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Impact of Yoga on Low Back Pain and Function: A Systematic Review and Meta-Analysis

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An estimated 70% of people will experience low back pain at some point in their lives, and recurrence rates can be as high as 85%. Recent studies suggest that yoga – a widely practiced physical/mental discipline – may relieve back pain and reduce functional disability. The objective of this study was to conduct a systematic review and meta-analysis of the existing research on the effects of yoga on chronic low back pain and function. Our literature search began April 2011 and continued through October 2011. Cochrane, PubMed, CINAHL, Embase, ProQuest Dissertations and Theses, Google Scholar, and Clinicaltrials.gov databases were searched electronically. The search terms used were: yoga AND back pain. A total of 58 relevant studies were originally identified through the database searches. Of those, 45 were excluded on the basis of the title and/or review of the abstract. The 13 remaining studies were fully evaluated via a careful review of the full text. On the basis of the inclusion and exclusion criteria, 6 studies were excluded, leaving a total of 7 studies to be included in the meta-analyses of the impact of yoga on low back pain and function. Effect sizes were calculated as the standardized mean difference and meta-analyses were completed using a random-effects model. Overall, yoga was found to result in a medium, beneficial effect on chronic low back pain [overall effect size (ES) = 0.58, p<0.001], indicating that subjects practicing yoga reported significantly less pain than control subjects. Yoga subjects also reported significantly less functional disability after the intervention (overall ES = 0.53, p<0.001). Moreover, the improvements in pain and function for yoga subjects remained statistically significant 12-24 weeks after the end of the intervention (overall ES = 0.44-0.54, p≤0.002). In conclusion, yoga practice can significantly reduce pain and increase functional ability in chronic low back pain patients.
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Volume 2 • Issue 4 • 1000120
J Yoga Phys Ther
ISSN: 2157-7595 JYPT, an open access journal
Research Article Open Access
Sawyer et al., J Yoga Phys Ther 2012, 2:4
http://dx.doi.org/10.4172/2157-7595.1000120
Research Article
Open Access
Yoga & Physical Therapy
Impact of Yoga on Low Back Pain and Function: A Systematic Review and
Meta-Analysis
Amy M Sawyer*, Sarah K Martinez and Gordon L Warren
Division of Physical Therapy, Georgia State University, Atlanta, Georgia, USA
*Corresponding author: Amy M Sawyer, SPT, Division of Physical Therapy,
Georgia State University, Atlanta, GA 30302, USA, P.O. Box 4019, Tel: (202)
445-5225; E-mail: awolfe3@student.gsu.edu
Received July 09, 2012; Accepted July 25, 2012; Published July 27, 2012
Citation: Sawyer AM, Martinez SK, Warren GL (2012) Impact of Yoga on Low
Back Pain and Function: A Systematic Review and Meta-Analysis. J Yoga Phys
Ther 2:120. doi:10.4172/2157-7595.1000120
Copyright: © 2012 Sawyer AM, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
Keywords: Yoga; Low back pain; Meta-analysis
Introduction
It is estimated that 70% of people will experience low back pain at
some point in their lives, and recurrence rates can be as high as 85%
[1,2]. In addition to causing general discomfort, chronic low back
pain may interfere with activities of daily living by reducing mobility,
hindering work duties, and negatively impacting self-care [3]. ese
functional decits can have adverse psychological and emotional
consequences as well [4]. Despite a wide variety of treatment options,
chronic low back pain can be dicult and costly to treat, and 17%
of U.S. adults turn to some form of complementary and alternative
medicine to address their back pain [5-8].
Yoga is form of complementary and alternative medicine that
encompasses a variety of practices, including physical postures (asanas),
breathing exercises (pranayama), and meditation [8]. e popularity
of yoga has increased steadily over the past decade, with roughly 6%
of U.S. adults practicing yoga as of 2007 [8,9]. It is estimated that the
number of current yoga practitioners in the U.S. may be as high as 20
million [10]. Recent research suggests that yoga may relieve back pain
and reduce functional disability associated with back pain [11,12].
