1 1345 165 HYPERTENSION ANALYSIS OF STRESS REDUCTION USING MINDFULNESS MEDITATION AND YOGA (THE HARMONY STUDY): STUDY PROTOCOL OF A RANDOMISED CONTROL TRIAL. INTRODUCTION: HYPERTENSION (HTN) IS A LEADING RISK FACTOR FOR PREVENTABLE CARDIOVASCULAR DISEASE, WITH OVER ONE IN FIVE ADULTS AFFECTED WORLDWIDE. LIFESTYLE MODIFICATION IS A KEY STRATEGY FOR THE PREVENTION AND TREATMENT OF HTN. STRESS HAS BEEN ASSOCIATED WITH GREATER CARDIOVASCULAR RISK, AND STRESS MANAGEMENT IS A RECOMMENDED INTERVENTION FOR HYPERTENSIVES. STRESS REDUCTION THROUGH RELAXATION THERAPIES HAS BEEN SHOWN TO HAVE AN EFFECT ON HUMAN PHYSIOLOGY, INCLUDING LOWERING BLOOD PRESSURE (BP). HOWEVER, INDIVIDUALISED BEHAVIOURAL INTERVENTIONS ARE RESOURCE INTENSIVE, AND GROUP STRESS MANAGEMENT APPROACHES HAVE NOT BEEN VALIDATED FOR REDUCING HTN. THE HARMONY STUDY IS A PILOT RANDOMISED CONTROLLED TRIAL DESIGNED TO DETERMINE IF MINDFULNESS-BASED STRESS REDUCTION (MBSR), A STANDARDISED GROUP THERAPY, IS AN EFFECTIVE INTERVENTION FOR LOWERING BP IN STAGE 1 UNMEDICATED HYPERTENSIVES. METHODS AND ANALYSIS: MEN AND WOMEN UNMEDICATED FOR HTN WITH MEAN DAYTIME AMBULATORY BLOOD PRESSURE (ABP) >/=135/85 MM HG OR 24 H ABP >/=130/80 MM HG ARE INCLUDED IN THE STUDY. SUBJECTS ARE RANDOMISED TO RECEIVE MBSR IMMEDIATELY OR AFTER A WAIT-LIST CONTROL PERIOD. THE PRIMARY OUTCOME MEASURE IS MEAN AWAKE AND 24 H ABP. THE PRIMARY OBJECTIVE OF THE HARMONY STUDY IS TO COMPARE ABP BETWEEN THE TREATMENT AND WAIT-LIST CONTROL ARM AT THE 12-WEEK PRIMARY ASSESSMENT PERIOD. RESULTS FROM THIS STUDY WILL DETERMINE IF MBSR IS AN EFFECTIVE INTERVENTION FOR LOWERING BP IN EARLY UNMEDICATED HYPERTENSIVES. ETHICS AND DISSEMINATION: THIS RESEARCH PROJECT WAS APPROVED BY THE SUNNYBROOK RESEARCH ETHICS BOARD AND THE UNIVERSITY HEALTH NETWORK RESEARCH ETHICS BOARD (TORONTO, CANADA). PLANNED ANALYSES ARE IN FULL COMPLIANCE WITH THE PRINCIPLES OF THE DECLARATION OF HELSINKI. DATA COLLECTION WILL BE COMPLETED BY EARLY SPRING 2012. PRIMARY AND SECONDARY ANALYSIS WILL COMMENCE IMMEDIATELY AFTER DATA MONITORING IS COMPLETED; DISSEMINATION PLANS INCLUDE PREPARING PUBLICATIONS FOR SUBMISSION DURING THE SUMMER OF 2012. TRIAL REGISTRATION NUMBER: THIS STUDY IS REGISTERED WITH HTTP://CLINICALTRIALS.GOV (NCT00825526).	2012	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
