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    Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial

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    Authors
    Saper, Robert B.
    Lemaster, Chelsey
    Delitto, Anthony
    Sherman, Karen J.
    Herman, Patricia M.
    Sadikova, Ekaterina
    Stevans, Joel
    Keosaian, Julia E.
    Cerrada, Christian J.
    Femia, Alexandra L.
    Roseen, Eric J.
    Gardiner, Paula
    Gergen Barnett, Katherine
    Faulkner, Carol
    Weinberg, Janice
    Show allShow less
    UMass Chan Affiliations
    Department of Family Medicine and Community Health
    Center for Integrated Primary Care
    Document Type
    Journal Article
    Publication Date
    2017-07-18
    Keywords
    Alternative and Complementary Medicine
    Behavioral Medicine
    Health Psychology
    Integrative Medicine
    Movement and Mind-Body Therapies
    Pain Management
    Physical Therapy
    Public Health Education and Promotion
    
    Metadata
    Show full item record
    Link to Full Text
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392183/
    Abstract
    Background: Yoga is effective for mild to moderate chronic low back pain (cLBP), but its comparative effectiveness with physical therapy (PT) is unknown. Moreover, little is known about yoga's effectiveness in underserved patients with more severe functional disability and pain. Objective: To determine whether yoga is noninferior to PT for cLBP. Design: 12-week, single-blind, 3-group randomized noninferiority trial and subsequent 40-week maintenance phase. (ClinicalTrials.gov: NCT01343927). Setting: Academic safety-net hospital and 7 affiliated community health centers. Participants: 320 predominantly low-income, racially diverse adults with nonspecific cLBP. Intervention: Participants received 12 weekly yoga classes, 15 PT visits, or an educational book and newsletters. The maintenance phase compared yoga drop-in classes versus home practice and PT booster sessions versus home practice. Measurements: Primary outcomes were back-related function, measured by the Roland Morris Disability Questionnaire (RMDQ), and pain, measured by an 11-point scale, at 12 weeks. Prespecified noninferiority margins were 1.5 (RMDQ) and 1.0 (pain). Secondary outcomes included pain medication use, global improvement, satisfaction with intervention, and health-related quality of life. Results: One-sided 95% lower confidence limits were 0.83 (RMDQ) and 0.97 (pain), demonstrating noninferiority of yoga to PT. However, yoga was not superior to education for either outcome. Yoga and PT were similar for most secondary outcomes. Yoga and PT participants were 21 and 22 percentage points less likely, respectively, than education participants to use pain medication at 12 weeks. Improvements in yoga and PT groups were maintained at 1 year with no differences between maintenance strategies. Frequency of adverse events, mostly mild self-limited joint and back pain, did not differ between the yoga and PT groups. Limitations: Participants were not blinded to treatment assignment. The PT group had disproportionate loss to follow-up. Conclusion: A manualized yoga program for nonspecific cLBP was noninferior to PT for function and pain. Primary Funding Source: National Center for Complementary and Integrative Health of the National Institutes of Health.
    Source

    Ann Intern Med. 2017 Jul 18;167(2):85-94. doi: 10.7326/M16-2579. Epub 2017 Jun 20. Link to article on publisher's site

    DOI
    10.7326/M16-2579
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/26761
    PubMed ID
    28631003
    Notes

    At the time of publication, Paula Gardiner was not yet affiliated with the University of Massachusetts Medical School.

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    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.7326/M16-2579
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