However, these studies have demonstrated mixed results, due in part
to inadequate statistical power and variation among studies in the
outcome measures used. e objective of this study was to determine,
using a rigorous systematic review and meta-analysis, the impact of
yoga on pain and disability related to chronic low back disorders.
Methods
Systematic review
We reviewed the research literature to identify studies of the eects
of yoga on pain and functional limitation in patients with chronic
low back pain. Our literature search began April 2011 and continued
through October 2011. Cochrane, PubMed, CINAHL, Embase,
ProQuest Dissertations and eses, Google Scholar, and Clinicaltrials.
gov databases were searched electronically. e search terms used were:
yoga AND back pain. Reference lists from 13 fully-evaluated articles
were also examined for studies not found through online database
searches.
Study inclusion and exclusion criteria
Studies meeting the following criteria were considered for review:
1) study participants reported having pain in the lower back region
lasting at least three months in duration and/or had visited a primary
care provider for treatment of back pain in the 3 to 18 months before
the study, 2) the study contained at least two separate groups of subjects
with chronic low back pain which were randomly assigned either to
a group that practiced yoga or a group that served as a comparison
control, and 3) the study measured pain and/or pain-related functional
outcomes. Studies were excluded for the following reasons: 1) subjects
were less than 18 years old, 2) subjects did not report chronic low back
pain, 3) subjects had serious spinal or neurologic pathology (including
stenosis, tumor, or active infection), 4) subjects were pregnant, and
5) studies had a rating of 4 out of 11 or lower on the PEDro Quality
Assessment Tool [13].
Abstract
An estimated 70% of people will experience low back pain at some point in their lives, and recurrence rates
can be as high as 85%. Recent studies suggest that yoga a widely practiced physical/mental discipline may
relieve back pain and reduce functional disability. The objective of this study was to conduct a systematic review and
meta-analysis of the existing research on the effects of yoga on chronic low back pain and function. Our literature
search began April 2011 and continued through October 2011. Cochrane, PubMed, CINAHL, Embase, ProQuest
Dissertations and Theses, Google Scholar, and Clinicaltrials.gov databases were searched electronically. The search
terms used were: yoga AND back pain. A total of 58 relevant studies were originally identied through the database
searches. Of those, 45 were excluded on the basis of the title and/or review of the abstract. The 13 remaining studies
were fully evaluated via a careful review of the full text. On the basis of the inclusion and exclusion criteria, 6 studies
were excluded, leaving a total of 7 studies to be included in the meta-analyses of the impact of yoga on low back pain
and function. Effect sizes were calculated as the standardized mean difference and meta-analyses were completed
using a random-effects model. Overall, yoga was found to result in a medium, benecial effect on chronic low back
pain [overall effect size (ES) = 0.58, p<0.001], indicating that subjects practicing yoga reported signicantly less pain
than control subjects. Yoga subjects also reported signicantly less functional disability after the intervention (overall
ES = 0.53, p<0.001). Moreover, the improvements in pain and function for yoga subjects remained statistically
signicant 12-24 weeks after the end of the intervention (overall ES = 0.44-0.54, p0.002). In conclusion, yoga
practice can signicantly reduce pain and increase functional ability in chronic low back pain patients.
Citation: Sawyer AM, Martinez SK, Warren GL (2012) Impact of Yoga on Low Back Pain and Function: A Systematic Review and Meta-Analysis. J
Yoga Phys Ther 2:120. doi:10.4172/2157-7595.1000120
Page 2 of 4
Volume 2 • Issue 4 • 1000120
J Yoga Phys Ther
ISSN: 2157-7595 JYPT, an open access journal
Selection of studies
A total of 58 relevant studies were originally identied through
the database searches. Of those, 45 were excluded on the basis of
the title and/or review of the abstract. At this point, 13 studies were
fully evaluated via a careful review of the full text. On the basis of the
inclusion and exclusion criteria, 6 studies were excluded, leaving a total
of 7 studies to be included in the meta-analyses (Table 1) [14-20].
Data extraction
For the meta-analyses, pain and functional outcome data
were extracted from three studies in the forms of means, Standard
Deviations (SD), and samples sizes (n) for both the yoga and control
group [16,18,19]. One study reported means, n, and Standard Errors of
the Mean (SEM), which were converted to SD [14]. ree studies did
not report means or SD, so the mean change score, p values, and n were
extracted [15,17,20].