2 2408  32 YOGA AND HEALTHCARE IN THE UNITED KINGDOM. THE EMERGENCE OF YOGA THERAPY IN THE UNITED KINGDOM BEGAN ABOUT 45 YEARS AGO WITH THE EMERGENCE OF YOGA THERAPY ORGANIZATIONS THAT OFFERED BOTH TREATMENT AND TRAINING. THE INTEGRATION OF YOGA INTO THE NATIONAL HEALTH SERVICE (NHS) IS GRADUALLY HAPPENING BECAUSE: (A) YOGA RESEARCH SUPPORTS ITS EFFICACY AS A COST-EFFECTIVE, PREVENTIVE AND COMPLEMENTARY TREATMENT FOR A HOST OF NON-COMMUNICABLE DISEASES; AND (B) THE ESCALATING ECONOMIC BURDEN OF LONG-TERM CONDITIONS IS OVERWHELMING THE NHS. THE NHS IS ACTIVELY DEVELOPING 'SUSTAINABILITY AND TRANSFORMATION PLANS' THAT INCLUDE YOGA. CHIEF AMONG THESE IS 'SOCIAL PRESCRIBING,' WHICH EMPOWERS PATIENTS WITH COMPLEX HEALTH NEEDS THROUGH ACTIVITIES GROUPS. THESE ACTIVITIES REDUCE SEDENTARY HABITS AND SOCIAL ISOLATION, WHILE HELPING PATIENTS TO BE MORE SELF-RELIANT. THE NHS HAS ALLOCATED POUND450 MILLION IN FUNDING TO IMPLEMENT A VARIETY OF PROGRAMS FOR ITS OWN STAFF, IN WHICH STAFF YOGA CLASSES WERE EXPRESSLY MENTIONED. THE YOGA COMMUNITY IS MOBILIZING FORCES AND APPLYING FOR FUNDING TO PILOT RELEVANT NHS STAFF YOGA COURSES THAT CAN SUPPORT THE SERVICE IN ACHIEVING ITS VISION. RESEARCH SHOWS THAT INTEGRATING YOGA THERAPY FOR THE TREATMENT OF LOW BACK PAIN (LBP) INTO THE NHS WOULD RESULT IN SIGNIFICANT COST SAVINGS AS COMPARED WITH USUAL CARE. THE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) GUIDELINES ON LBP AND SCIATICA INCLUDE YOGA AS ONE OF THE RECOMMENDED TREATMENTS FOR THESE CONDITIONS. THREE GROUPS OF YOGA TEACHERS, USING DIFFERENT YOGA PRACTICES, HAVE GAINED TRACTION WITH THE NHS FOR THE APPLICATION OF YOGA THERAPY TO LBP. MANY REGIONAL HOSPITALS IN ENGLAND HAVE YOGA CLASSES. THE NHS CHOICES WEBSITE, WHICH CONVEYS INFORMATION TO THE PUBLIC REGARDING TREATMENT OPTIONS, HAS A PAGE DEDICATED TO THE HEALTH BENEFITS OF YOGA. SEVERAL INSTITUTIONS OFFER COMPREHENSIVE TRAINING PROGRAMS IN YOGA THERAPY AND YOGA THERAPY IS RECOGNIZED AS AN OFFICIAL PROFESSION. THE YOGA IN HEALTHCARE ALLIANCE HAS BEEN ESTABLISHED TO HELP INTEGRATE YOGA THERAPY INTO THE NHS. THIS CONSISTS OF PARLIAMENTARIANS, LEADERS IN THE NHS, YOGA RESEARCHERS, HEALTH PROFESSIONALS, AND REPRESENTATIVES FROM LEADING YOGA ORGANIZATIONS.	2017	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
3  308  35 AN EVIDENCE MAP OF YOGA FOR LOW BACK PAIN. OBJECTIVE: YOGA IS BEING INCREASINGLY STUDIED AS A TREATMENT STRATEGY FOR A VARIETY OF DIFFERENT CLINICAL CONDITIONS, INCLUDING LOW BACK PAIN (LBP). WE SET OUT TO CONDUCT AN EVIDENCE MAP OF YOGA FOR THE TREATMENT, PREVENTION AND RECURRENCE OF ACUTE OR CHRONIC LOW BACK PAIN (CLBP). METHODS: WE SEARCHED MEDLINE, COCHRANE DATABASE OF SYSTEMATIC REVIEWS, EMBASE, ALLIED AND COMPLEMENTARY MEDICINE DATABASE AND CLINICALTRIALS.GOV FOR RANDOMIZED CONTROLLED TRIALS (RCT), SYSTEMATIC REVIEWS OR PLANNED STUDIES ON THE TREATMENT OR PREVENTION OF ACUTE BACK PAIN OR CLBP. TWO INDEPENDENT REVIEWERS SCREENED PAPERS FOR INCLUSION, EXTRACTED DATA AND ASSESSED THE QUALITY OF INCLUDED STUDIES. RESULTS: THREE ELIGIBLE SYSTEMATIC REVIEWS WERE IDENTIFIED THAT INCLUDED 10 RCTS (N=956) THAT EVALUATED YOGA FOR NON-SPECIFIC CLBP. WE DID NOT IDENTIFY ADDITIONAL RCTS BEYOND THOSE INCLUDED IN THE SYSTEMATIC REVIEWS. OUR SEARCH OF CLINICALTRIALS.GOV IDENTIFIED ONE SMALL (N=10) UNPUBLISHED TRIAL AND ONE LARGE (N=320) PLANNED CLINICAL TRIAL. THE MOST RECENT GOOD QUALITY SYSTEMATIC REVIEW INDICATED SIGNIFICANT EFFECTS FOR SHORT- AND LONG-TERM PAIN REDUCTION (N=6 TRIALS; STANDARDIZED MEAN DIFFERENCE [SMD] -0.48; 95% CI, -0.65 TO -0.31; I(2)=0% AND N=5; SMD -0.33; 95% CI, -0.59 TO -0.07; I(2)=48%, RESPECTIVELY). LONG-TERM EFFECTS FOR BACK SPECIFIC DISABILITY WERE ALSO IDENTIFIED (N=5; SMD -0.35; 95% CI, -0.55 TO -0.15; I(2)=20%). NO STUDIES WERE IDENTIFIED EVALUATING YOGA FOR PREVENTION OR TREATMENT OF ACUTE LBP. CONCLUSION: EVIDENCE SUGGESTS BENEFIT OF YOGA IN MIDLIFE ADULTS WITH NON-SPECIFIC CLBP FOR SHORT- AND LONG-TERM PAIN AND BACK-SPECIFIC DISABILITY, BUT THE EFFECTS OF YOGA FOR HEALTH-RELATED QUALITY OF LIFE, WELL- BEING AND ACUTE LBP ARE UNCERTAIN. WITHOUT ADDITIONAL STUDIES, FURTHER SYSTEMATIC REVIEWS ARE UNLIKELY TO BE INFORMATIVE.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
4 2575  31 YOGA FOR FUNCTIONAL ABILITY, PAIN AND PSYCHOSOCIAL OUTCOMES IN MUSCULOSKELETAL CONDITIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS. OBJECTIVES: MUSCULOSKELETAL CONDITIONS (MSCS) ARE THE LEADING CAUSE OF DISABILITY AND CHRONIC PAIN IN THE DEVELOPED WORLD, IMPACTING BOTH FUNCTIONAL ABILITY AND PSYCHOSOCIAL HEALTH. THE CURRENT REVIEW INVESTIGATES THE EFFECTIVENESS OF YOGA ON PRIMARY OUTCOMES OF FUNCTIONAL ABILITY, PAIN AND PSYCHOSOCIAL OUTCOMES ACROSS A RANGE OF MSCS. METHODS: A COMPREHENSIVE SEARCH OF 20 DATABASES WAS CONDUCTED FOR FULL-TEXT, RANDOMIZED CONTROLLED TRIALS OF YOGA IN CLINICALLY DIAGNOSED MSCS. RESULT: SEVENTEEN STUDIES MET THE INCLUSION CRITERIA, INVOLVING 1,626 PARTICIPANTS WITH LOW BACK PAIN (LBP), OSTEOARTHRITIS (OA), RHEUMATOID ARTHRITIS (RA), KYPHOSIS OR FIBROMYALGIA. STUDIES WERE QUALITY RATED, AND ANALYSED FOR THE EFFECT OF YOGA ON PRIMARY OUTCOMES, IMMEDIATELY POST-INTERVENTION. TWELVE STUDIES WERE RATED AS GOOD QUALITY. YOGA INTERVENTIONS RESULTED IN A CLINICALLY SIGNIFICANT IMPROVEMENT IN FUNCTIONAL OUTCOMES IN MILD-TO-MODERATE LBP AND FIBROMYALGIA, AND SHOWED A TREND TO IMPROVEMENT IN KYPHOSIS. YOGA SIGNIFICANTLY IMPROVED PAIN IN OA, RA AND MILD-TO-SEVERE LBP. PSYCHOSOCIAL OUTCOMES WERE SIGNIFICANTLY IMPROVED IN MILD-TO-MODERATE LBP AND OA. META-ANALYSIS OF GOOD-QUALITY STUDIES SHOWED A MODERATE TREATMENT EFFECT FOR YOGA OF -0.64 (95%CI -0.89 TO -0.39) FOR FUNCTIONAL OUTCOMES AND -0.61 (95%CI -0.97 TO -0.26) FOR PAIN OUTCOMES. CONCLUSIONS: EVIDENCE SUGGESTS THAT YOGA IS AN ACCEPTABLE AND SAFE INTERVENTION, WHICH MAY RESULT IN CLINICALLY RELEVANT IMPROVEMENTS IN PAIN AND FUNCTIONAL OUTCOMES ASSOCIATED WITH A RANGE OF MSCS. FUTURE ANALYSIS OF OUTCOMES WHICH TAKE INTO ACCOUNT THE AMOUNT OF YOGA RECEIVED BY PARTICIPANTS MAY PROVIDE INSIGHT INTO ANY PUTATIVE DURATION OR DOSAGE EFFECTS OF YOGA INTERVENTIONS FOR MSCS.	2013	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
