) or knee osteoarthritis (OA) were randomly assigned to 8 weeks of yoga (2 60 min classes and 1 home practice/wk) or waitlist. Poses were modified for individual needs. The primary endpoint was physical health (SF36 Physical Component Summary [PCS]) adjusted for baseline; exploratory adjusted outcomes included fitness, mood, stress, self-efficacy, SF36 health-related quality of life (HRQL) and RA disease activity. In everyone completing yoga, we explored long-term effects at 9 months.Results—Participants were mostly female (96%), white (55%), and college-educated (51%), with a mean (SD) age of 52 (12). Average disease duration was 9 (9) yrs. and 49% had RA. At 8 weeks, yoga was associated with significantly higher PCS (6.5; 95% CI: 2.0,10.7), walking capacity (125 m; 95% CI:15,235), positive affect (5.2; 95% CI:1.4,8.9) and lower CES-D (−3.0; 95% CI: −4.8,−1.3). Significant (p<.05) improvements were evident in SF36 Role Physical, Pain, General Health, Vitality and Mental Health scales. Balance, grip strength, and flexibility were similar between groups. 22/28 on waitlist completed yoga. Among all yoga participants, significant (p<.05) improvements were observed in mean PCS, flexibility, 6-min walk, all psychological and most HRQL domains at 8 weeks with most still evident 9 months later. Of seven adverse events, none were associated with yoga.Conclusions—Preliminary evidence suggests yoga classes may help sedentary individuals with arthritis safely increase physical activity and improve physical and psychological health, and HRQL.Key Indexing
... that favored yoga group. At the same time, 4 citations [10,15,20] with a total of 423 participants referred SF-36 pain (Fig. 4). The SMD of SF-36 pain was 1.27 (95% CI 1.03, 1.51, P < .05, ...
... This meta-analysis showed yoga training was beneficial for patients' general health conditions compared with control group. Meanwhile, 4 citations [10,15,20] with 205 participants reported SF-36 mental health score (Fig. 4). The SMD of SF-36 mental health was 0.49 (95% CI 0.14, 0.82, P < .05, ...
... HAQ was also a comprehensive method used to assess patients' health related ability in arthritis. [21] In our research, 5 citations [10,20] with a total of 249 participants was involved in meta-analysis (Fig. 4). The SMD of HAQ was À0.55 (95% CI À0.83, À0.26, P < .05, ...
Background:
Benefits of yoga practice in patients with knee osteoarthritis and rheumatoid arthritis remains controversial. This study performs a meta-analysis to quantify the efficiency of yoga exercise for patients pain reduction, functional recovery, and general wellbeing.
Methods:
A computerized search of PubMed and Embase was performed to identify relevant studies. The outcome measures were pain, stiffness, and physical function. Two investigators identified eligible studies and extracted data independently. The quality of citations was measured using Jadad score. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for pain, musculoskeletal impairment, quality of life, general wellbeing, and mental wellbeing.
Results:
A total of 13 clinical trials involving 1557 patients with knee osteoarthritis and rheumatoid arthritis were included in final meta-analysis with the average Jadad score 2.8. The SMD was -0.98 (95% CI -1.18, -0.78, P < .05) for pain, -1.83 (95% CI -2.09, -1.57, P < .05) for functional disability, was 0.80 (95% CI 0.59, 1.01, P < .05) for Short Form 36 Health Survey (SF-36) general health, 0.49 (95% CI 0.14, 0.82, P < .05) for SF-36 mental health, and HAQ was -0.55 (95% CI -0.83, -0.26, P < .05) for health associated questionnaire (HAQ). All the results favor yoga training group.
Conclusions:
Regular yoga training is helpful in reducing knee arthritic symptoms, promoting physical function, and general wellbeing in arthritic patients.
... Os portadores de AR têm tendência a apresentar diminuição da funcionalidade e aumento da incapacidade, o que afeta diretamente na dificuldade na realização de atividades relacionadas ao trabalho, às atividades de vida diária e à QV [1][2][3][9][10][11] . ...
... A AR é uma doença de caráter crônico, que reduz a funcionalidade e compromete amplamente a QV relatada pelos indivíduos. Diversos autores compreendem que se trata de uma das patologias que apresentam maior impacto negativo nesse aspecto 3,8,10,11,19 . ...
... Os estudos aqui elencados apontaram alguns questionários específicos para avaliar a QV em indivíduos com AR, tais como o Medical Outcomes Study Short Form 12 item (SF-12) 1 , o Medical Outcomes Study Short Form 36 item (SF-36) 10,16 o EuroQol five-dimensions questionnaire (EQ-5D) 15 e o Arthritis Impact Score 2 -Short Form (AIMS2-SF) 18 . Apenas um estudo 17 não especificou o tipo de questionário usado para avaliar a QV. ...
Introdução: a artrite reumatoide é uma doença reumática inflamatória que causa alterações musculoesqueléticas importantes, interferindo diretamente na qualidade de vida dos indivíduos acometidos. A fisioterapia destaca-se pela sua segurança e evolução apresentada. Objetivo: verificar os efeitos da fisioterapia na qualidade de vida de indivíduos com artrite reumatoide. Materiais e Métodos: realizou-se uma revisão sistemática na base de dados PubMed, a partir dos descritores Rheumatoid Arthritis, Quality of Life e Physical Therapy Specialty, do período de 2009 a 2015. Resultados: encontraram-se 84 artigos. Inicialmente 15 artigos potencialmente relevantes foram selecionados para o estudo, e, após uma análise qualitativa criteriosa, selecionaram-se 06 artigos completos que preencheram os critérios de inclusão exigidos. Conclusão: os estudos indicam que há uma variedade de métodos terapêuticos que possibilitam o manejo da patologia e que a aderência do indivíduo ao protocolo interventivo torna-se indispensável para o sucesso do tratamento fisioterapêutico na qualidade de vida em indivíduos com artrite reumatoide.
... One meta-analysis, 72 one systematic review, 73 three RCTs [163][164][165] and two non-randomised trials 166 167 studied yoga for RA. The meta-analysis reported a large effect of yoga on pain (but included some patients with OA) 72 as did one RCT, 165 whereas two other RCTs reported no effect, and the systematic review graded the evidence as very low. ...
... 73 163 164 The meta-analysis (only including studies of RA) 72 and one RCT reported medium-sized effects on function, 163 whereas another RCT reported no effect. 164 No effect on disease activity was reported by two RCTs. 163 164 Studies were generally small therefore potentially some findings are due to chance (online supplemental tables 48-50). ...
Background
A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs.
Methods
Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013–2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases.
Results
236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies.
Conclusion
The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
... 23 However, these studies suffer from limitations of small sample sizes and lack of representability since RA patients were either studied together with osteoarthritis 20 or only certain age groups were included. 19 Thus, a wider understanding of this intervention is still lacking. In addition, a variety of different yogic styles are used in the research, which may reduce comparisons of their effects. ...
... There was no between-group difference in disease activity measure and inflammatory marker CRP. Our results are in line with some of the previous studies 19,39 but not all. 21,23,46 Trials of mind-body interventions in various chronic conditions have shown that longer period of follow-up is needed to observe changes in CRP while inflammatory gene expression changes might be perceived earlier. ...
Background
Rheumatoid arthritis (RA) patients experience reduced health-related quality of life (HRQOL). Previous studies suggest that yoga, a mind-body practice, can improve physical and mental health but it has not been extensively studied in RA.
Objectives
To investigate the effect of yoga on HRQOL and secondary on fatigue, anxiety, depression and disease activity in RA patients
Methods
43 RA patients (mean (SD) age 55 (10) years, median (IQR) disease duration 5 (3,8) years, 93% female), stable on standard pharmacological treatment and DAS28CRP < 5.1 were randomly assigned to 12 weeks yoga intervention (2x/week 90 min; n=22) or arthritis-related educational lectures control (1x/week 60 min; n=21). Yoga based on „Yoga in daily life system“ included asanas, relaxation, pranayama and meditation. Study evaluations at baseline, post-intervention and 3-month follow-up included The Short Form-36 (SF-36) scores for Physical Component Summary (PCS) and Mental Component Summary (MCS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Hospital Anxiety and Depression scale (HADS) and Disease Activity Score-28CRP (DAS28CRP) questionnaires. Data were presented as change from baseline to each time point. Between group differences were analyzed using the t-test for normally and Mann-Whitney U test for non-normally distributed variables. P values <0.05 were considered statistically significant.
Results
35 patients (17 = intervention, 18 = control group) completed the trial period. Significant improvement in FACIT-F (p=0.013), HADS anxiety (p=0.047) and HADS depression (p=0.004) was found in yoga group compared to control at post-intervention and maintained at follow-up (p=0.025, p=0.02 and p=0.045, respectively). There was no significant difference found between groups for SF-36 MCS, PCS and DAS28CRP at all time points (all p>0.05). No serious adverse events were observed during trial period.
Conclusion
Although no change in SF-36 scores and disease activity was observed, yoga practice produced significant and sustained improvement in fatigue and mood which strongly account for decreased life quality in RA. Despite limitations our findings suggest that yoga may be of benefit in management of RA patients.
Table. Changes in outcomes
N= 37 (postintervention ) N= 35 (follow-up )
Variables
Baseline mean (SD )
Change from baseline (95%CI )
Difference between groups (95%CI, p-value )
Change from baseline (95%CI )
Difference between groups (95%CI, p-value )
FACIT-F (0-52)
Yoga 33.89 (10.77) Control 35.37 (9.3)
4.18 (-0.26,8.61) -2.17 (-5.58,1.25)
6.66 (1.53,11.78) p= 0.013
3.29 (-1.23,7.82) -3.33 (-7.27,0.61)
6.63 (0.85,12.4) p=0.025
HADS-A (0-21)
Yoga 7.39 (3.72) Control 6.89 (2.86)
-1.94 (-3.28,-0.6) 0.056 (-1.39,1.51)
-1.83 (-3.64,-0.024) p= 0.047
-2.24 (-3.63,-0.84) 0.17 (-1.38,1.71)
-2.4 (-4.4,-0.04) p=0.02
HADS-D (0-21)
Yoga 5.11 (3.03) Control 5.0 (1.82)
-1.06 (-1.92,-0.2) 0.83 (-0.06,1.72)
-1.73 (-2.88,-0.58) p= 0.004
-0.2 (-1.1,0.63) 0.94 (0.12,1.77)
-1.18 (-2.33,-0.03) p=0.045
SF-36:MCS (0-100)
Yoga 49.49 (11.99) Control 49.71 (8.99)
2.97 (-4.15,10.09) -1.59 (-7.51,4.33)
3.86 (-4.66,12.33) p= 0.366
1.25 (-3.62,6.12) -0.45 (-5.56,4.65)
1.7 (-5.09,8.49) p=0.618
SF-36:PCS (0-100)
Yoga 52.57 (10.11) Control 48.30 (9.76)
0.44 (-3.13,4.02) -1.16 (-4.81,2.48)
1.61 (-3.31,6.53) p= 0.511
-1.54 (-5.44,2.35) 0.35 (-3.21,3.92)
-1.9 (-6.98,3.18) p=0.453
DAS28CRP
Yoga 2.32 (0.81) Control 2.91 (0.84)
-0.0024 (-0.42,0.42) -0.096 (-0.45,0.26)
0.093 (-0.44,0.63) p=0.724
0.11 (-0.43,0.66) -0.54 (-0.92,-0.17)
0.66 (0.02,1.3) p=0.092
Disclosure of Interests
Silva Puksic: None declared, Josko Mitrovic: None declared, Melanie-Ivana Culo: None declared, Marcela Zivkovic: None declared, Biserka Orehovec: None declared, Marko Lucijanic: None declared, Dubravka Bobek: None declared, Jadranka Morovic-Vergles Speakers bureau: Abbvie., Roche, MSD, Eli Lilly, Pfizer, Mylan, Amgen, Fresenius Kabi
... 23 However, these studies suffer from limitations of small sample sizes and lack of representability since RA patients were either studied together with osteoarthritis 20 or only certain age groups were included. 19 Thus, a wider understanding of this intervention is still lacking. In addition, a variety of different yogic styles are used in the research, which may reduce comparisons of their effects. ...