Meta-analysis
e extracted pain and functional limitation data were converted
to a standard format by calculating the standardized mean dierence,
which will be referred to as an Eect Size (ES) from this point on. Meta-
analyses were run using a random-eects model that accounts for true
interstudy variation in eects as well as random error within each
study [21]. A random-eects model was chosen over the xed-eect
model because of the variation in experimental factors (e.g. type of
control comparison, hours of yoga practiced, how pain and functional
outcomes were measured, study length) used in the seven studies. In
the study with more than one control group (yoga vs. exercise and yoga
vs. self-care book) being evaluated, an ES was calculated for each factor
and was treated as if it originated from an independent study [17].
Meta-analyses were conducted using Comprehensive Meta-
Analysis soware (Version 2.2; Biostat Inc., Englewood, NJ). An
α level of 0.05 was used in all analyses. ES values of 0.2, 0.5, and 0.8
were considered to be small, moderate, and large, respectively [22].
e eect of publication bias on the meta-analyses was addressed by
combining a funnel plot assessment with the Duval and Tweedie’s trim
and ll correction. is is a preferred method for assessing the extent
of publication bias as well as for making a correction to the overall ES
[23].
Results
Description of included studies
In total, six studies were included for meta-analysis of yoga’s eect
on low back pain and seven studies were included for meta-analysis
of yoga’s eect on functional ability as related to low back pain. e
characteristics of those investigations are summarized in Table 1. All
seven studies were published in peer-reviewed journals and used a
randomized control trial design. In two studies the control group took
part in conventional exercise [16,17]; other control groups received
written advice on back care and/or standard medical care (Table 1).
One study included two control groups, one of which participated in
conventional exercise and the other of which received a self-help book
[17]. Six of the studies reported some form of pain outcome measure
[14-18,20], while all seven studies [14-20] included a measure of
functional disability as related to low back pain. ese measures were
ones reported at pre-treatment, immediately post-treatment, and/or at
follow up at 12, 14, and 24 weeks post-treatment. Four studies made
follow-up assessments ranging from 12 to 24 weeks post intervention
[14,15,17,18]. ree of the seven studies [16,19,20] only provided pre-
and post-treatment measures and did not include a follow up. A total
of 403 subjects were used in the seven studies. e median subject
number per study was 58, and subject gender was a mixture of males
and females in all studies. Subject age ranged from 18 to 67 years old,
with the average participant in his/her mid-late 40’s. e duration of
the yoga intervention varied greatly among the studies, ranging from a
daily, one-week intensive course to 24 weeks of twice-weekly practice.
In order to standardize the intervention data, the total number of yoga
Subjects:
total (n);
(n) experimental,
(n) control
Experimental
intervention
Total yoga
(hours)
Control
Intervention
Time of long-
term follow-up
measurements
(if applicable)
Pain
outcome measure
Functional
Disability
outcome
measure
Cox (2010)
[20]
20; 10 yoga, 10
control
12 weeks,
75 min/week
15 Written advice N/A Aberdeen back pain scale RMDQ 24 point
Galantino (2004)
[19]
22; 11 yoga, 11
control
6 weeks,
120 min/week
12 No treatment N/A N/A ODI
Saper (2009)
[15]
30; 15 yoga, 15
control
12 weeks,
75 min/week
15 Educational book,
routine medical
care
14 weeks 0-10 pain scale Modied RMDQ
(23 item)
Sherman (2005)
[17]
101; 36 yoga, 30
book,
35 exercise
12 weeks, 75min/
week
15 1 group self care
book; 1 group
exercise
14 weeks 0-10 “bothersomeness” of
pain scale
RMDQ 24 point
Tekur (2008)
[16]
80; 40 yoga, 40
control
1 week intensive,
2 hours physical
yoga practice/day
14 Conventional
exercise
N/A ODI section 1 ODI
Williams K
(2009) [14]
90; 43 yoga, 47
control
24 weeks,
180 min/week
72 Standard medical
care
24 weeks VAS ODI
Williams KA
(2005) [18]
60; 30 yoga, 30
control
16 weeks, 90min/
week
24 Educational
pamphlets
12 weeks VAS PDI
RMDQ: Roland and Morris Disability Scale Questionnaire; ODI: Oswestry Disability Index; PDI: Pain Disability Index; VAS: Visual Analog Scale
Table 1: Characteristics of the 7 studies examining the effects of yoga on low back pain or functional disability.