5 2433  29 YOGA AND PILATES IN THE MANAGEMENT OF LOW BACK PAIN. MANY INTERVENTIONS FOR THE MANAGEMENT OF LOW BACK PAIN EXIST, HOWEVER MOST HAVE MODEST EFFICACY AT BEST, AND THERE ARE FEW WITH CLEARLY DEMONSTRATED BENEFITS ONCE PAIN BECOMES CHRONIC. THERAPEUTIC EXERCISE, ON THE OTHER HAND, DOES APPEAR TO HAVE SIGNIFICANT BENEFITS FOR MANAGING PATIENTS WITH CHRONIC LOW BACK PAIN (CLBP) IN TERMS OF DECREASING PAIN AND IMPROVING FUNCTION. IN ADDITION, BECAUSE CHRONIC PAIN IS COMPLEX AND DOES NOT FIT A SIMPLE MODEL, THERE HAVE ALSO BEEN NUMEROUS TRIALS INVESTIGATING AND DEMONSTRATING THE EFFICACY OF MULTIDISCIPLINARY PAIN PROGRAMS FOR CLBP. IT FOLLOWS THAT INTERVENTIONS THAT TREAT MORE THAN ONE ASPECT OF LBP WOULD HAVE SIGNIFICANT BENEFITS FOR THIS PATIENT POPULATION. YOGA AND PILATES WHICH HAVE, BOTH BEEN GAINING IN POPULARITY OVER THE LAST DECADE ARE TWO MIND-BODY EXERCISE INTERVENTIONS THAT ADDRESS BOTH THE PHYSICAL AND MENTAL ASPECTS OF PAIN WITH CORE STRENGTHENING, FLEXIBILITY, AND RELAXATION. THERE HAS BEEN A SLOW EVOLUTION OF THESE NONTRADITIONAL EXERCISE REGIMENS INTO TREATMENT PARADIGMS FOR LBP, ALTHOUGH FEW STUDIES EXAMINING THEIR EFFECTS HAVE BEEN PUBLISHED. THE FOLLOWING ARTICLE WILL FOCUS ON THE SCIENTIFIC AND THEORETICAL BASIS OF USING YOGA AND PILATES IN THE MANAGEMENT OF CLBP.	2008	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
6  162  38 A RANDOMISED CONTROLLED TRIAL OF YOGA FOR THE TREATMENT OF CHRONIC LOW BACK PAIN: RESULTS OF A PILOT STUDY. OBJECTIVE: 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. DESIGN: A PRAGMATIC RANDOMISED CONTROLLED TRIAL WAS UNDERTAKEN COMPARING YOGA TO USUAL CARE. PARTICIPANTS: 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. INTERVENTIONS: 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. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSION: 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.	2010	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