... There was no between-group difference in disease activity measure and inflammatory marker CRP. Our results are in line with some of the previous studies 19,39 but not all. 21,23,46 Trials of mind-body interventions in various chronic conditions have shown that longer period of follow-up is needed to observe changes in CRP while inflammatory gene expression changes might be perceived earlier. ...
Objectives
To explore the feasibility and effectiveness of a yoga program in improving health-related quality of life (HQOL), physical and psychological functioning in rheumatoid arthritis (RA) patients.
Design
Single-centre parallel-arms randomized controlled trialcomparing yoga (n = 30) and education control group (n = 27).
Setting
Tertiary care University hospital.
Intervention
A 12-weekyoga program, based on the Yoga in Daily Life system, included 2x weekly/90-minute sessions. The control group had 1xweekly/60-minute educational lectures on arthritis-related topics.
Main outcome measures
Assessments were performed at baseline, 12 (post-intervention) and 24 weeks (follow-up). The primary outcome was change in The Short Form-36 (SF-36) HQOL at 12 weeks. Linear regression analysis was adjusted for baseline scores.
Results
No significant between-group differences were found for SF-36 (all p > 0.05). At 12 weeks the adjusted mean difference between groups favoured yoga for Functional Assessment of Chronic Illness Therapy-fatigue (5.08 CI 1.29 to 8.86; p = 0.009) and Hospital Anxiety and Depression Scale (HADS)-depression (-1.37 CI -2.38 to -0.36; p = 0.008) and at 24 weeks for HADS-anxiety (-1.79 CI-3.34 to -0.23; p = 0.025), while the impact on fatigue was sustained (5.43 CI 1.33 to 9.54, p = 0.01). The program had no impact on RA disease activity. Feasibility outcomes included recruitment rate 16 %, retention 80.7 %, and adherence to yoga 87.5 vs 82.7 % for control. No serious adverse events were recorded.
Conclusions
Yoga in Daily Life program was not associated with change in health-related quality of life of RA patients. Significant improvements in fatigue and mood were observed at postintervention and follow-up. This yoga program was found feasible and safe for patients and may complement standard RA treat-to-target strategy.
... A randomized-controlled trial (RCT) involving RA patients by Zautra et al. 23 reported that meditation reduced daily pain, depression, joint tenderness, and IL-6. Another RCT by Evans et al. 24 from the United States compared a 6-week Iyengar yoga intervention twice weekly with usual care and found a significant decrease in pain disability, but no difference in disease activity. Other studies conducted on RA patients reported improvements in disease activity, 25 hand grip strength, 26 and improvements in psychologic distress and well-being. ...
... This finding is consistent with the findings of Badsha et al., 25 who reported reduction in the counts of tender and swollen joints and disease activity after 8 weeks of yoga therapy. Evans et al. 24 reported significant improvement in quality of life in the YG, but no significant difference was seen in disease activity in the YG compared with the CG in their study. This difference may be due to duration of yoga therapy given to the RA patients. ...
Background:
Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease. Antirheumatoid treatment reduces disease activity and inflammation, but not all patients respond to treatment. Autonomic dysfunction is common in RA leading to frequent cardiovascular complications. Yoga therapy may be useful in these patients, but there are little data on the effect of yoga on disease activity, inflammatory markers, and heart rate variability (HRV).
Objectives:
This study assessed the effect of 12-week yoga therapy on disease activity, inflammatory markers, and HRV in patients with RA.
Materials and Methods:
This randomized control trial was conducted on newly diagnosed RA patients attending outpatient services at the Department of Clinical Immunology, JIPMER. One hundred and sixty-six participants were randomized into two groups: the control group (CG) (n = 83) and yoga group (YG) (n = 83). Yoga therapy was administered to participants in the YG for 12 weeks, along with standard medical treatment. The CG received only standard medical treatment. Primary outcomes were disease activity score 28, interleukin-1α (IL-1α), IL-6, tumor necrosis factor-α (TNF-α), cortisol, and HRV parameters. All parameters were measured at baseline and after 12 weeks.
Results:
Disease activity significantly decreased in both groups after 12 weeks, but it was reduced more in YG, which was statistically significant (p < 0.05). In both YG and CG, IL-1α, IL-6, TNF-α, and cortisol decreased after 12 weeks, but IL-1α and cortisol decreased more significantly in YG than in CG. Low-frequency component expressed as normalized unit (LFnu) and the low-frequency/high-frequency (LF-HF) ratio decreased significantly, and total power and HF component expressed as normalized unit (HFnu) increased significantly in the YG compared with CG.
Conclusion:
Twelve-week yoga therapy, if given along with standard medical treatment, significantly reduces disease activity and improves sympathovagal balance in RA patients.
... Prior to 2018, few RCTs had examined the role of yoga for managing pain in patients with RA [37,38], and no studies had examined the effects of tai chi on pain in patients with RA. The RCTs of yoga did not find statistically significant differences in pain between participants randomized to yoga vs. a wait list control. ...
Purpose of review
Many individuals with rheumatoid arthritis (RA) continue to suffer from pain despite treatment with disease-modifying antirheumatic drugs. In this review, we aim to summarize the evidence for non-pharmacological approaches for managing pain in RA.
Recent findings
Few studies have examined the effect of non-pharmacological therapies on pain in patients with RA. Of these studies, many were not designed to specifically target pain and examined pain as a secondary outcome. While most studies reported within group improvements in pain, the magnitude of improvement varied, and differences between intervention and control groups often were not statistically significant.
Summary
We recommend non-pharmacologic approaches for management of RA, based primarily on data for improving pain-related outcomes (e.g., physical function, overall health), as opposed to pain itself. The evidence base for non-pharmacologic interventions for pain remains poor, and there is a critical need for large RCTs designed to specifically target pain.
... One participant did experience a disease flare during the intervention, which was attributed to the disease process by the treating rheumatologist and not to the yoga intervention. Yoga has been deemed safe via randomized controlled trials in adult rheumatic disease populations [9,10], and additional research is needed to confirm safety in JIA. ...
Background/Objectives: Yoga is effective for adults with arthritis but unstudied in adolescents with juvenile idiopathic arthritis (JIA). Methods: A pilot study assessed the feasibility and acceptability of an 8-week group yoga intervention for adolescents ages 14–18 with JIA. Each 75-min session included breathing techniques, relaxation, mindfulness, and modified yoga postures, using yoga props and a rope wall. An online video was available for home practice. The outcome measures administered at the baseline and at 8 weeks were physician global assessment with joint count, visual assessment with a joint damage assessment index, the Pediatric Quality of Life Arthritis Module 3.0 (Peds QL), and the visual analog scale for pain. Results: Thirteen out of 25 participants attended ≥1 class with a mean of 5.7 ± 2.2 classes. Common reasons for non-enrollment included distance, schedule, and lack of interest. The average distance to classes was 29.0 ± 41.7 miles. There was a trend toward improvement for joint count (p = 0.07), global assessment (p = 0.10), and the Pain and Hurt domain of the Peds QL (p = 0.13), but no other outcomes approached significance. Satisfaction data from an anonymous survey (n = 8) were high in all areas. Conclusions: Adolescents with JIA who attended yoga reported enjoyment, pain reduction, and interest in continued practice with no adverse events. Future studies should consider stakeholder engagement to reduce barriers and larger sample sizes to test the effectiveness.
... For instance, after 6 weeks of intervention, some studies have reported significant improvements in self-esteem, VAS, and health assessment questionnaire scores with 2 yoga lessons per week. [73,74] Similarly, tai chi [75] and dance classes [76,77] have been suggested as potentially helpful interventions. ...
Rheumatoid arthritis (RA) is a prolonged multifactorial autoimmune disease of unknown etiology. With the global population aging, the incidence of RA is increasing, highlighting the need for more effective treatments. Exercise interventions have been recognized as safe and effective for managing pain, improving function, and reducing fatigue in RA patients. However, the existing literature in this field lacks a thorough, organized, and clear line of analysis. In this study, we conducted a comprehensive analysis of the 20-year literature on exercise interventions for RA, aiming to identify hotspots and cutting-edge trends. Our objective is to provide subsequent researchers with valuable ideas and references. Using Cite Space, VOS viewer, and R-bibliometrix software for visualization and analysis, we compiled the main dataset from the web of science database, consisting of 1790 articles on exercise interventions in RA published between 2000 and 2023. Among these articles, the United States contributed the highest number of papers (433), while Karolinska Institutet ranked first institutionally with 90 papers. The study focused on the keyword’s quality of life, cardiovascular disease, aerobic exercise, social support, psychology, and multidisciplinary care. The research highlighted the importance of clinical efficacy studies that investigate different types of exercise modalities (cardiorespiratory aerobic, resistance, aquatic, and neurological) either alone or in combination, to improve pain and function and reduce cardiovascular disease risk in patients with RA. Additionally, sedentary behavior, fatigue, and multidisciplinary care were identified as potential areas for further research. Overall, this study provides a scientific perspective on exercise interventions for RA and offers valuable insights for academics, funding organizations, and policymakers.
... El gráfico de Galbraith evidenció alta homogeneidad en siete de los nueve estudios (todos los estudios se encontraron entre las dos líneas de homogeneidad, excepto Evans et al. (2013) y Sareen et al., (2007) (Figura 5). Realizado el análisis de sensibilidad, reportó que estos dos estudios eran los más influyente, eliminando estos dos estudios del análisis la heterogeneidad cambió a heterogeneidad baja (Q = 5,65, p = 0,463, I² = 122,46%). ...
El objetivo principal de esta revisión es analizar los efectos de los ejercicios de Pilates y yoga en la vitalidad y salud mental, utilizando la escala de calidad de vida SF-36. Se realizó una exhaustiva búsqueda en las bases de datos de Pubmeb, PEDRo, Scopus, Scielo, Google Scholar y WorldWideScience, identificando un total de 169 artículos. Después de llevar a cabo los procesos de selección, elegibilidad e inclusión, se seleccionaron 20 artículos (11 de Pilates, 8 de yoga y 1 con intervención de Pilates y yoga). Tanto en el subgrupo de estudios de Pilates (n=12) como en el subgrupo de yoga (n=9), se observaron cambios estadísticamente significativos en la salud mental, con tamaños de efecto moderados (subgrupo Pilates Cohen's d= 0,69 [IC del 95%: 0,37 a 1,01]; subgrupo de yoga Cohen's d= 0,50 [IC del 95%: 0,26 a 0,74]). En cuanto a la vitalidad, se observaron cambios estadísticamente significativos tanto en el subgrupo de estudios de Pilates (n=12) como en el subgrupo de yoga (n=9), con tamaños de efecto moderados-bajos (subgrupo Pilates Cohen's d= 0,38 [IC del 95%: 0,14 a 0,61]; subgrupo de yoga Cohen's d= 0,34 [IC del 95%: 0,08 a 0,59]). Estos resultados respaldan que los ejercicios de Pilates y yoga son eficaces como terapia física y mejoran de forma moderada la calidad de vida en términos de vitalidad y salud mental. Palabras clave: Pilates, yoga, Cuestionario de Calidad de Vida SF-36, calidad de vida, vitalidad, rol emocional, salud mental. Abstract. The main objective of this review is to analyze the effects of Pilates and yoga exercises on vitality and mental health, using the SF-36 quality of life scale. An exhaustive search was conducted in the Pubmeb, PEDRo, Scopus, Scielo, Google Scholar, and WorldWideScience databases, identifying a total of 169 articles. After performing the selection, eligibility, and inclusion processes, 20 articles were selected (11 on Pilates, 8 on yoga, and 1 with Pilates and yoga intervention). Statistically significant changes were observed in mental health in both the Pilates subgroup (n=12) and the yoga subgroup (n=9), with moderate effect sizes (Pilates subgroup Cohen's d=0.69 [95% CI: 0.37 to 1.01]; yoga subgroup Cohen's d=0.50 [95% CI: 0.26 to 0.74]). Regarding vitality, statistically significant changes were observed in both the Pilates subgroup (n=12) and the yoga subgroup (n=9), with moderate-low effect sizes (Pilates subgroup Cohen's d=0.38 [95% CI: 0.14 to 0.61]; yoga subgroup Cohen's d=0.34 [95% CI: 0.08 to 0.59]). These results support the effectiveness of Pilates and yoga exercises as physical therapy in moderately improving quality of life in terms of vitality and mental health. Keywords: Pilates, yoga, SF-36 Quality of Life Questionnaire, quality of life, vitality, emotional role, mental health.