Citation: Sawyer AM, Martinez SK, Warren GL (2012) Impact of Yoga on Low Back Pain and Function: A Systematic Review and Meta-Analysis. J
Yoga Phys Ther 2:120. doi:10.4172/2157-7595.1000120
Page 3 of 4
Volume 2 • Issue 4 • 1000120
J Yoga Phys Ther
ISSN: 2157-7595 JYPT, an open access journal
hours was calculated by multiplying the number of hours of yoga per
week by the number of weeks of the intervention (Table 1). Total yoga
hours ranged from 12 to 78 hours, with an average of 24 hours. Five of
the studies scored at least 7 out of 11 on the PEDro scale.
Meta-analysis on pain outcomes
All six studies that included a pain outcome measure exhibited
positive eects of yoga compared to control (Figure 1A). Meta-
analysis of the six studies yielded a statistically signicant and medium
overall ES for pain, indicating that subjects practicing yoga reported
signicantly less pain than control subjects (overall ES = 0.58, p<0.001).
is equates to at least an eighteen point reduction on a 100-point
visual analog scale [24]. ere was no single study that dominated the
overall ES. Publication bias was assessed by examining a funnel plot of
standard error versus study ES. No asymmetry was noted in the plot.
Furthermore, the overall ES remained unchanged aer application
of the Duval and Tweedie’s trim and ll correction. e ratio of true
between-study variance to total variance was found to be nonexistent
for this outcome measure as indicated by equaling zero (p=0.72).
Finally, the reduction in pain for yoga subjects remained statistically
signicant 12-24 weeks aer the end of the intervention. Meta-analysis
of the four studies that included follow-up data yielded a statistically
signicant and medium ES for pain that favored the yoga group (overall
ES = 0.54, p<0.001).
Meta-analysis on functional ability outcomes
Overall, yoga subjects also reported signicantly improved
functional ability as a result of the intervention (overall ES = 0.53,
p<0.001; Figure 1B). is equates approximately to a two or three point
reduction on the Roland Morris Disability Scale or a ten point reduction
on the Oswestry Disability Index [24]. As for the pain outcomes, there
was no single study that dominated the overall ES and no asymmetry
was noted in a funnel plot of standard error versus study ES. e overall
ES was also not aected aer application of the Duval and Tweedie’s
trim and ll correction. e ratio of true between-study variance to
total variance was found to be low to moderate (I²=36%, p=0.15).
Meta-analysis of the four studies that included follow-up data 12-24
weeks aer intervention yielded a statistically signicant and medium
overall ES that favored the yoga group (overall ES = 0.44, p=0.002).
Discussion
e main nding of this study suggests that the practice of yoga
can decrease pain and increase functional ability in patients with
chronic low back pain. Given these ndings, yoga maybe considered
an eective treatment for individuals with chronic low back pain that
are seeking non-surgical intervention. In addition to stretching and
strengthening the muscles of the back and lower extremities through
physical postures, yoga may have the additional benet of reducing
stress through meditation and breathing exercises, contributing to an
overall reduction in symptoms for individuals with low back pain.
ere are several potential limitations of our systematic review
and meta-analysis, as well as some methodological concerns with
the underlying studies themselves. One possible limitation of our
systematic review is publication bias. Publication bias occurs when
published research is systematically unrepresentative of the total
population of studies [21]. Studies with non-signicant and/or negative
ndings are less likely to be published, and this may inate the overall
ES in a meta-analysis that is based largely on published studies. ough
we identied one doctoral dissertation in our systematic review (which
has subsequently been published), the study was not a randomized
controlled trial, and so was not included in our analysis [25]. ere is
no evidence of publication bias occurring in our meta-analyses. ere
was no asymmetry noted in the funnel plot and the overall ESs were
not aected by the Duval and Tweedie’s trim and ll correction. A
second potential limitation of our analysis was the inability to explain
the heterogeneity in the meta-analysis on functional ability outcomes
(I²=36%, p=0.15). Sub-group meta-analyses that examine ES based on
type of control treatment (education or exercise) or total number of
hours of yoga practice may help account for this variance, but given the
small number of studies in our meta-analyses we were unable to probe
the eects of potential moderator variables.