7 1794  40 PRENATAL YOGA FOR BACK PAIN, BALANCE, AND MATERNAL WELLNESS: A RANDOMIZED, CONTROLLED PILOT STUDY. BACKGROUND: THE OBJECTIVE WAS TO ASSESS THE FEASIBILITY OF A PRENATAL YOGA RANDOMIZED CONTROLLED TRIAL (RCT) FOR GESTATIONAL LOW BACK PAIN (LBP), MOBILITY, AND MATERNAL WELL-BEING. METHODS: IN THIS PILOT, WOMEN AGED 18 TO 39 YEARS WITH UNCOMPLICATED PREGNANCIES AT 12 TO 26 WEEKS WERE RANDOMIZED, STRATIFIED BY PRESENCE OF LBP, TO ATTEND A WEEKLY YOGA CLASS OR A TIME-MATCHED EDUCATIONAL SUPPORT GROUP FOR 12 WEEKS. SAMPLE SIZE WAS BASED ON ANTICIPATED ENROLLMENT OF 2 SUBJECTS PER MONTH. PRIMARY OUTCOMES WERE MEASURES OF FEASIBILITY AND ACCEPTABILITY. SECONDARY OUTCOMES INCLUDED LBP DISABILITY, PREGNANCY SYMPTOM BURDEN, CHILDBIRTH SELF-EFFICACY, INSTRUMENTED GAIT, BALANCE, AND FALLS AT BASELINE, EVERY 4 WEEKS, AND 6 WEEKS POSTPARTUM. RESULTS: FROM APRIL 2015 TO DECEMBER 2015, 168 WOMEN WERE CONTACTED AND 115 (68%) WERE ELIGIBLE. TWENTY WOMEN ENROLLED (N = 11 YOGA; N = 9 CONTROL; MEAN GESTATIONAL AGE 20.2 WEEKS). RETENTION AT 12 WEEKS WAS 81% IN YOGA AND 77% IN CONTROL. THERE WERE NO YOGA-RELATED ADVERSE EVENTS. EXPLORATORY ANALYSES SHOW NO DIFFERENCES IN BACK PAIN DISABILITY BETWEEN GROUPS. SIGNIFICANT GROUPS EFFECTS WERE FOUND ON BIOMECHANICAL ASSESSMENTS, INCLUDING PERCENTAGE CHANGE IN GAIT SPEED (F = 4.4, P = .04), DOUBLE SUPPORT TIME (F = 23.6, P < .01), INSTRUMENTED TIMED-UP-AND-GO (F = 8.6, P < .01), AND TURN TIME (F = 5.7, P = .02) SUGGESTING CLINICALLY RELEVANT IMPROVEMENTS WITH YOGA. PREGNANCY SYMPTOM INVENTORY (PSI) SCORES IMPROVED (13.1 POINT DIFFERENCE, 95% CONFIDENCE INTERVAL, 5.1-21.1) AT 12 WEEKS IN YOGA COMPARED TO CONTROL, ADJUSTED FOR BASELINE GESTATIONAL AGE. CONCLUSION: CONDUCTING AN RCT OF PRENATAL YOGA TO IMPROVE GESTATIONAL LBP AND MATERNAL WELL-BEING IS FEASIBLE AND SAFE. WHILE NO DIFFERENCES IN BACK PAIN WERE OBSERVED, BIOMECHANICAL MEASURES WERE SENSITIVE ASSESSMENTS FOR EVALUATING GESTATIONAL LBP-RELATED MOBILITY IMPAIRMENT AND SHOWED GROUP DIFFERENCES. ADDITIONALLY, THE PSI SHOWED SIGNIFICANT DIFFERENCES IN SYMPTOM BURDEN OVER 12 WEEKS, SUPPORTING THE ONGOING CLAIMS THAT YOGA IMPROVES A PREGNANT WOMAN'S OVERALL WELL-BEING.	2019	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
8 2638  45 YOGA FOR VETERANS WITH CHRONIC LOW BACK PAIN: DESIGN AND METHODS OF A RANDOMIZED CLINICAL TRIAL. CHRONIC LOW BACK PAIN (CLBP) AFFLICTS MILLIONS OF PEOPLE WORLDWIDE, WITH PARTICULARLY HIGH PREVALENCE IN MILITARY VETERANS. MANY TREATMENT OPTIONS EXIST FOR CLBP, BUT MOST HAVE LIMITED EFFECTIVENESS AND SOME HAVE SIGNIFICANT SIDE EFFECTS. IN GENERAL POPULATIONS WITH CLBP, YOGA HAS BEEN SHOWN TO IMPROVE HEALTH OUTCOMES WITH FEW SIDE EFFECTS. HOWEVER, YOGA HAS NOT BEEN ADEQUATELY STUDIED IN MILITARY VETERAN POPULATIONS. IN THE CURRENT PAPER WE WILL DESCRIBE THE DESIGN AND METHODS OF A RANDOMIZED CLINICAL TRIAL AIMED AT EXAMINING WHETHER YOGA CAN EFFECTIVELY REDUCE DISABILITY AND PAIN IN US MILITARY VETERANS WITH CLBP. A TOTAL OF 144 US MILITARY VETERANS WITH CLBP WILL BE RANDOMIZED TO EITHER YOGA OR A DELAYED TREATMENT COMPARISON GROUP. THE YOGA