... Il est probable que la « taille » de ces impacts dépend de l'expertise du méditant, de sa capacité à méditer, de la durée de la période de méditation et de la procédure de méditation qui peuvent être standardisées pour une stratégie de soin comme le programme MBSR. Il est nécessaire de poursuivre les évaluations par des études rigoureuses qui explorent des marqueurs pertinents en utilisant des méthodes standardisées d'explorations neuro-anatomiques, neuro-biologiques et immunoendocriniennes [83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][114][115][116][117] (tableau I). Globalement, le yoga, quand il peut être pratiqué dans les rhumatismes inflammatoires, semble pouvoir améliorer l'état fonctionnel (mesuré par le HAQ) mais sans réelle efficacité sur la douleur, les signes objectifs (articulations douloureuses et gonflées) et les signes biologiques. ...
... Yoga, one of the oldest sciences originating in India, has been tried as an adjunctive therapy in many of the chronic inflammatory arthritides and has shown substantial benefit in improved physical function, QoL, especially in RA and spondyloarthritis (SpA) [44]. It has also been described to have anti-inflammatory and antiaging benefits by increasing the levels of IL-10 and decreasing IL-12 and can be tailored according to patient's physical disabilities and damage accrued over the years due to the underlying AIRD [45]. ...
Inflammatory rheumatic disorders come with their plethora of complications including accelerated ovarian aging and the associated adversities which could be a consequence of disease itself or treatment with immunosuppressants. While aiming for treat-to-target in these patients, its effect on the ovaries takes a backseat. This review focusses on this underexplored avenue of effect of inflammation, inflamm-aging and the associated complications that come with early menopause, in the context of autoimmune rheumatic diseases (AIRDs). Some autoimmune diseases like lupus have a major role of estrogen in their causation and tend to be less severe when the onset is after menopause, while in other inflammatory arthritis like rheumatoid arthritis (RA), estrogen may have some anti-inflammatory potential. Inflamm-aging that is associated with the AIRDs also leads to early menopause and premature ovarian insufficiency in some patients, which adds-on to the morbidity and sometimes, mortality. With early ovarian aging and precipitous decline in circulating estrogen, there is accelerated reduction in the bone mass and early set-in of osteoporosis. Long-term steroids, on-going inflammation and RA itself are major risk factors. The high risk of detrimental fragility fractures in these patients with a consequential reduction in the quality of life with higher loss of disability adjusted life years (DALY) and poorer functional outcomes, contributes to long-term morbidity. While remission induction and maintenance are a major part of treatment, physicians should exercise a keen eye towards recognizing early menopause and its adversities and inculcate measures for osteo-protection and prevent adding on to the morbidity. Future prospects would include attempts at delaying ovarian aging by targeting mTOR/S6 kinase pathways and preservation of ovarian tissue.
... There are several aspects that affect the QoL in cancer patients which can be in the form of physical aspects including body image, response to treatment and care. The psychological and social aspects include self-esteem, happiness, spirituality, relationships with other people, financial problems, self-perception ofQoL, positive feelings and social well-being [8], [9]. ...
Breast cancer is the most common cancer that affects women and can impact the quality of life (QoL) of patients. Objective: The aim of this study is to identify interventions to improve the QoL of breast cancer patients. Method: This study uses a systematic scoping review approach on Pubmed, CINAHL, Cochrane Library, and ScienceDirect with a publication range of articles from 2018-2022, full-text articles, and randomized controlled trials. The quality assessment of the study uses critical appraisal checklist tools for randomized controlled trial research from the Joanna Briggs Institute (JBI). Results: Overall, 11 studies found interventions that are effective in improving the QoL of breast cancer patients, including nutritional counseling, Qigong, Yoga, music therapy, lymphedema self-management education, adapted physical activity and diet "APAD," patient-centered self-management support programs, Calorie Restriction and Synbiotics (CRS), and patient navigation. Recommendation: Our study highlights the potential of self-management approaches to improve the QoL of breast cancer patients. These findings can be a recommendation for nurses and other healthcare professionals in determining interventions to improve the QoL of breast cancer patients.
... The magnitude of the effect of yoga on anxiety compared with all control groups (usual care, wait list, others) was moderate (SMD = À 0.51; 95% CI = À0.81 to À0. 20). In this context, in addition to the protocols of the studies already mentioned, which showed positive results in the anxiety of patients with diseases 58,64,65 the study of Hennard 63 found positive results in anxiety after an 8-week intervention with one session per week of asanas, pranayama, yoga nidra, and meditation. ...
Objective:
the aim of the study is to investigate the effects of yoga on depressive symptoms, anxiety, sleep quality, and mood of patients with rheumatic diseases through a systematic literature review with meta-analysis.
Literature survey:
This review followed the PRISMA Statement and the Cochrane recommendations and risk of bias tool. The study was registered in the PROSPERO. Studies were selected using the PICOS strategy. Searches were carried out until March 2022 and performed in Web of Science, Pubmed, SportDiscus, Scopus, Cochrane, and EBSCO databases METHODOLOGY: Data were extracted in order to identify the differences between yoga and control and exercise groups and effect sizes.
Synthesis:
In total, 27 studies were included for qualitative analysis and 18 for meta-analysis. The studies found investigated yoga in osteoarthritis, fibromyalgia, rheumatoid arthritis, and chronic fatigue syndrome patients. Regarding the risk of bias, the majority of studies showed a high risk or uncertain risk of bias in several criteria. Regarding the meta-analysis, yoga was favored to decrease depressive symptoms (SMD:-0.88; CI95%:-1.42;-0.34), anxiety (SMD- 0.51; 95%CI = -0.81 to -0.20), and sleep quality =-0.96; 95%CI = -1.36 to -0.56). No differences were found between yoga and other exercise modalities in depression (p<0.01).
Conclusions:
Yoga is effective in reducing depression, anxiety, and sleep of patients with rheumatic diseases. However, research in this field still needs further studies, due to methodological issues in the studies, and a reduced number of studies conducted on each rheumatic disease and on the effects of yoga on each variable. This article is protected by copyright. All rights reserved.
... A potentially more accessible alternative may be physical activity. Although cross-sectional studies have shown a positive association between regular physical activity and good sleep (8,9), only a few clinical trials, including one randomised controlled trial (RCT) (10), one feasibility study (11), and four pilot studies (12)(13)(14), have examined the effect of physical exercise on sleep in people with RA. However, these studies were characterized by the risk of a floor effect arising from a lack of screening for poor sleep at baseline and the limited descriptions of the content, intensity, and duration of the exercise interventions. ...
Objective:
This study's objective was to investigate the efficacy and acceptability of intermittent aerobic exercise training on sleep parameters, fatigue, pain, depressive symptoms, physical function, and cardiorespiratory fitness in people with rheumatoid arthritis (RA).
Methods:
Thirty-eight people with RA were assigned to intermittent aerobic exercise training (three sessions/week for 6 weeks; intervention group, n = 17) or usual care (control group, n = 21). The primary outcome was a change in polysomnography-assessed sleep efficiency from baseline to the end of the intervention. Secondary outcomes were sleep quality (Pittsburgh Sleep Quality Index), fatigue (Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire), depression (Center for Epidemiological Studies-Depression), and cardiorespiratory fitness (watt max test).
Results:
No between-group differences were found in changes in polysomnography-assessed sleep efficiency (0.04; 95% confidence interval [CI]: -0.02 to 0.09, P = 0.17). In the intervention group, sleep efficiency was improved significantly from baseline (0.84; 95% CI: 0.80-0.88) compared with the end of the intervention (6 weeks) (0.88; 95% CI: 0.85-0.92); however, there was no significant difference in the control group. Fatigue and depression measures were significantly lower in the intervention group than in the control group. Between-group differences were overall fatigue (-16.1; 95% CI: -25.1 to -7.0, P = 0.001), physical fatigue (-5.0; 95% CI: -7.3 to -2.7, P = 0.0001), cognitive fatigue (-2.4; 95% CI: -4.2 to 0.6, P = 0.009), living with fatigue (-2.5; 95% CI: -4.5 to -0.5, P = 0.01), and depressive symptoms (-6.8; 95% CI: -12.4 to -1.1, P = 0.02).
Conclusion:
The intervention yielded no significantly better sleep efficiency compared with usual care. However, aspects of fatigue, including physical and cognitive fatigue, and depressive symptoms were significantly improved in the intervention group.
... Yoga practice was found to be associated with a decrease in inflammatory markers. [16][17][18] Yoga is an effective intervention in musculoskeletal disorders by improving range of motion and physical functioning and reducing inflammation by down regulating Nuclear factor kappa β (F-Kβ). 19,20 However, the role of yoga in AS patients has not been studied. ...
Background
Ankylosing spondylitis (AS) is a chronic autoimmune inflammatory spondyloarthropathy with unclear pathogenesis. The inflammatory pain in AS leads to restricted spinal mobility and significant disability. Yoga is a nonpharmacological intervention that has positive effects on various musculoskeletal-related problems. However, its role in AS is unknown.
Objective
The present retrospective study assessed the efficacy of a two-week residential yoga intervention on spinal flexibility among AS patients.
Methods
The records for 24 male AS patients within the age range 30 to 50 years (average age 38.3 ± 10.5 years) who underwent a two-week residential yoga retreat between 2015 and 2020 were obtained from a yoga center located in South India. Yoga intervention consisted of yoga postures, breathing practices, meditation, a healthy diet, and devotional sessions. Pre and Post data of the sit-and-reach test, blood pressure, heart rate, and symptom score were analyzed using Statistical Package for Social Sciences (SPSS).
Results
Compared to the baseline, the post scores of the sit-and-reach test, systolic blood pressure and heart rate were found to be significantly ( P < .05) lower. The symptom score and analgesic medication score also showed significant improvement after two-weeks compared to the baseline.
Conclusion
This retrospective study indicates the positive impact of on and analgesic use among AS patients. However, additional studies using robust research designs are warranted.
... As pain was examined more consistently than QOL, we used pain as a proxy. In our previous pilot studies of yoga and CBT for chronic health conditions, improvements in QoL had larger effect sizes than pain [24][25][26][27] suggesting that our power analyses based on changes in pain are conservative. Other meta-analyses examining yoga for generalised chronic back pain have found more modest effects (d=0.62). ...
Introduction
Endometriosis is a debilitating chronic inflammatory condition highly burdensome to the healthcare system. The present trial will establish the efficacy of (1) yoga and (2) cognitive–behavioural therapy (CBT), above (3) education, on quality of life, biopsychosocial outcomes and cost-effectiveness.
Methods and analysis
This study is a parallel randomised controlled trial. Participants will be randomly allocated to yoga, CBT or education. Participants will be English-speaking adults, have a diagnosis of endometriosis by a qualified physician, with pain for at least 6 months, and access to internet. Participants will attend 8 weekly group CBT sessions of 120 min; or 8 weekly group yoga sessions of 60 min; or receive weekly educational handouts on endometriosis. The primary outcome measure is quality of life. The analysis will include mixed-effects analysis of variance and linear models, cost–utility analysis from a societal and health system perspective and qualitative thematic analysis.
Ethics and dissemination
Enrolment in the study is voluntary and participants can withdraw at any time. Participants will be given the option to discuss the study with their next of kin/treating physician. Findings will be disseminated via publications, conferences and briefs to professional organisations. The University’s media team will also be used to further disseminate via lay person articles and media releases.
Trial registration number
ACTRN12620000756921p; Pre-results.
... The role of yoga as an effective intervention has been documented in the literature to assist in the management of chronic diseases like RA concerning its clinical symptoms like pain perception, stress management, disability outcomes, sleep quality, functional ability, QOL and psychosocial outcomes (Evans et al., 2011(Evans et al., , 2013Telles and Singh, 2012;Middleton et al., 2013;Gautam et al., 2019). Further exploration of a possible mode of action underlying the therapeutic effect of yoga at a cellular level is required and to establish how regular yoga practice affects the systemic biomarkers at the level of the psycho-neuro-immune axis to form a mindbody communication especially, in RA. ...