Several other experimental factors may help explain the between-
study variation in study ES. ough all seven studies used yoga
postures as the intervention, there was some variability among studies
in the postures that were utilized. Of the seven studies included in this
analysis, six provided either written or pictorial descriptions of the
yoga postures used in the intervention [14-19]. Two studies excluded
backward-bending postures [14,18], while the other ve included
these exercises [15-17,19,20]. It is also unclear how many repetitions
of each posture were performed and/or the length of time spent in a
posture. ese are all variables that may impact the outcome measures
of pain and function. Another source of variability among studies was
the instruction of the yoga intervention. In some cases one instructor
taught all of the yoga classes [17,19], while in other studies there were
multiple instructors [14-16,18,20]. ough all classes were taught by
certied yoga instructors, they represented a variety of dierent yoga
traditions (including Iyengar, viniyoga, and general Hatha yoga) and
varied in terms of their teaching background and experience. is
introduces an additional source of variance and makes it more dicult
to exactly replicate the yoga interventions.
Figure 1: Forest plot of effect sizes from studies that assessed the effect
of yoga on low back pain (A) or functional ability related to low back pain
(B). A square represents the effect size for a given study with the size of the
square being proportional to the weighting of that study in the meta-analysis.
A horizontal line indicates the 95% condence interval (CI) for an effect.
Studies are arranged from the lowest to highest effect size. The diamond
at the bottom represents the overall effect size calculated using a random-
effects model. The width of the diamond represents the 95% CI for the overall
effect size.
Citation: Sawyer AM, Martinez SK, Warren GL (2012) Impact of Yoga on Low Back Pain and Function: A Systematic Review and Meta-Analysis. J
Yoga Phys Ther 2:120. doi:10.4172/2157-7595.1000120
Page 4 of 4
Volume 2 • Issue 4 • 1000120
J Yoga Phys Ther
ISSN: 2157-7595 JYPT, an open access journal
Methodological issues within the studies themselves are also a
potential limitation of this analysis. None of the seven included studies
blinded the subjects and therapists. According to PEDro criteria,
subjects and therapists are considered to be “blind” only if they are
unable to distinguish between the treatments applied to dierent
groups [13]. However, given that the therapists that administered the
intervention are yoga teachers and are employing yoga postures as the
intervention, it would be virtually impossible to satisfy these criteria
in studies of this nature. Lack of allocation concealment increases the
source of bias in three of the studies [18-20]. Another concern is the
low completion rate for these studies. Only two of the seven studies
collected complete data from more than 85% of the subjects that were
initially allocated to groups [16,17]. Given that initial sample sizes were
small (thirty or fewer participants) for three of these studies [15,19,20],
a high drop-out rate further increases the risk of bias.
is study provides justication for future research. Future
research studies would benet from clearly described allocation
concealment and blinding procedures, as well as larger sample sizes
and higher completion rates. It may also be helpful to identify a clear
set of yoga postures, including specic variations and modications, to
form the basis of a replicable low back care protocol. is would help
ensure that yoga interventions are taught more uniformly regardless
of the specic yoga tradition and background of the instructor. Yoga
may aect participants through both physical and mental means, and
current research does not demonstrate how these may intertwine to
aect low back pain. Only two studies in the current analysis included
range of motion measurements [16,18], and the inclusion of this and
other objective measures in future studies may help determine the
mechanism(s) by which yoga decreases pain and increases function.
It is also unclear how cost-eective yoga may be as compared to other
forms of conservative treatment.