INTERVENTION WILL CONSIST OF 2X WEEKLY YOGA CLASSES FOR 12WEEKS, COMPLEMENTED BY REGULAR HOME PRACTICE GUIDED BY A MANUAL. THE DELAYED TREATMENT GROUP WILL RECEIVE THE SAME INTERVENTION AFTER SIX MONTHS. THE PRIMARY OUTCOME IS THE CHANGE IN BACK PAIN-RELATED DISABILITY MEASURED WITH THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE AT BASELINE AND 12-WEEKS. SECONDARY OUTCOMES INCLUDE PAIN INTENSITY, PAIN INTERFERENCE, DEPRESSION, ANXIETY, FATIGUE/ENERGY, QUALITY OF LIFE, SELF-EFFICACY, SLEEP QUALITY, AND MEDICATION USAGE. ADDITIONAL PROCESS AND/OR MEDIATIONAL FACTORS WILL BE MEASURED TO EXAMINE DOSE RESPONSE AND EFFECT MECHANISMS. ASSESSMENTS WILL BE CONDUCTED AT BASELINE, 6-WEEKS, 12-WEEKS, AND 6-MONTHS. ALL RANDOMIZED PARTICIPANTS WILL BE INCLUDED IN INTENTION-TO-TREAT ANALYSES. STUDY RESULTS WILL PROVIDE MUCH NEEDED EVIDENCE ON THE FEASIBILITY AND EFFECTIVENESS OF YOGA AS A THERAPEUTIC MODALITY FOR THE TREATMENT OF CLBP IN US MILITARY VETERANS.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
9 2831  46 YOGA VS. PHYSICAL THERAPY VS. EDUCATION FOR CHRONIC LOW BACK PAIN IN PREDOMINANTLY MINORITY POPULATIONS: STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL. BACKGROUND: CHRONIC LOW BACK PAIN CAUSES SUBSTANTIAL MORBIDITY AND COST TO SOCIETY WHILE DISPROPORTIONATELY IMPACTING LOW-INCOME AND MINORITY ADULTS. SEVERAL RANDOMIZED CONTROLLED TRIALS SHOW YOGA IS AN EFFECTIVE TREATMENT. HOWEVER, THE COMPARATIVE EFFECTIVENESS OF YOGA AND PHYSICAL THERAPY, A COMMON MAINSTREAM TREATMENT FOR CHRONIC LOW BACK PAIN, IS UNKNOWN. METHODS/DESIGN: THIS IS A RANDOMIZED CONTROLLED TRIAL FOR 320 PREDOMINANTLY LOW-INCOME MINORITY ADULTS WITH CHRONIC LOW BACK PAIN, COMPARING YOGA, PHYSICAL THERAPY, AND EDUCATION. INCLUSION CRITERIA ARE ADULTS 18-64 YEARS OLD WITH NON-SPECIFIC LOW BACK PAIN LASTING >/= 12 WEEKS AND A SELF-REPORTED AVERAGE PAIN INTENSITY OF >/= 4 ON A 0-10 SCALE. RECRUITMENT TAKES PLACE AT BOSTON MEDICAL CENTER, AN URBAN ACADEMIC SAFETY-NET HOSPITAL AND SEVEN FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS LOCATED IN DIVERSE NEIGHBORHOODS. THE 52-WEEK STUDY HAS AN INITIAL 12-WEEK TREATMENT PHASE WHERE PARTICIPANTS ARE RANDOMIZED IN A 2:2:1 RATIO INTO I) A STANDARDIZED WEEKLY HATHA YOGA CLASS SUPPLEMENTED BY HOME PRACTICE; II) A STANDARDIZED EVIDENCE-BASED EXERCISE THERAPY PROTOCOL ADAPTED FROM THE TREATMENT BASED CLASSIFICATION METHOD, INDIVIDUALLY DELIVERED BY A PHYSICAL THERAPIST AND SUPPLEMENTED BY HOME PRACTICE; AND III) EDUCATION DELIVERED THROUGH A SELF-CARE BOOK. CO-PRIMARY OUTCOME MEASURES ARE 12-WEEK PAIN INTENSITY MEASURED ON AN 11-POINT NUMERICAL RATING SCALE AND BACK-SPECIFIC FUNCTION MEASURED USING THE MODIFIED ROLAND MORRIS DISABILITY