Various external stressors and environmental challenges lead to the provocation of the immune system in autoimmune diseases like Rheumatoid arthritis (RA). The inappropriate immune response further triggers the cascade of inflammatory changes resulting in precipitation of symptoms and hampers quality of life (QOL). The underlying psycho-somatic component of the disease requires a holistic approach to its treatment dimension rather than the use of pharmacotherapy. The applicability of mind-body interventions has become essential in today’s fast-paced life. Yoga, a mind-body technique, alters the mind’s capacity to facilitate systemic functioning at multiple organ system levels. Hence, we conducted this study to evaluate the impact of 8 weeks of a yoga-based lifestyle intervention (YBLI) on psycho-neuro-immune markers, gene expression patterns, and QOL in RA patients on routine medical therapy. A total of 66 patients were randomized into two groups: yoga group or non-yoga group and were assessed for a panel of inflammatory cytokines (IL-6, IL-17A, TNF-α, and TGF-β), mind-body communicative markers (BDNF, DHEAS, β-endorphin, and sirtuin) and transcript levels of various genes (IL-6, TNF-α, NFKB1, TGF-β, and CTLA4). We assessed disease activity and QOL using the DAS28-ESR and WHOQOL-BREF questionnaire, respectively. Yoga group observed significant improvements in the levels of markers, which influenced the psycho-neuro-immune axis (p < 0.001) with an estimated effect size from small to medium range. In the yoga group, there was a significant reduction in DAS28-ESR (p < 0.001) and improvement seen in the physical health, psychological, social relationships domains (p < 0.001) of QOL, except environmental (p > 0.05). The yoga group showed downregulation of IL-6, TNF-α, and CTLA4 and upregulation of TGF-β. These results suggest that a decrease in disease activity after yoga practice is associated with a significant reduction in inflammatory cytokines, the elevation of mind-body communicative markers, and normalization of various transcript levels, which improved QOL. Thus the adoption of YBLI improves clinical outcome in RA, and decreases systemic inflammation by its beneficial effects on psycho-neuro-immune axis and normalization of dysregulated transcripts. Thus YBLI may be used for RA patients as an adjunctive therapy.
... Evans et al. evaluated the impact of 6-week Iyengar yoga program on quality of life in patients with rheumatoid arthritis. Although the program led to some benefits regarding quality of life, it showed no effect on weekly reported sleep difficulties [65]. On the other hand, weekly progressive resistance training for 6 weeks was shown to improve sleep scale significantly [66]. ...
Sleep impairment is a common clinical condition in patients with rheumatoid arthritis. There are several confounding factors for poor sleep quality including inflammation, pain, comorbidities, and medications. Consequences of impaired sleep vary within a wide spectrum, as well. These include exacerbated inflammation and inflammation-related symptoms, mental and physical fatigue, mood disorders, daytime sleepiness, and poor quality of life. Sleep impairment in rheumatoid arthritis and its association with disease-related variables including health-related quality of life have been studied several times in the literature. Therefore, it would be of value to review the existing data on the crosstalk between sleep and rheumatoid arthritis. In the present article, the mechanism, confounders, and consequences of this association will be reviewed in detail. The evaluation of sleep impairment in rheumatoid arthritis along with the potential management strategies will be discussed.
... 66). Instructions are given throughout classes, and are focused on awareness of muscle and joint activity [37][38][39]. Poses are typically "held" for 30-60 s, however, poses can be tailored to the individual weight-related or pain-related needs of the participant [20,39]. These aspects of Iyengar yoga are particularly important when considering the obesity-related mechanical forces on the lower back and lower extremities and the negative effect of obesity on balance [25,[40][41][42][43]. ...
Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary outcome) in youths with obesity. Secondary outcomes included health-related quality of life (HRQoL), physical activity, and pain. Feasibility and acceptability were also assessed. Nine youths (11–17 years) participated in an eight-week Iyengar yoga intervention (bi-weekly 1-h classes). Gait, HRQOL (self and parent-proxy reports), and physical activity were assessed at baseline and post-yoga. Pain was self-reported at the beginning of each class. Significant improvements were found in multiple gait parameters, including hip, knee, and ankle motion and moments. Self-reported and parent-proxy reports of emotional functioning significantly improved. Time spent in physical activity and weight did not change. This study demonstrates that a relatively brief, non-invasive Iyengar yoga intervention can result in improved malalignment of the lower extremities during ambulation, as well as in clinically meaningful improvements in emotional functioning. This study extends current evidence that supports a role for yoga in pediatric obesity.
... 66). Instructions are given throughout classes, and are focused on awareness of muscle and joint activity [37][38][39]. Poses are typically "held" for 30-60 s, however, poses can be tailored to the individual weight-related or pain-related needs of the participant [20,39]. These aspects of Iyengar yoga are particularly important when considering the obesity-related mechanical forces on the lower back and lower extremities and the negative effect of obesity on balance [25,[40][41][42][43]. ...
Childhood obesity in the United States has more than tripled in the past three decades. Differences in lower extremity kinematics between obese and nonobese children during walking have been investigated, but the validity of using the gait deviation index (GDI) for measuring gait in obese children has not been explored. Nine obese children (13.9 ± 2.4 years old) with a body mass index of 33.3 ± 3.5 participated in the study. Reflective markers were placed on all children in a widely used standard lower extremity marker configuration. All participants walked along a 20-foot walkway at a self-selected speed. The kinematic and kinetic measurements for all children were taken, and the GDI for each subject was calculated. The mean ± standard deviation (SD) GDI of the nine obese children was 88.5 ± 12, which was significantly lower than the GDI of the typically developing children (100 ± 10, p < 0.002). There were no statistically significant correlations between the GDI and the Pediatric Quality of Life (PedsQL) Total score or PedsQL Physical Functioning score. Obese children had a significantly increased anterior pelvic tilt, hip flexion, hip adduction, hip adduction moment, knee flexion, knee valgus, and plantar flexion in stance phase (p < 0.05). While in swing phase, obese children had increased hip adduction and knee varus. The kinematic differences may reveal lower limb mal-alignment in obese children during walking. Overall, the GDI can play a major role in evaluating gait pathology in obese children. Future studies will increase the sample size to further evaluate the correlation between the GDI and functional outcomes.
... It is important to utilize these results to develop interventions to improve QoL for TGN youth. Interventions to improve HRQOL for children and youth with other conditions have been successful [39][40][41][42][43]. As the number of TGN youth increases, children for whom poor quality of life is a major factor will continue to present to community physicians as well as specialists in TGN care. ...
PurposeTo quantify HRQOL of TGN patients using the PedsQL 4.0 generic core scales, and to compare reported HRQOL of TGN adolescents with published data from comparison populations. Methods
Transgender children and adolescents (N = 142; 68% natal females) ages 6–23 years (M = 15.9, SD = 3.7) attending an outpatient clinic for TGN care at an academic pediatric hospital and caregivers of children and adolescents (N = 95) completed the PedsQL 4.0 generic core scales. Scores were compared with published scores for healthy adolescents and adolescents with 10 chronic diseases. ResultsTGN youth reported significantly lower overall HRQOL (more than twice the clinically meaningful difference) compared to youth without chronic disease. Total self-reported TGN HRQOL (M(SD), 65.72(17.40)) was lower than all chronic disease comparison groups except for rheumatology and cerebral palsy. TGN youth reported physical functioning (M(SD), 75.33(22.87)) lower than or similar to chronically ill comparisons, but higher than rheumatology and cerebral palsy groups. Psychosocial functioning (M(SD), 59.87(17.83)) was lower than all comparison samples and similar to youth with cerebral palsy. Results were similar for parent proxy-reports of TGN youth HRQOL (LS means: 68.75; 95% CI 65.87–71.61 vs 66.16; 95% CI 62.87–69.45; p = 0.12). ConclusionsTGN youth reported low HRQOL across all domains; most were significantly lower than healthy peers or peers with chronic diseases. Clinicians should understand the magnitude of TGN youth’s low HRQOL and offer them and their caregivers resources to maximize their ability to achieve their full potential for healthy and productive lives.
... Similar to other outcome measures, yoga has also shown to improve measures of HRQOL. Several studies have shown yoga improves HRQOL in individuals with cancer, arthritis, and chronic bodily pain [15,16,17]. ...
Objectives
Yoga is commonly being adopted and prescribed with the intent to increase a participant’s health-related quality of life. In practice, the current gold-standard health-related quality of life measurement tool is the SF-36 and SF-12 assessments. Therefore, it is important for yoga scientists and practitioners to understand yoga’s effects on health-related quality of life when in fact a gold-standard assessment is implemented. The purpose of this study was to employ systematic review and meta-analytic techniques to examine the effect of yoga on measures of health-related quality of life measured using only the SF-36/12 assessments.
Methods
A current (January 2007 to December 2016) systematic review of the Pubmed database was conducted and included studies that used yoga as an intervention with outcomes measures of health-related quality of life measured by the SF-36/12. Ten different measures were extracted from studies including eight dimension scores (physical functioning, bodily pain, physical role function, general health, mental health, emotional role function, social function, and vitality) and two summary scores (physical component and mental component). Ten different meta-analyses were performed using calculated standardized mean effect sizes and random effects models. Both moderator and sensitivity analyses were conducted.
Results
A total of 34 studies were included is the analyses with 185 independent effect sizes. Yoga intervention showed a significant positive effect on all ten measures of the SF-36/12. Effects ranged from 0.56 (0.39-0.73) to 0.28 (0.17-0.40). Yoga type (Hatha, Iyengar, Other) moderated the effects of yoga intervention on the mental component (p=.021), with Hatha yielding the greatest effects (ES=1.63, 0.61-2.65). The sensitivity analysis showed little to no bias in mean effect size estimates.
Conclusions
The meta-analytic evidence clearly supports the small-to-medium positive effects of yoga on health-related quality of life, as measured by the SF-36/12 assessments.
Keywords: Health-related quality of life Meta-analysis; SF-12; SF-36; Systematic review
... Among a wide array of methods that may favourably impact arthritis pain self-efficacy, aquatic programs [50], cognitive behavioural self-help interventions [51], exercise and dietary weight loss approaches [52], exercise and education [53], online cognitive-behavioural self-management group therapy with weekly telephone support [54], tai-chi [55] and yoga [56] have been shown to be efficacious. ...
This brief overview focuses on some relevant past and current research concerning the link between behavior specific arthritis self-efficacy beliefs and pain, the most important feature of arthritis.
... There is promising evidence that yoga may be a safe and beneficial intervention for both osteoarthritis (OA) and rheumatoid arthritis (RA). [1][2][3] A limitation of the existing yoga research is the under-representation of diverse and minority populations. Lifetime yoga practitioners are more likely female, younger, non-Hispanic white, college educated, higher earners, and have better health status than non-practitioners. ...
Objectives
To examine the acceptability of yoga research tailored to recruit and retain a minority population (both English and Spanish speaking) with arthritis. Yoga research for arthritis often underrepresents minorities and acceptability for this population has not previously been investigated.
Design
Acceptability was evaluated using retention, adherence, journals, and semi-structured exit interviews from twelve participants with osteoarthritis or rheumatoid arthritis undergoing an 8-week yoga intervention. Journal quotes were analyzed using content analysis techniques. NVivo software was used to organize transcripts and assemble themes. Two methods of triangulation (data and investigator) were used to overcome potential bias from a single-perspective interpretation. Exit interview comments were content analyzed using a card sort method. The study was designed with a cultural infrastructure including a multicultural research team, translators, and bilingual materials and classes, to facilitate trust and acceptability for primarily Hispanic and Black/African-American adults.
Setting
Washington, D.C. metropolitan area, USA.
Results
On average participants attended 10 of 16 classes, with home practice 2–3 days a week. All who completed were still practicing yoga three-months later. Qualitative narrative analysis identified major themes related to facilitating factors and barriers for yoga practice, self-efficacy, and support. Participant comments indicated that offering an arthritis-based yoga intervention and using a culturally congruent research design was found to be acceptable.