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... golf), or weight loading at the end of a range-ofmotion (e.g. weightlifting) are greater concerned with damage to the lower back (Sawyer et al;2012) [6] Running and jogging are excellent forms of aerobic exercise and can become an enjoyable part of one's daily routine. However, running involves repetitive jarring of spine and can worsen a current or emerging back problem. ...
... golf), or weight loading at the end of a range-ofmotion (e.g. weightlifting) are greater concerned with damage to the lower back (Sawyer et al;2012) [6] Running and jogging are excellent forms of aerobic exercise and can become an enjoyable part of one's daily routine. However, running involves repetitive jarring of spine and can worsen a current or emerging back problem. ...
Research
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Sports injuries are injuries occur to sportsperson participating in sporting events. In many cases,
... The population under research is the adult population with preexisting condition of neck or back pain for minimum 3 months preceding intervention, comparing yoga group with other treatment group. Studies were excluded if the pain of spine (back or neck) was not the primary outcome, that is, [24] or the study was related to research of other health condition than back or neck pathology, that is, [25,26] if the study was not related to Iyengar yoga method that is, [27][28][29][30] or were not pertaining to the RCT study design that is, [31][32][33][34] Nevertheless, one study [37] with little sample size and pertaining to RCT pilot design was not excluded in the analyses since it was the first phase of the best presented RCT of the current review. [38] Figure 1 presents the details of selection of studies. ...
Article
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Considerable amount of money spent in health care is used for treatments of lifestyle related, chronic health conditions, which come from behaviors that contribute to morbidity and mortality of the population. Back and neck pain are two of the most common musculoskeletal problems in modern society that have significant cost in health care. Yoga, as a branch of complementary alternative medicine, has emerged and is showing to be an effective treatment against nonspecific spinal pain. Recent studies have shown positive outcome of yoga in general on reducing pain and functional disability of the spine. The objective of this study is to conduct a systematic review of the existing research within Iyengar yoga method and its effectiveness on relieving back and neck pain (defined as spinal pain). Database research form the following sources (Cochrane library, NCBI PubMed, the Clinical Trial Registry of the Indian Council of Medical Research, Google Scholar, EMBASE, CINAHL, and PsychINFO) demonstrated inclusion and exclusion criteria that selected only Iyengar yoga interventions, which in turn, identified six randomized control trials dedicated to compare the effectiveness of yoga for back and neck pain versus other care. The difference between the groups on the postintervention pain or functional disability intensity assessment was, in all six studies, favoring the yoga group, which projected a decrease in back and neck pain. Overall six studies with 570 patients showed, that Iyengar yoga is an effective means for both back and neck pain in comparison to control groups. This systematic review found strong evidence for short-term effectiveness, but little evidence for long-term effectiveness of yoga for chronic spine pain in the patient-centered outcomes.
... Peer-reviewed, meta-analyses of yoga for musculoskeletal problems suggest that yoga is helpful for chronic pain and low back problems in younger adult population [14][15][16]; however, concerns of feasibility and safety remain when attempting to translate these studies to the older adult population. A literature review of yoga for arthritis supports its efficacy in reducing disease symptoms (tender/swollen joints, pain) and disability and improving self-efficacy and mental health [17]. ...