QUESTIONNAIRE. IN THE SUBSEQUENT 40-WEEK MAINTENANCE PHASE, YOGA PARTICIPANTS ARE RE-RANDOMIZED IN A 1:1 RATIO TO EITHER STRUCTURED MAINTENANCE YOGA CLASSES OR HOME PRACTICE ONLY. PHYSICAL THERAPY PARTICIPANTS ARE SIMILARLY RE-RANDOMIZED TO EITHER FIVE BOOSTER SESSIONS OR HOME PRACTICE ONLY. EDUCATION PARTICIPANTS CONTINUE TO FOLLOW RECOMMENDATIONS OF EDUCATIONAL MATERIALS. WE WILL ALSO ASSESS COST EFFECTIVENESS FROM THE PERSPECTIVES OF THE INDIVIDUAL, INSURERS, AND SOCIETY USING CLAIMS DATABASES, ELECTRONIC MEDICAL RECORDS, SELF-REPORT COST DATA, AND STUDY RECORDS. QUALITATIVE DATA FROM INTERVIEWS WILL ADD SUBJECTIVE DETAIL TO COMPLEMENT QUANTITATIVE DATA. TRIAL REGISTRATION: THIS TRIAL IS REGISTERED IN CLINICALTRIALS.GOV, WITH THE ID NUMBER: NCT01343927.	2014	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
10 2813  19 YOGA TO TREAT NONSPECIFIC LOW BACK PAIN. LOW BACK PAIN IS COMMON AND POSES A CHALLENGE FOR CLINICIANS TO FIND EFFECTIVE TREATMENT TO PREVENT IT FROM BECOMING CHRONIC. CHRONIC LOW BACK PAIN CAN HAVE A SIGNIFICANT IMPACT ON AN EMPLOYEE'S ABILITY TO REMAIN AN ACTIVE AND PRODUCTIVE MEMBER OF THE WORK FORCE DUE TO INCREASED ABSENTEEISM, DUTY RESTRICTIONS, OR PHYSICAL LIMITATIONS FROM PAIN. LOW BACK PAIN IS THE MOST COMMON CAUSE OF WORK-RELATED DISABILITY AMONG EMPLOYEES YOUNGER THAN 46 YEARS. ADVANCING TECHNOLOGY AND LESS INVASIVE SURGICAL PROCEDURES HAVE NOT IMPROVED OUTCOMES FOR EMPLOYEES WHO SUFFER FROM LOW BACK PAIN. MOST CONTINUE TO EXPERIENCE SOME PAIN AND DYSFUNCTION AFTER CONVENTIONAL TREATMENTS SUCH AS INJECTIONS AND SURGERY. AN ALTERNATIVE TREATMENT THAT COULD REDUCE NONSPECIFIC CHRONIC LOW BACK PAIN WOULD BENEFIT BOTH EMPLOYEES AND EMPLOYERS. EXERCISING AND REMAINING ACTIVE ARE PART OF MOST GUIDELINES' ROUTINE CARE RECOMMENDATIONS BUT ARE NOT WELL DEFINED.	2011	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
11 2824  48 YOGA VERSUS EDUCATION FOR VETERANS WITH CHRONIC LOW BACK PAIN: STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL. BACKGROUND: CHRONIC LOW BACK PAIN IS THE MOST FREQUENT PAIN CONDITION IN VETERANS AND CAUSES SUBSTANTIAL SUFFERING, DECREASED FUNCTIONAL CAPACITY, AND LOWER QUALITY OF LIFE. SYMPTOMS OF POST-TRAUMATIC STRESS, DEPRESSION, AND MILD TRAUMATIC BRAIN INJURY ARE HIGHLY PREVALENT IN VETERANS WITH BACK PAIN. YOGA FOR LOW BACK PAIN HAS BEEN DEMONSTRATED TO BE EFFECTIVE FOR CIVILIANS IN RANDOMIZED CONTROLLED TRIALS. HOWEVER, IT IS UNKNOWN IF RESULTS FROM PREVIOUSLY PUBLISHED TRIALS GENERALIZE TO MILITARY POPULATIONS. METHODS/DESIGN: THIS STUDY IS A PARALLEL RANDOMIZED CONTROLLED TRIAL COMPARING YOGA TO EDUCATION FOR 120 VETERANS WITH CHRONIC LOW BACK PAIN. PARTICIPANTS ARE VETERANS >/=18 YEARS OLD WITH LOW BACK