Conclusions
As yoga research grows, there is a need to understand and promote acceptability for typically under-represented populations. This study attempts to inform the expansion of multicultural research designed to recruit and retain those from diverse backgrounds.
Rheumatoid arthritis (RA) presents patients with chronic pain and functional limitations due to its autoimmune nature. Despite symptomatic and pharmaceutical interventions, many patients experience inadequate relief, prompting exploration into non-pharmacological approaches such as yoga. This study aims to evaluate the effectiveness of yoga as an adjunctive therapy for RA by examining clinical data from patients experiencing chronic pain and limitations. This study analyzed several clinical cases at the Shymkent City Regional Clinical Hospital. Ten RA patients, irrespective of various demographic factors, were enrolled. Parameters including pain intensity, inflammation activity, systolic blood pressure, joint function, and morning stiffness were assessed to gauge the impact of yoga. The findings demonstrated notable positive changes following a three-month yoga program. These changes encompassed enhanced joint health, reduced pain severity, and decreased disease activity. Particularly noteworthy was the reduction in morning stiffness by an average of 31 min, alongside a decrease in the average pain index from 80 mm to 41.5 mm. The mean RA activity level decreased from 5.8 to 4.7. Furthermore, mean systolic blood pressure decreased by 15.5 mmHg, and mean cholesterol levels decreased from 5.3 mmol/L to 4.8 mmol/L. These results underscore the potential significance of yoga as a supplementary intervention for RA. Yoga practice may enhance patients’ quality of life and alleviate disease symptoms. Nevertheless, the study’s limited sample size necessitates caution, and further research is warranted to validate these findings.
Objective: To identify the best evidence on the efficacy of non-pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the identified studies to inform European Alliance of Associations for Rheumatology recommendations for the management of fatigue in people with I-RMDs.
Methods: Systematic review of randomised controlled trials (RCTs) including adults with I-RMDs conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. Data were pooled in meta-analyses.
Results: From a total of 4150 records, 454 were selected for full-text review, 82 fulfilled the inclusion criteria and 55 RCTs were included in meta-analyses. Physical activity or exercise was efficacious in reducing fatigue in rheumatoid arthritis (RA) (standardised mean differences (SMD)=−0.23, 95% CI=−0.37 to −0.1), systemic lupus erythematosus (SLE) (SMD=−0.54, 95% CI=−1.07 to −0.01) and spondyloarthritis (SMD=−0.94, 95% CI=−1.23 to −0.66); reduction of fatigue was not significant in Sjögren’s syndrome (SMD=−0.83, 95% CI=−2.13 to 0.47) and systemic sclerosis (SMD=−0.66, 95% CI=−1.33 to 0.02). Psychoeducational interventions were efficacious in reducing fatigue in RA (SMD=−0.32, 95% CI=−0.48 to −0.16), but not in SLE (SMD=−0.19, 95% CI=−0.46 to 0.09). Follow-up models in consultations (SMD=−0.05, 95% CI=−0.29 to 0.20) and multicomponent interventions (SMD=−0.20, 95% CI=−0.53 to 0.14) did not show significant reductions of fatigue in RA. The results of RCTs not included in the meta-analysis suggest that several other non-pharmacological interventions may provide a reduction of fatigue, with reassuring safety results.
Conclusions: Physical activity or exercise and psychoeducational interventions are efficacious and safe for managing fatigue in people with I-RMDs.
Introduction: Rheumatoid Arthritis (RA) is a chronic inammatory auto immune disorder, where immune system attacks synovial lining of joints, resulting into, stiffness and dysfunction. In response to this the body releases CRP (C-Reactive Protein) in the bloodstream. Present study has Aim: been planned to see the effect of yogic exercises in order to subside the intensity of the RA symptoms and to determine the effects of yogic exercises on serum CRP and RF levels in RA patients. Present study was carried out in MGM Medical College and Material and method: Government Holkar Science College, Indore during December 2020-February 2022. Total 100 study subjects were taken out of which 50 were control and 50 RA cases. Fasting blood samples were collected from subjects and analyzed for CRP levels on fully automated biochemistry analyzer. Blood samples were also subjected for testing of RF. Medically healthy people of Inclusion criteria: 30-50 years of age and RA patients with 30-50 years of age. RA patients with diabetes, CHD and other major complications. Resul Exclusion criteria: Results: ts reveal that; Ÿ Increased level of CRP and RF has been observed in RA patients in comparison to healthy control. Ÿ Signicant decrease in levels of CRP and RF has been observed in RA patients with Yogic exercises as compared to RA patients without yogic exercises. Conclusion: Yogic exercises brought down the CRP and RF levels and because of which complications and pain in RA patients can be reduced. Some yogic exercises should be practiced as an add on therapy in management of RA
La présente recherche visera à comprendre au moyen d’une approche féministe matérialiste, les répercussions de la douleur et de la fatigue chronique, provoquées par la spondylarthrite ankylosante et la fibromyalgie sur la spatialité des femmes vivant avec ces pathologies. Pour ce faire, elle montrera que la maladie est un processus d’adaptation interrelationnel, se traduisant spatialement par la recomposition des géographies quotidiennes. Elle cherchera ainsi à mettre en évidence la nouvelle normalité sociospatiale qui s’institue en réaction à une corporéité endolorie. Cette recherche postule, par conséquent, que la restructuration des spatialités quotidiennes s’articule autour d’une fréquentation de nouveaux espaces, d’une resignification de la symbolique attribuée à certains lieux et d’une diminution de certains déplacements et de certaines activités. L’hypothèse soutenue sera évaluée sous l’angle de la production discursive récoltée durant une étude de terrain exploratoire. Celle-ci a été menée au sein de communautés virtuelles dédiées à ces affections et réalisée à l’aide d’outils de méthodologie qualitative tels que l’ethnographie en ligne et l’entretien biographique
Background- Despite of high prevalence, India reported very low incidence of varicose veins due to negligence, no reporting or late reporting. Among the treatment options, Yoga and Naturopathy can be one of the effective tool in managing varicose veins. Objective- The presenting study evaluates the effectiveness of Yoga and Naturopathy intervention on perceived stress and quality of life in uncomplicated varicose veins (UVV). Materials and methods- 50 UVV participants were randomized into two groups i.e. Experimental and control. Experimental group had undergone Yoga and Naturopathy interventions, whereas control group performed Passive exercises and Stretching. Data was recorded for EQ-5D-5L, PSS and SF-36 questionnaires at 30, 60 and 120 days of intervention. Results- PSS- Perceived stress significantly reduced (p<0.001) on Day 30, 60 and 120 in experimental group, whereas the control group showed significant reduction (p<0.001) on Day 60 and 120. EQ-5D-5L- In experimental group, all the domains of descriptive EQ-5D-5L reduced significantly ( p<0.001), except “Usual activities” (p<0.01). EQ-VAS shows significant increase (p<0.001) at all time points. Control group shows no significant changes for any of the domain at day-30. On Day 60, only “pain/discomfort” reduced significantly (p<0.01) whereas on Day 120, significant reduction was observed in all the domains. EQ-VAS significantly improved at Day 60 and 120. SF-36-In experimental group, all the components increased significantly (p<0.001) at all points of time. In control group, no significant changes were observed for any domain at day-30. At Day-60, significant increase was observed in all the components. At Day-120, significant improvement in mean was observed for all the domains (p<0.001). Conclusion- The results indicates that Yoga and Naturopathy intervention as well as passive exercise with stretching, both are effective in improving perceived stress and quality of life, but Yoga and Naturopathy have shown its efficacy in shorter duration of practice.
Z E T Yoga, binlerce yıl önce Hindistan'da ortaya çıkan, bireyin fiziksel, zihinsel, duygusal ve spirütüel boyutlarına denge ve sağlık getirmek için tasarlanan eski bir disiplindir. Son yıllarda sağlık için yoga uygulaması dünya çapında popüler hale gelmiştir. Esnekliği artırmak, genel kondisyonu, genel sağlığı, fiziksel uygunluğu iyileştirmek ve stresi azaltmak yogaya başlamak için en çok bildirilen nedenlerdir. Yoga yararlı etkilerinden dolayı alternatif bir terapatik yaklaşım olarak bilinir. Klinik yoga, hastalığı önlemek, iyileştirmek ve/veya düzeltmek için geleneksel yoga uygulamalarının kullanımını içerir. Romatizmal hastalıklar eklemlerde ağrı, şişlik, sertlik ve fonksiyon kaybına neden olarak bireylerin yaşam kalitesinde azalma ve engelliliğe neden olabilir. Artrit hastalarının yönetiminde ilaç ve cerrahi müdahalenin yanı sıra öz-yönetim, fizik tedavi, ergoterapi, kilo kaybı gibi farmakolojik olmayan yaklaşımlar önerilmektedir. Öz yönetimin ve fiziksel aktivitenin artmasının rolü, artritin tedavisinde büyük önem taşır. Terapatik etkilerinden dolayı yoga romatizmal hastalığı olanlar için alternatif bir yaklaşım olarak düşünülebilir. Son yıllarda romatoid artrit, osteoartrit ve fibromyalji gibi romatizmal hastalıklarda yoganın etkinliğinin araştırıldığı çalışmalar artmaktadır. Mekanizması tam olarak açıklanamasa da yoganın özellikle ağrı üzerine olumlu etkileri olduğu bildirilmiştir. Ayrıca hastalık semptomları, fonksiyon, psikolojik durum, uyku ve yaşam kalitesinde iyileşmeler bildirilmiştir. Fiziksel duruşlar, nefes çalışmaları, meditasyon ve yoga felsefesi birlikte uygulandığında daha etkili sonuçlar gözlenmiştir. Fakat çalışmalardaki randomizasyon eksiklikleri, küçük örneklem büyüklükleri, yoga müdahalelerinin standardizasyonunun olmaması ve müdahalelerin değişen dozajları nedeniyle çalışma sonuçlarının dikkatli yorumlanması gereklidir. Çalışmaların tüm bu sınırlamalarına rağmen, yoga artrit için umut verici bir yöntemdir. Yoga, romatoid atrit, osteoartrit, fibromyalji sendromu olan hastalar için yardımcı bir tedavi olarak düşünülebilir. A B S T R A C T Yoga is an ancient discipline that emerged in India thousandans of years ago, designed to bring balance and health to the physical, mental, emotional and spiritual dimensions of the individual. Yoga practice for health has become popular worldwide in recent years. Increasing flexibility, improving overall condition, overall health, physical fitness, and reducing stress are the most reported reasons for starting yoga. Yoga is known as an alternative therapeutic approach due to its beneficial effects. Clinical yoga involves the use of traditional yoga practices to prevent, cure and / or ameliorate disease. Rheumatic diseases can cause pain, swelling, stiffness and loss of function in the joints, leading to decreased quality of life and disability. In the management of arthritis patients, non-pharmacological approaches such as self-management, physical therapy, ergotherapy, weight loss, as well as drug and surgical intervention are recommended. The role of self-management and increased physical activity is of great importance in the treatment of arthritis. Due to its therapeutic effects, yoga can be considered as an alternative approach for those with rheumatic disease. In recent years, studies investigating the effectiveness of yoga in rheumatic diseases such as rheumatoid arthritis, osteoarthritis and fibromyalgia have been increasing. Although the mechanism is not fully explained, yoga has been reported to have positive effects especially on pain. In addition, improvements in disease symptoms, function, psychological state, sleep and quality of life have been reported. More effective results were observed when physical postures, breathing exercises, meditation and yoga philosophy were applied together. However, due to lack of randomization in studies, small sample sizes, lack of standardization of yoga interventions and changing dosages of interventions, study results should be interpreted with caution. Despite all these limitations of studies, yoga is a promising method for arthritis. Yoga can be considered as an adjunct therapy for patients with rheumatoid atritis, osteoarthritis, fibromyalgia syndrome.