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Background: Osteoarthritis (OA) is a common problem in older women that is associated with pain and disabilities. Although yoga is recommended as an exercise intervention to manage arthritis, there is limited evidence documenting its effectiveness, with little known about its long term benefits. This study's aims were to assess the feasibility and potential efficacy of a Hatha yoga exercise program in managing OA-related symptoms in older women with knee OA. Methods: Eligible participants (N=36; mean age 72 years) were randomly assigned to 8-week yoga program involving group and home-based sessions or wait-list control. The yoga intervention program was developed by a group of yoga experts (N=5). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score that measures knee OA pain, stiffness, and function at 8 weeks. The secondary outcomes, physical function of the lower extremities, body mass index (BMI), quality of sleep (QOS), and quality of life (QOL), were measured using weight, height, the short physical performance battery (SPPB), the Pittsburgh Sleep Quality Index (PSQI), the Cantril Self-Anchoring Ladder, and the SF12v2 Health Survey. Data were collected at baseline, 4 weeks and 8 weeks, and 20 weeks. Results: The recruitment target was met, with study retention at 95%. Based on ANCOVAs, participants in the treatment group exhibited significantly greater improvement in WOMAC pain (adjusted means [SE]) (8.3 [.67], 5.8 [.67]; p=.01), stiffness (4.7 [.28], 3.4 [.28]; p=.002) and SPPB (repeated chair stands) (2.0 [.23], 2.8 [.23]; p=.03) at 8 weeks. Significant treatment and time effects were seen in WOMAC pain (7.0 [.46], 5.4 [.54]; p=.03), function (24.5 [1.8], 19.9 [1.6]; p=.01) and total scores (35.4 [2.3], 28.6 [2.1]; p=.01) from 4 to 20 weeks. Sleep disturbance was improved but the PSQI total score declined significantly at 20 weeks. Changes in BMI and QOL were not significant. No yoga related adverse events were observed. Conclusions: A weekly yoga program with home practice is feasible, acceptable, and safe for older women with knee OA, and shows therapeutic benefits. Trial registration: ClinicalTrials.gov: NCT01832155.
Article
Puntos para una lectura rápida •Aunque es posible que en la lumbalgia mecánica se requiera fisioterapia, manipulación y/o medicación, el elemento central es el ejercicio. •El movimiento de inclinación hacia delante forma parte de la gran mayoría de las acciones que se realizan a lo largo del día. •En el movimiento de recuperación de la postura erecta tras la inclinación hacia delante, la región lumbar funciona como una palanca de 3.er grado. •La lumbalgia inespecífica se produce en estas dos situaciones que ocupan toda la vida: el mantenimiento de la postura y el movimiento. •El ejercicio es útil en la lumbalgia crónica para reducir el dolor, aumentar la funcionalidad y acelerar la vuelta a las actividades normales diarias y al trabajo. •En el movimiento de todo el organismo actúan todos los músculos, bien de forma estática o bien dinámica. •La práctica de cualquier tipo de ejercicio aeróbico puede servir para mantener una buena salud de la región lumbar en personas con posturas ortostáticas normales. •El método pilates es útil en la lumbalgia crónica, pero en la misma medida que cualquier otro programa que se articule con ejercicios de la región lumbar. •A partir de las dos primeras semanas del comienzo de la lumbalgia, se puede iniciar un programa de ejercicios terapéuticos que trabajen la flexión, extensión, flexión lateral y rotación de la región lumbar. •En la hernia de disco se pueden hacer ejercicios isométricos de la musculatura abdominal porque no producen flexión de la región lumbar.
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Meta-analysis collects and synthesizes results from individual studies to estimate an overall effect size. If published studies are chosen, say through a literature review, then an inherent selection bias may arise, because, for example, studies may tend to be published more readily if they are statistically significant, or deemed to be more “interesting” in terms of the impact of their outcomes. We develop a simple rank-based data augmentation technique, formalizing the use of funnel plots, to estimate and adjust for the numbers and outcomes of missing studies. Several nonparametric estimators are proposed for the number of missing studies, and their properties are developed analytically and through simulations. We apply the method to simulated and epidemiological datasets and show that it is both effective and consistent with other criteria in the literature.
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It has been suggested that yoga has a positive effect on low back pain and function. The objective of this systematic review was to assess the effectiveness of yoga as a treatment option for low back pain. Seven databases were searched from their inception to March 2011. Randomized clinical trials were considered if they investigated yoga in patients with low back pain and if they assessed pain as an outcome measure. The selection of studies, data extraction and validation were performed independently by two reviewers. Seven randomized controlled clinical trials (RCTs) met the inclusion criteria. Their methodological quality ranged between 2 and 4 on the Jadad scale. Five RCTs suggested that yoga leads to a significantly greater reduction in low back pain than usual care, education or conventional therapeutic exercises. Two RCTs showed no between-group differences. It is concluded that yoga has the potential to alleviate low back pain. However, any definitive claims should be treated with caution.
