https://immattersacp.org/weekly/archives/2017/06/20/1.htm

Yoga noninferior to physical therapy for treating chronic low back pain, study finds

At 12 weeks, the mean change on a disability questionnaire in the yoga group was noninferior to a physical therapy group, and both groups were less likely than participants in an education-only group to use pain medication after 12 weeks.


Yoga is as effective as physical therapy (PT) for improving pain and function in patients with moderate to severe chronic low back pain, according to a recent randomized controlled trial.

Researchers enrolled 320 adults ages 18 to 64 with nonspecific chronic low back pain who were seen at a university hospital and seven affiliated community health centers that care for low-income people. Most participants were female, nonwhite, non-college graduates, with earnings of $30,000 per year or less.

Participants were randomized to one of three groups: weekly yoga classes for 12 weeks (n=127), 15 physical therapy sessions over the course of 12 weeks (n=129), or an education control involving a self-care book and newsletters (n=64). From week 12 to week 52, intervention participants entered a maintenance phase where they were encouraged to attend more sessions or practice at home.

Primary outcomes were change from baseline to 12 weeks in scores on the modified Roland Morris Disability Questionnaire (RMDQ) and on a pain scale from 0 to 10, with higher scores on both measures indicating worse function or pain. Secondary outcomes included self-reported use of pain medication in the previous week (yes or no).

Results were published online on June 19 by Annals of Internal Medicine.

At 12 weeks, the mean RMDQ change in the yoga group was −3.8 (95% CI, −4.6 to −2.9), which was noninferior to the PT group's mean change of −3.5 (95% CI, −4.5 to −2.6). Pain scores also decreased in the yoga group with a mean within-group change of −1.7 (95% CI, −2.1 to −1.4), which was again noninferior to the PT group (mean within-group change, −2.3; 95% CI, −2.7 to −1.9). Improvements were maintained at one year, and adverse events were uncommon (mostly mild, self-limited joint and back pain).

Neither group had significantly greater changes in RMDQ than the education group at 12 weeks, but 57% of yoga, 56% of PT, and 21% of education participants who were adherent experienced clinically meaningful improvement in RMDQ scores. Yoga and PT participants were 21 and 22 percentage points, respectively, less likely than education participants to use pain medication after 12 weeks of the intervention.

Limitations of the study include the fact that participants were not blinded to the treatments they received and attended a low number of yoga and physical therapy sessions. Indeed, adherence (defined as attending about three-quarters of yoga or PT sessions over 12 weeks) was low: 36% to 44%, an accompanying editorial noted.

Further research could identify crucial barriers to adherence, the authors wrote, but yoga appears to be a viable option for low back pain. “[Y]oga offers some persons tangible benefit without much risk,” they wrote. “In the end, however, it represents one tool among many.”