In diesem Beitrag werden wesentliche aktuelle Grundlagen, Krankheitscharakteristika und Behandlungsmöglichkeiten der rheumatoiden Arthritis vorgestellt. Im Kontext von Prävention und Gesundheitsförderung werden schwerpunktmäßig Maßnahmen beleuchtet, die Risikopersonen oder bereits an rheumatoider Arthritis Erkrankte eigenständig im Alltag selbst durchführen können. Diese Lebensstilmodifikationen, die sich in diesem Beitrag insbesondere auf die Bereiche körperliche Aktivität, Ernährung, psychosoziale Gesundheitsressourcen, Tabakkonsum, Entspannung und Selbsthilfe beziehen, stellen im Kontext von Prävention und Gesundheitsförderung relevante Determinanten dar, um positiv auf das Krankheitsgeschehen der rheumatoiden Arthritis einzuwirken. Dies setzt allerdings dahingehend geschulte und befähigte Patienten voraus.
Background:
Juvenile idiopathic arthritis (JIA) is one of the most common types of arthritis among children . According to JIA guidelines for physical activity (PA), structured PA interventions led to improved health outcomes. However, many PA programs, such as yoga and aerobic dance, have not been studied in this population despite being popular among youth. Web-based PA programs could provide patients with accessible and affordable interventions.
Objective:
The primary objectives of the proposed pilot randomized controlled trial (RCT) are to examine (1) the feasibility of conducting a full-scale RCT to evaluate the effectiveness of two popular types of PA, a yoga training program and an aerobic dance training program, in female adolescents (aged 13-18 years) with JIA compared with an electronic pamphlet control group and (2) the acceptability of these interventions.
Methods:
A three-arm prospective randomized open-label study with a parallel group design will be used. A total of 25 female adolescents with JIA who have pain will be randomized in a ratio of 2:2:1 to one of the 3 groups: (1) online yoga training program (group A; n=10), (2) online aerobic dance training program (group B; n=10), and (3) electronic pamphlet control group (group C; n=5). Participants in groups A and B will complete 3 individual 1-hour sessions per week using online exercise videos, as well as a 1-hour virtual group session per week using a video-conferencing platform for 12 weeks. Participants from all groups will have access to an electronic educational pamphlet on PA for arthritis developed by the Arthritis Society. All participants will also take part in weekly online consultations with a research coordinator and discussions on Facebook with participants from their own group. Feasibility (ie, recruitment rate, self-reported adherence to the interventions, dropout rates, and percentage of missing data), acceptability, and usability of Facebook and the video-conferencing platform will be assessed at the end of the program. Pain intensity, participation in general PA, morning stiffness, functional status, fatigue, self-efficacy, patient global assessment, disease activity, and adverse events will be assessed using self-administered electronic surveys at baseline, weekly, until the end of the 12-week program.
Results:
This pilot RCT has been funded by the Arthritis Health Professions Association. This protocol was approved by the Children's Hospital of Eastern Ontario Research Ethics Board (#17/08X). As of May 11, 2020, recruitment and data collection have not started.
Conclusions:
To our knowledge, this is the first study to evaluate the effectiveness of yoga and aerobic dance as pain management interventions for female adolescents with JIA. The use of online programs to disseminate these 2 PA interventions may facilitate access to alternative methods of pain management. This study can lead to a full-scale RCT.
Clinicaltrial:
ClinicalTrials.gov NCT03833609; https://clinicaltrials.gov/ct2/show/NCT03833609.
Mind-body exercises such as yoga offer patients with rheumatoid arthritis (RA) a symptom management strategy for improving physical and mental health. Studies have evaluated yoga to manage symptoms of RA and improve physical function; however, none has examined the relationship between yoga and work status in adults with RA. The objective was to describe differences in RA symptomatology, physical function scores, and work status between adults with RA who participate in yoga and those who do not. This cross-sectional study surveyed adults with rheumatologist-diagnosed RA regarding yoga use in the past year, symptoms, physical function, and work status. Differences between yoga and non-yoga participation groups were assessed with 2-sided t tests or Pearson χ tests. Multivariate linear regression analyses were conducted to identify significant associations between yoga participation and primary outcomes. The sample included 398 adults with RA; 88% were females, 66% were white, mean age 61.8 years, mean disease duration 24.8 years; 10.6% participated in yoga. Vinyasa, Bikram, Hatha, Iyengar, and restorative yoga styles were practiced, mostly in a group setting. Yoga participants were significantly more likely to work full-time, less likely to be unable to work due to disability, and had better physical function. These findings characterize yoga practice and practitioners among adults with RA. In adults with RA, yoga participation is associated with full-time work status and better physical function than nonparticipation. This study adds additional information to the growing body of literature about adults with RA who practice yoga.
Irritable bowel syndrome (IBS) is a common condition associated with recurrent abdominal pain and altered bowel habits. It is particularly pernicious to youth, who may withdraw from life tasks due to pain, diarrhea, and/or fear of symptoms. Emotional stress exacerbates IBS symptoms, and mind-body interventions may be beneficial. In this mixed-methods study of 18 teens aged 14 to 17 years undertaking a 6-week Iyengar yoga intervention, we aimed to identify treatment responders and to explore differences between responders and nonresponders on a range of quantitative outcomes and qualitative themes related to yoga impact, goodness of fit, and barriers to treatment. Half of the teens responded successfully to yoga, defined as a clinically meaningful reduction in abdominal pain. Responders differed from nonresponders on postintervention quantitative outcomes, including reduced abdominal pain, improved sleep, and increased visceral sensitivity. Qualitative outcomes revealed that responders reported generalized benefits early in treatment and that their parents were supportive and committed to the intervention. Responders and nonresponders alike noted the importance of home practice to achieve maximal, sustained benefits. This study reveals the need for developmentally sensitive yoga programs that increase accessibility of yoga for all patients.
Objective: The aim of the present study was to determine the feasibility of a relaxation‐based
yoga intervention for rheumatoid arthritis, designed and reported in accordance with Delphi
recommendations for yoga interventions for musculoskeletal conditions.
Methods: Participants were recruited from a hospital database, and randomized to either
eight weekly 75‐min yoga classes or a usual care control. Feasibility was determined by recruitment
rates, retention, protocol adherence, participant satisfaction and adverse events. Secondary
physical and psychosocial outcomes were assessed using self‐reported questionnaires at baseline
(week 0), week 9 (primary time point) and week 12 (follow‐up).
Results: Over a 3‐month period, 26 participants with mild pain, mild to moderate functional
disability and moderate disease activity were recruited into the study (25% recruitment rate).
Retention rates were 100% for yoga participants and 92% for usual care participants at both
weeks 9 and 12. Protocol adherence and participant satisfaction were high. Yoga participants
attended a median of seven classes; additionally, seven of the yoga participants (54%) reported
continuing yoga at home during the follow‐up period. No serious adverse events were related
to the study. Secondary outcomes showed no group effects of yoga compared with usual care.
Conclusions: A relaxation‐based yoga programme was found to be feasible and safe for participants
with rheumatoid arthritis‐related pain and functional disability. Adverse events were
minor, and not unexpected from an intervention including physical components. This pilot provides
a framework for larger intervention studies, and supports further exploration of yoga as a
complex intervention to assist with the management of rheumatoid arthritis.
KEYWORDS
complementary medicine, RCT, rheumatoid arthritis, yoga
There is evidence that the psychological attribute of perceived self-efficacy plays a role in mediating health outcomes for persons with chronic arthritis who take the Arthritis Self-Management Course. An instrument to measure perceived self-efficacy was developed through consultation with patients and physicians and through study of 4 groups of patients. Tests of construct and concurrent validity and of reliability showed that the instrument met appropriate standards. Health outcomes and self-efficacy scores improved during the Arthritis Self-Management Course, and the improvements were correlated.
This report presents selected estimates of complementary and alternative medicine (CAM) use among U.S. adults and children, using data from the 2007 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). Trends in adult use were assessed by comparing data from the 2007 and 2002 NHIS.
Estimates were derived from the Complementary and Alternative Medicine supplements and Core components of the 2007 and 2002 NHIS. Estimates were generated and comparisons conducted using the SUDAAN statistical package to account for the complex sample design.
In 2007, almost 4 out of 10 adults had used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (17.7%) and deep breathing exercises (12.7%). American Indian or Alaska Native adults (50.3%) and white adults (43.1%) were more likely to use CAM than Asian adults (39.9%) or black adults (25.5%). Results from the 2007 NHIS found that approximately one in nine children (11.8%) used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (3.9%) and chiropractic or osteopathic manipulation (2.8%). Children whose parent used CAM were almost five times as likely (23.9%) to use CAM as children whose parent did not use CAM (5.1%). For both adults and children in 2007, when worry about cost delayed receipt of conventional care, individuals were more likely to use CAM than when the cost of conventional care was not a worry. Between 2002 and 2007 increased use was seen among adults for acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy, and yoga. CAM use for head or chest colds showed a marked decrease from 2002 to 2007 (9.5% to 2.0%).
Although several studies have illustrated the effectiveness of cognitive behavior therapy (CBT) on adult pain patients, there are few randomized controlled trials on children and adolescents. There is particularly a need for studies on pediatric patients who are severely disabled by longstanding pain syndromes. Acceptance and Commitment Therapy, as an extension of traditional CBT, focuses on improving functioning and quality of life by increasing the patient's ability to act effectively in concordance with personal values also in the presence of pain and distress. Following a pilot study, we sought to evaluate the effectiveness of an ACT-oriented intervention based on exposure and acceptance strategies and to compare this with a multidisciplinary treatment approach including amitriptyline (n=32). The ACT condition underwent a relatively brief treatment protocol of approximately 10 weekly sessions. Assessments were made before and immediately after treatment, as well as at 3.5 and 6.5 months follow-up. Prolonged treatment in the MDT group complicated comparisons between groups at follow-up assessments. Results showed substantial and sustained improvements for the ACT group. When follow-up assessments were included, ACT performed significantly better than MDT on perceived functional ability in relation to pain, pain intensity and to pain-related discomfort (intent-to-treat analyses). At post-treatment, significant differences in favor of the ACT condition were also seen in fear of re/injury or kinesiophobia, pain interference and in quality of life. Thus, results from the present study support previous findings and suggest the effectiveness of this ACT-oriented intervention for pediatric longstanding pain syndromes.
The Pain Disability Index (PDI) is a brief instrument that was developed to assess pain-related disability, providing information that complements assessment of physical impairment. This paper presents the results of two studies concerning the psychometric properties and the validity of the PDI. In study I, PDI scores of 108 patients appeared internally consistent (alpha = .86), although a factor analysis revealed two factors. The first factor (59.3% of variance) seemed to include more discretionary, less obligatory activities. The second factor (14.3% of variance) included activities more basic to daily living and survival. Study II found that the PDI scores of 37 former inpatients were significantly higher than 36 former outpatients who responded to a follow-up questionnaire. These findings support the validity of the PDI. Several methodologic issues are discussed, and suggestions are made for future uses of the instrument.
The present study aimed at assessing the effects of a set of yoga practices on normal adults (n = 37), children (n = 86), and patients with rheumatoid arthritis (n = 20). An equal number of normal adults, children, and patients with rheumatoid arthritis who did not practice yoga were studied under each category, forming respective control groups. Yoga and control group subjects were assessed at baseline and after varying intervals, as follows, adults after 30 days, children after 10 days and patients after 15 days, based on the duration of the yoga program, which they attended, which was already fixed. Hand grip strength of both hands, measured with a grip dynamometer, increased in normal adults and children, and in rheumatoid arthritis patients, following yoga, but not in the corresponding control groups, showing no re-test effect. Adult female volunteers and patients showed a greater percentage improvement than corresponding adult males. This gender-based difference was not observed in children. Hence yoga practice improves hand grip strength in normal persons and in patients with rheumatoid arthritis, though the magnitude of improvement varies with factors such as gender and age.
Research and clinical developments over the past 20 years are beginning to shed new light on thoughts, sensations, emotions, their role in influencing behavior, and the particular ways in which private experiences contribute to human suffering (e.g. Hayes et al., 2001). This has led to different approaches to treating a broad array of behavior problems, approaches that incorporate a partnership of acceptance and change. We have defined acceptance of chronic pain as an active willingness to engage in meaningful activities in life regardless of pain-related sensations, thoughts, and other related feelings that might otherwise hinder that engagement. It is about not engaging in unnecessary struggles with private experiences, struggles that often intensify the aversiveness of those experiences and enhance their life disrupting influences. What is novel about this approach is that it is not simply a new psychological variable but a description of a different set of processes of pain and suffering. This approach is fully situated within the broader empirical tradition of the behavioral and cognitive therapies. The examination of its potential merits is already underway.