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To conduct a pilot trial of yoga for the treatment of chronic low back pain (LBP) to inform the feasibility and practicality of conducting a full-scale trial in the UK; and to assess the efficacy of yoga for the treatment of chronic low back pain. A pragmatic randomised controlled trial was undertaken comparing yoga to usual care. Twenty participants who had presented to their GP with chronic low back pain in the previous 18 months were recruited via GP records from one practice in York, UK. Twenty patients were randomised to either 12 weekly 75-min sessions of specialised yoga plus written advice, or usual care plus written advice. Allocation was 50/50. Recruitment rate, levels of intervention attendance, and loss to follow-up were the main non-clinical outcomes. Change as measured by the Roland and Morris disability questionnaire was the primary clinical outcome. Changes in the Aberdeen back pain scale, SF-12, EQ-5D, and pain self-efficacy were secondary clinical outcomes. Data were collected via postal questionnaire at baseline, 4 weeks, and 12 weeks follow-up. Of the 286 patients identified from the GP database, 52 (18%) consented and returned the eligibility questionnaire, out of these 20 (6.9%) were eligible and randomised. The total percentage of patients randomised from the GP practice population was 0.28%. Ten patients were randomised to yoga, receiving an average of 1.7 sessions (range 0-5), and 10 were randomised to usual care. At 12 weeks follow-up data was received from 60% of patients in the yoga group and 90% of patients in the usual care group (75% overall). No significant differences were seen between groups in clinical outcomes apart from on the Aberdeen back pain scale at four weeks follow-up where the yoga group reported significantly less pain. This pilot study provided useful data and information to inform the design and development of a full-scale trial of yoga for CLBP in the UK. A key finding is the calculation of GP practice total list size required for patient recruitment in a full-scale trial, and the need to implement methods to increase class attendance.
Article
Background and Purpose. Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions. Method. In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]). Results. The kappa value for each of the 11 items ranged from .36 to .80 for individual assessors and from .50 to .79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was .56 (95% confidence interval=.47–.65) for ratings by individuals, and the ICC for consensus ratings was .68 (95% confidence interval=.57–.76). Discussion and Conclusion. The reliability of ratings of PEDro scale items varied from “fair” to “substantial,” and the reliability of the total PEDro score was “fair” to “good.”
Article
IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points
Chapter
IntroductionHistory and DevelopmentModelling Publication BiasAdjusting for Publication BiasFormal Tests for Publication BiasApplying ‘Trim and Fill’ in PracticeLimitations and Future ResearchExamplesConclusions References
Article
To compare clinical and demographic characteristics of individuals self-selecting yoga or physical therapy (PT) for treatment of chronic low back pain (cLBP) and to examine predictors of short-term pain and functional outcomes. Descriptive, longitudinal study. A hospital-based clinic that offers modified integral yoga classes for cLBP and 2 outpatient PT clinics that offer exercise-based PT. Adults (n=53) with cLBP≥12 weeks: yoga (n=27), PT (n=26). Yoga participants attended a 6-week, once weekly, 2-hour yoga class. PT participants underwent twice weekly, 1-hour individualized PT. Data were collected at baseline and at 6 weeks. Groups were compared by using χ2 and independent samples t-tests. Hierarchical linear regression was used to predict treatment outcomes. Disability (Roland Morris Disability Questionnaire), health status (Rand Short Form 36 Health Survey 1.0), pain bothersomeness (numerical rating scale), back pain self-efficacy (Back Pain Self-Efficacy Scale), and treatment satisfaction. At baseline, yoga participants were significantly less disabled (P=.013), had higher health status (P=.023), greater pain self-efficacy (P=.012), and less average pain bothersomeness (P=.001) compared with PT participants. At 6 weeks, when controlling for baseline group differences, greater pain self-efficacy was the strongest predictor for reduced pain and higher function for the entire sample. A significant group interaction by baseline pain self-efficacy predicted disability at 6 weeks. PT participants with low pain self-efficacy reported significantly greater disability than those with high pain self-efficacy. Yoga participants with low and high pain self-efficacy had similar disability outcomes. These findings strengthen evidence that self-efficacy is associated with cLBP outcomes, especially in individuals self-selecting PT. Further research to evaluate outcomes after yoga and PT in participants with low pain self-efficacy is needed.