Patient-reported outcomes (PROs) provide intrinsic knowledge about a patient's health, functional status, symptoms, treatment preferences, satisfaction, and quality of life. They have become an established approach for assessing health outcomes. The Health Assessment Questionnaire (HAQ), introduced in 1980, is among the first PRO instruments designed to represent a model of patient-oriented outcome assessment. The HAQ is based on five patient-centered dimensions: disability, pain, medication effects, costs of care, and mortality. It has been validated by mail, in the office, by telephone, and by comparison with paraprofessional and physician judgments as a reliable instrument, and has been significantly correlated with other PRO instruments. Typically, one of two HAQ versions is used: the Full HAQ, which assesses all five dimensions, and the Short or 2-page HAQ, which contains only the HAQ disability index (HAQ-DI) and the HAQ's patient global and pain visual analog scales (VAS). The HAQ-DI and the global and pain VAS (i.e., the short HAQ) have essentially retained their original content since their inception, while the Full HAQ undergoes periodic revision to address issues of contemporary scientific interest. The HAQ-DI has been translated or culturally adapted into more than 60 different languages or dialects and has become part of the National Institutes of Health "Road-map" Project, the Patient-Reported Outcomes Measurement Information System (PROMIS).
Between March and June 2004, a systematic review was carried out of the research evidence on the effectiveness of yoga for the treatment of anxiety and anxiety disorders. Eight studies were reviewed. They reported positive results, although there were many methodological inadequacies. Owing to the diversity of conditions treated and poor quality of most of the studies, it is not possible to say that yoga is effective in treating anxiety or anxiety disorders in general. However, there are encouraging results, particularly with obsessive compulsive disorder. Further well conducted research is necessary which may be most productive if focused on specific anxiety disorders.
The authors examine the facet structure of mindfulness using five recently developed mindfulness questionnaires. Two large samples of undergraduate students completed mindfulness questionnaires and measures of other constructs. Psychometric properties of the mindfulness questionnaires were examined, including internal consistency and convergent and discriminant relationships with other variables. Factor analyses of the combined pool of items from the mindfulness questionnaires suggested that collectively they contain five clear, interpretable facets of mindfulness. Hierarchical confirmatory factor analyses suggested that at least four of the identified factors are components of an overall mindfulness construct and that the factor structure of mindfulness may vary with meditation experience. Mindfulness facets were shown to be differentially correlated in expected ways with several other constructs and to have incremental validity in the prediction of psychological symptoms. Findings suggest that conceptualizing mindfulness as a multifaceted construct is helpful in understanding its components and its relationships with other variables.
Previous research on assessment of mindfulness by self-report suggests that it may include five component skills: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience. These elements of mindfulness can be measured with the Five Facet Mindfulness Questionnaire (FFMQ). The authors investigated several aspects of the construct validity of the FFMQ in experienced meditators and nonmeditating comparison groups. Consistent with predictions, most mindfulness facets were significantly related to meditation experience and to psychological symptoms and well-being. As expected, relationships between the observing facet and psychological adjustment varied with meditation experience. Regression and mediation analyses showed that several of the facets contributed independently to the prediction of well-being and significantly mediated the relationship between meditation experience and well-being. Findings support the construct validity of the FFMQ in a combination of samples not previously investigated.
Thank you for your interest in:
Ware, JE, Jr., Kosinski, M, Bjorner, JB, et al., User’s manual for the SF-36v2® Health Survey (2nd ed.). Lincoln, RI: QualityMetric Incorporated, 2007.
This 309-page manual is available at and for loan from many university research libraries. Because it is the most requested book; Boston University research library has multiple copies for library loan.
Good luck with your research,
John E. Ware, Jr., PhD
Rheumatoid arthritis (RA) is a chronic disease that often impacts patient's quality of life. For young people with RA, there is a need for rehabilitative approaches that have been shown to be safe and to lead to improved functioning.
This pilot study investigated the feasibility of a single-arm, group-administered, six-week, biweekly Iyengar yoga (IY) program for eight young adults with RA.
IY is known for its use of props, therapeutic sequences designed for patient populations, emphasis on alignment, and a rigorous teacher training. Treatment outcomes were evaluated using a mixed-methods approach that combined quantitative results from standardized questionnaires and qualitative interviews with participants.
Initial attrition was 37% (n=3) after the first week because of scheduling conflicts and a prior non-RA related injury. However, the remaining participants (n=5) completed between 75% and 100% of treatment sessions (mean=95%). No adverse events were reported. The quantitative results indicated significant improvements in pain, pain disability, depression, mental health, vitality, and self-efficacy. Interviews demonstrated improvement in RA symptoms and functioning but uncertainty about whether the intervention affected pain.
These preliminary findings indicate that IY is a feasible complementary approach for young people with RA, although larger clinical trials are needed to demonstrate safety and efficacy.
The major objectives in treating patients with rheumatoid arthritis are managing the symptoms of disease and preserving joint structure, with the ultimate goal of disease remission. Several independent studies have shown that treatment decisions driven by quantitative rather than subjective monitoring of disease activity result in significantly improved patient outcomes. Various assessment tools are available that measure both clinical and patient-reported outcomes. While some measurement tools may be more appropriate for use in clinical trials, several have been developed that are simple and practical to use, even in a busy clinic. As pivotal members of the multidisciplinary rheumatology healthcare provider team, the nurse and the rheumatologist play key roles in managing a patient's progress by closely monitoring their response to treatment. Here, we discuss optimal disease management founded on a multidisciplinary approach and provide an overview of some key measures for assessing patient response to treatment.
A questionnaire survey of 363 children and young adults with juvenile arthritis was conducted to assess the relations among disease severity, psychosocial functioning, and adjustment in three age groups--primary school, high school, and young adult. Parents were surveyed separately to determine which characteristics of the ill child at different ages most significantly impact the well-being of the family. Indices of psychologic functioning and disease severity were associated with adjustment in the primary school and high school groups, whereas measures of social relationships were strongly associated with adjustment only in the high school group. Relations among measures of psychologic functioning, social relationships, disease severity, and adjustment in young adults were minimal. Level of disease severity was associated with the presence of financial concerns, emotional problems, and physical strain in parents of high school children and young adults. The results emphasize the importance of using a developmental model for understanding the adjustment of individuals with chronic juvenile arthritis and their families.
This paper reports the development and validation of a questionnaire assessing fatigue and anemia-related concerns in people with cancer. Using the 28-item Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire as a base, 20 additional questions related to the symptoms and concerns of patients with anemia were developed. Thirteen of these 20 questions dealt with fatigue, while the remaining 7 covered other concerns related to anemia. Using semi-structured interviews with 14 anemic oncology patients and 5 oncology experts, two instruments were produced: The FACT-Fatigue (FACT-F), consisting of the FACT-G plus 13 fatigue items, and the FACT-Anemia (FACT-An), consisting of the FACT-F plus 7 nonfatigue items. These measures were, in turn, tested on a second sample of 50 cancer patients with hemoglobin levels ranging from 7 to 15.9 g/dL. The 41-item FACT-F and the 48 item FACT-An scores were found to be stable (test-retest r = 0.87 for both) and internally consistent (coefficient alpha range = 0.95-0.96). The symptom-specific subscales also showed good stability (test-retest r range = 0.84-0.90), and the Fatigue subscale showed strong internal consistency (coefficient alpha range = 0.93-0.95). Internal consistency of the miscellaneous nonfatigue items was lower but acceptable (alpha range = 0.59-0.70), particularly in light of their strong relationship to patient-rated performance status and hemoglobin level. Convergent and discriminant validity testing revealed a significant positive relationship with other known measures of fatigue, a significant negative relationship with vigor, and a predicted lack of relationship with social desirability. The total scores of both scales differentiated patients by hemoglobin level (p < 0.05) and patient-rated performance status (p < 0.0001). The 13-item Fatigue subscale of the FACT-F and the 7 nonfatigue items of the FACT-An also differentiated patients by hemoglobin level (p < 0.05) and patient-rated performance status (p < or = 0.001). The FACT-F and FACT-An are useful measures of quality of life in cancer treatment, adding more focus to the problems of fatigue and anemia. The Fatigue Subscale may also stand alone as a very brief, but reliable and valid measure of fatigue.
Irritable bowel syndrome is characterized by recurrent abdominal pain and altered bowel function. In designing studies to evaluate new treatments for this disease, however, it is difficult to select appropriate endpoints to reflect improvement in the range of symptoms of the syndrome. In the present study we evaluated the parameter of adequate relief of abdominal pain and discomfort, as perceived by the patients, as a key endpoint for efficacy in the treatment of patients with irritable bowel syndrome. Abdominal pain and bowel function data were collected daily from 370 patients with the disease during treatment with placebo or a novel potent 5HT3 receptor antagonist. Once every 7 days adequate relief of pain and discomfort was assessed. Quality-of-life data were collected using self-administered questionnaires. The endpoint of adequate relief was significantly (P < 0.05) correlated with improvement in pain severity scores, percentage of pain-free days, percentage of days with urgency, improvement in stool frequency and consistency, and quality-of-life parameters. Adequate relief of pain and discomfort is significantly correlated with changes in multiple parameters associated with irritable bowel syndrome and can be used as an endpoint for assessing response to therapy in these patients.
Carpal tunnel syndrome is a common complication of repetitive activities and causes significant morbidity.
To determine the effectiveness of a yoga-based regimen for relieving symptoms of carpal tunnel syndrome.
Randomized, single-blind, controlled trial.
A geriatric center and an industrial site in 1994-1995.
Forty-two employed or retired individuals with carpal tunnel syndrome (median age, 52 years; range, 24-77 years).
Subjects assigned to the yoga group received a yoga-based intervention consisting of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation given twice weekly for 8 weeks. Patients in the control group were offered a wrist splint to supplement their current treatment.
Changes from baseline to 8 weeks in grip strength, pain intensity, sleep disturbance, Phalen sign, and Tinel sign, and in median nerve motor and sensory conduction time.
Subjects in the yoga groups had significant improvement in grip strength (increased from 162 to 187 mm Hg; P = .009) and pain reduction (decreased from 5.0 to 2.9 mm; P = .02), but changes in grip strength and pain were not significant for control subjects. The yoga group had significantly more improvement in Phalen sign (12 improved vs 2 in control group; P = .008), but no significant differences were found in sleep disturbance, Tinel sign, and median nerve motor and sensory conduction time.
In this preliminary study, a yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome.
To determine prevalence estimates for rheumatoid arthritis (RA) in noninstitutionalized older adults in the US. Prevalence estimates were compared using 3 different classification methods based on current classification criteria for RA.
Data from the Third National Health and Nutrition Examination Survey (NHANES-III) were used to generate prevalence estimates by 3 classification methods in persons 60 years of age and older (n = 5,302). Method 1 applied the "n of k" rule, such that subjects who met 3 of 6 of the American College of Rheumatology (ACR) 1987 criteria were classified as having RA (data from hand radiographs were not available). In method 2, the ACR classification tree algorithm was applied. For method 3, medication data were used to augment case identification via method 2. Population prevalence estimates and 95% confidence intervals (95% CIs) were determined using the 3 methods on data stratified by sex, race/ethnicity, age, and education.
Overall prevalence estimates using the 3 classification methods were 2.03% (95% CI 1.30-2.76), 2.15% (95% CI 1.43-2.87), and 2.34% (95% CI 1.66-3.02), respectively. The prevalence of RA was generally greater in the following groups: women, Mexican Americans, respondents with less education, and respondents who were 70 years of age and older.
The prevalence of RA in persons 60 years of age and older is approximately 2%, representing the proportion of the US elderly population who will most likely require medical intervention because of disease activity. Different classification methods yielded similar prevalence estimates, although detection of RA was enhanced by incorporation of data on use of prescription medications, an important consideration in large population surveys.
Research and treatment of chronic pain over the past 20 or more years have tended to focus on patient coping as the primary behavioral contribution to adjustment. The purpose of the present study was to compare a coping approach to chronic pain with a different behavioral approach referred to as acceptance of chronic pain. These approaches were compared in terms of their ability to predict distress and disability in a sample of patients seeking treatment for chronic pain. Subjects were 230 adults assessed at a university pain management center. All patients completed the coping strategies questionnaire and the chronic pain acceptance questionnaire among other standard measures. Results showed that coping variables were relatively weakly related to acceptance of pain and relatively unreliably related to pain adjustment variables. On the other hand, acceptance of chronic pain was associated with less pain, disability, depression and pain-related anxiety, higher daily uptime, and better work status. Regression analyses examined the independent contributions of coping and acceptance to key adjustment indicators in relation to chronic pain. Results from these analyses demonstrated that acceptance of pain repeatedly accounted for more variance than coping variables.
To provide recommendations for the core outcome domains that should be considered by investigators conducting clinical trials of the efficacy and effectiveness of treatments for chronic pain. Development of a core set of outcome domains would facilitate comparison and pooling of data, encourage more complete reporting of outcomes, simplify the preparation and review of research proposals and manuscripts, and allow clinicians to make informed decisions regarding the risks and benefits of treatment.
Under the auspices of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT), 27 specialists from academia, governmental agencies, and the pharmaceutical industry participated in a consensus meeting and identified core outcome domains that should be considered in clinical trials of treatments for chronic pain.
There was a consensus that chronic pain clinical trials should assess outcomes representing six core domains: (1) pain, (2) physical functioning, (3) emotional functioning, (4) participant ratings of improvement and satisfaction with treatment, (5) symptoms and adverse events, (6) participant disposition (e.g. adherence to the treatment regimen and reasons for premature withdrawal from the trial). Although consideration should be given to the assessment of each of these domains, there may be exceptions to the general recommendation to include all of these domains in chronic pain trials. When this occurs, the rationale for not including domains should be provided. It is not the intention of these recommendations that assessment of the core domains should be considered a requirement for approval of product applications by regulatory agencies or that a treatment must demonstrate statistically significant effects for all of the relevant core domains to establish evidence of its efficacy.
Acceptance of chronic pain entails that an individual reduce unsuccessful attempts to avoid or control pain and focus instead on participation in valued activities and the pursuit of personally relevant goals. Recent research suggests that pain-related acceptance leads to enhanced emotional and physical functioning in chronic pain patients above and beyond the influence of depression, pain intensity, and coping. In these studies, acceptance was measured using the Chronic Pain Acceptance Questionnaire (CPAQ). Preliminary analyses of the CPAQ have supported its psychometric properties. The present study sought to further refine the CPAQ by examining its factor structure and evaluating the relations of these factors to other indices of pain-related distress and disability. Although a previously demonstrated factor structure of the CPAQ was generally supported, only factors assessing (a) the degree to which one engaged in life activities regardless of the pain and (b) willingness to experience pain had adequate reliability and validity and were significantly related to the other measures of patient functioning. A revised version of the CPAQ is suggested.
Effectiveness of the traditional rehabilitation approaches used in pediatric rheumatology has been difficult to prove and, in times of cost containment, this lack of evidence may lead to undertreatment with physical and occupational therapies. Quantitative methods such as those described in this issue by Broström and colleagues can be used to validate those approaches and to reinforce the need for careful attention to the effects of even minor loss of range and strength in children with juvenile arthritis. Historically, up to half of the children affected by polyarticular juvenile arthritis became disabled. Some factors that have led to improved outcomes for childhood rheumatic diseases are discussed, including medications (use of weekly low-dose methotrexate, intra-articular steroid injections, new biologic agents that specifically block mediators of inflammation, for example, tumor necrosis factor and interleukin-1), surgery (joint replacements), and psychosocial interventions (with schools and families). The importance of maintaining range of movement, strength, weight bearing, and ambulation, in an effort to prevent sequelae such as osteoporosis and wheelchair dependence, is emphasized. Early identification of children with rheumatic diseases and aggressive intervention, with a combined medical, rehabilitation, psychosocial, and, rarely, surgical approach, should now allow most affected children to reach adulthood with little or no disability.
Adolescent arthritis or rheumatism (AAR) has been shown to influence the activities, mental health, and healthcare utilization of affected individuals. However, these effects have never been estimated in a population-based sample. We examined the association of AAR with health status, health services use, health behaviors, and activity limitations. We also investigated the effect of socioeconomic status and family background on respondents with AAR.
The 1996 National Population Health Survey is a nationally representative survey exploring the health status and behaviors of Canadians. Among the 26,012 individuals aged 12 to 19 with complete responses on the presence of chronic illnesses, the 213 self-reporting arthritis or rheumatism (AAR) were compared to: (1) all other adolescents as a single group; or (2) the group of 9161 adolescents reporting other chronic diseases (OCD) but not AAR, and the group of 16,638 adolescents without chronic disease (WCD). Between-group differences were examined for the following variables: health status; use of health services; presence of activity limitations in school, work, or at home; and school enrollment and work status.
Compared to those without, respondents with AAR reported more diagnoses of non-AAR chronic illnesses. Depression among AAR individuals was more prevalent than among non-AAR individuals, as was suffering from moderate or severe pain. Those with AAR were more likely than WCD individuals to use physician services, hospital services, and pain relief medications. AAR patients were more likely to be limited in their activities, and less likely to be enrolled in school than OCD or WCD individuals.
This study indicates a broad range of effects of AAR in a nationally representative sample. Arthritis or rheumatism affected measures of mental health, health service use, and the school, work, and home activities of affected individuals, compared to individuals without chronic disease or with other chronic disease.
To evaluate quality of life (QOL) in adults with juvenile idiopathic arthritis (JIA), using validated measures of functional disability and generic health status, and to quantify their educational attainment and employment status.
The adult rheumatology departmental database was used to identify patients. Functional disability and generic health status/QOL were assessed by the Health Assessment Questionnaire (HAQ) and the Short Form 36-item health profile (SF-36), respectively. Educational achievement and employment status were assessed by questionnaire.
Complete data were available for 82 of the 101 patients identified. The median age of patients was 30 years, and the median disease duration was 21 years. No deaths were recorded. All subtypes of JIA were represented. Thirty-nine percent of patients had active disease (based on the physician global assessment scale score). The median HAQ score was 1.125 (range 0-3). SF-36 scores for bodily pain, general health, physical functioning, vitality, emotion, and social isolation were significantly worse in patients compared with controls, and this trend increased with increasing age of the patients and disease duration. The SF-36 mental summation scores of patients were low compared with those of controls, for all subtypes of JIA, and this finding was independent of the degree of functional disability (by HAQ and SF-36 physical summation scores). The educational attainment of patients was comparable to that of local controls, but unemployment rates for patients were 3-fold higher than those for controls.
This is the largest study in which the SF-36 was used to assess generic health status and QOL in adults with JIA. Many patients had active disease in adulthood, and although the physical outcome of adults with JIA is relatively good, a profound effect on generic health status and QOL was demonstrated for all types of JIA. Furthermore, despite excellent educational attainment, there was a high rate of unemployment among patients.
The concept of acceptance is receiving increased attention as an alternate approach to the suffering that is often associated with persistent and disabling pain. This approach differs from established treatments in that it does not principally focus on reducing pain, but on reducing the distressing and disabling influences of pain as they concern important areas in patients' lives. The present analyses represent a preliminary evaluation of an acceptance-based approach to chronic pain within an interdisciplinary treatment program. One hundred and eight patients with complex chronic pain conditions completed treatment and provided data for the current study. Treatment was conducted in a 3- or 4-week residential or hospital-based format. It included a number of exposure-based, experiential, and other behavior change methods focused on increasing (a) engagement in daily activity regardless of pain and (b) willingness to have pain present without responding to it. Significant improvements in emotional, social, and physical functioning, and healthcare use were demonstrated following treatment. The majority of improvements continued at 3-months post-treatment. Improvements in most outcomes during treatment were correlated with increases in acceptance, supporting the proposed process of treatment.
To determine the effects of participation in a low-impact aerobic exercise program on fatigue, pain, and depression; to examine whether intervention groups compared with a control group differed on functional (grip strength and walk time) and disease activity (total joint count, erythrocyte sedimentation rate, and C-reactive protein) measures and aerobic fitness at the end of the intervention; and to test which factors predicted exercise participation.
A convenience sample of 220 adults with rheumatoid arthritis (RA), ages 40-70, was randomized to 1 of 3 groups: class exercise, home exercise using a videotape, and control group. Measures were obtained at baseline (T1), after 6 weeks of exercise (T2), and after 12 weeks of exercise (T3).
Using structural equation modeling, overall symptoms (latent variable for pain, fatigue, and depression) decreased significantly at T3 (P < 0.04) for the class exercise group compared with the control group. There were significant interaction effects of time and group for the functional measures of walk time and grip strength: the treatment groups improved more than the control group (P <or= 0.005). There were no significant increases in measures of disease activity. Fatigue and perceptions of benefits and barriers to exercise affected participants' amount of exercise, supporting previous research.
This study supported the positive effects of exercise on walk time and grip strength, and demonstrated that fatigue and perceived benefits/barriers to exercise influenced exercise participation. Furthermore, overall symptoms of fatigue, pain, and depression were positively influenced in this selective group of patients with RA ages 40-70 years.
Induction of malignancy is a major concern when rheumatoid arthritis (RA) is treated with biologic therapy. A meta-analysis of RA biologic clinical trials found a general increased risk of malignancy, but this risk was not found in a large observational study. We undertook this study to assess the risk of malignancy among biologic-treated patients in a large US observational database.
We studied incident cases of cancer among 13,001 patients during approximately 49,000 patient-years of observation in the years 1998-2005. Cancer rates were compared with population rates using the US National Cancer Institute SEER (Surveillance, Epidemiology, and End-Results) database. Assessment of the risk of biologic therapy utilized conditional logistic regression to calculate odds ratios (ORs) as estimates of the relative risk, further adjusted for 6 confounders: age, sex, education level, smoking history, RA severity, and prednisone use.
Biologic exposure was 49%. There were 623 incident cases of nonmelanotic skin cancer and 537 other cancers. The standardized incidence ratios and 95% confidence intervals (95% CIs) compared with SEER data were as follows: all cancers 1.0 (1.0-1.1), breast 0.8 (0.6-0.9), colon 0.5 (0.4-0.6), lung 1.2 (1.0-1.4), lymphoma 1.7 (1.3-2.2). Biologics were associated with an increased risk of nonmelanotic skin cancer (OR 1.5, 95% CI 1.2-1.8) and melanoma (OR 2.3, 95% CI 0.9-5.4). No other malignancy was associated with biologic use; the OR (overall risk) of any cancer was 1.0 (95% CI 0.8-1.2).
Biologic therapy is associated with increased risk for skin cancers, but not for solid tumors or lymphoproliferative malignancies. These associations were consistent across different biologic therapies.
Unlabelled:
A consensus meeting was convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to provide recommendations for interpreting clinical importance of treatment outcomes in clinical trials of the efficacy and effectiveness of chronic pain treatments. A group of 40 participants from universities, governmental agencies, a patient self-help organization, and the pharmaceutical industry considered methodologic issues and research results relevant to determining the clinical importance of changes in the specific outcome measures previously recommended by IMMPACT for 4 core chronic pain outcome domains: (1) Pain intensity, assessed by a 0 to 10 numerical rating scale; (2) physical functioning, assessed by the Multidimensional Pain Inventory and Brief Pain Inventory interference scales; (3) emotional functioning, assessed by the Beck Depression Inventory and Profile of Mood States; and (4) participant ratings of overall improvement, assessed by the Patient Global Impression of Change scale. It is recommended that 2 or more different methods be used to evaluate the clinical importance of improvement or worsening for chronic pain clinical trial outcome measures. Provisional benchmarks for identifying clinically important changes in specific outcome measures that can be used for outcome studies of treatments for chronic pain are proposed.
Perspective:
Systematically collecting and reporting the recommended information needed to evaluate the clinical importance of treatment outcomes of chronic pain clinical trials will allow additional validation of proposed benchmarks and provide more meaningful comparisons of chronic pain treatments.
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