PAIN PRESENT ON AT LEAST HALF THE DAYS IN THE PAST SIX MONTHS AND A SELF-REPORTED AVERAGE PAIN INTENSITY IN THE PREVIOUS WEEK OF >/=4 ON A 0-10 SCALE. THE 24-WEEK STUDY HAS AN INITIAL 12-WEEK INTERVENTION PERIOD, WHERE PARTICIPANTS ARE RANDOMIZED EQUALLY INTO (1) A STANDARDIZED WEEKLY GROUP YOGA CLASS WITH HOME PRACTICE OR (2) EDUCATION DELIVERED WITH A SELF-CARE BOOK. PRIMARY OUTCOME MEASURES ARE CHANGE AT 12 WEEKS IN LOW BACK PAIN INTENSITY MEASURED BY THE DEFENSE AND VETERANS PAIN RATING SCALE (0-10) AND BACK-RELATED FUNCTION USING THE 23-POINT ROLAND MORRIS DISABILITY QUESTIONNAIRE. IN THE SUBSEQUENT 12-WEEK FOLLOW-UP PERIOD, YOGA PARTICIPANTS ARE ENCOURAGED TO CONTINUE HOME YOGA PRACTICE AND EDUCATION PARTICIPANTS CONTINUE FOLLOWING RECOMMENDATIONS FROM THE BOOK. QUALITATIVE INTERVIEWS WITH VETERANS IN THE YOGA GROUP AND THEIR PARTNERS EXPLORE THE IMPACT OF CHRONIC LOW BACK PAIN AND YOGA ON FAMILY RELATIONSHIPS. WE ALSO ASSESS COST-EFFECTIVENESS FROM THREE PERSPECTIVES: THE VETERAN, THE VETERANS HEALTH ADMINISTRATION, AND SOCIETY USING ELECTRONIC MEDICAL RECORDS, SELF-REPORTED COST DATA, AND STUDY RECORDS. DISCUSSION: THIS STUDY WILL HELP DETERMINE IF YOGA CAN BECOME AN EFFECTIVE TREATMENT FOR VETERANS WITH CHRONIC LOW BACK PAIN AND PSYCHOLOGICAL COMORBIDITIES. TRIAL REGISTRATION: CLINICALTRIALS.GOV: NCT02224183.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
12 2589  37 YOGA FOR LOW BACK PAIN: A SYSTEMATIC REVIEW OF RANDOMIZED CLINICAL TRIALS. 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.	2011	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
13 1291  30 GROUP ACUPUNCTURE THERAPY WITH YOGA THERAPY FOR CHRONIC NECK, LOW BACK, AND OSTEOARTHRITIS PAIN IN SAFETY NET SETTING FOR AN UNDERSERVED POPULATION: DESIGN AND RATIONALE FOR A FEASIBILITY PILOT. CHRONIC PAIN IS PREVALENT IN THE UNITED STATES, WITH IMPACT ON PHYSICAL AND PSYCHOLOGICAL FUNCTIONING AS WELL AS LOST WORK PRODUCTIVITY. MINORITY AND LOWER SOCIOECONOMIC POPULATIONS HAVE INCREASED PREVALENCE OF CHRONIC PAIN WITH LESS ACCESS TO PAIN CARE, POORER OUTCOMES, AND HIGHER RISK OF FATAL OPIOID OVERDOSE. ACUPUNCTURE THERAPY IS EFFECTIVE IN TREATING CHRONIC PAIN CONDITIONS INCLUDING CHRONIC LOW BACK PAIN, NECK PAIN, SHOULDER PAIN, AND KNEE PAIN FROM OSTEOARTHRITIS. ACUPUNCTURE THERAPY, INCLUDING GROUP ACUPUNCTURE, IS FEASIBLE AND EFFECTIVE, AND SPECIFICALLY SO FOR UNDERSERVED AND DIVERSE POPULATIONS AT RISK FOR HEALTH OUTCOME DISPARITIES. ACUPUNCTURE THERAPY ALSO ENCOURAGES PATIENT ENGAGEMENT AND ACTIVATION. AS CHRONIC PAIN IMPROVES, THERE IS A NATURAL PROGRESSION TO WANT AND NEED TO INCREASE ACTIVITY AND MOVEMENT RECOVERY. DIVERSE MOVEMENT APPROACHES ARE IMPORTANT FOR IMPROVING RANGE OF MOTION, MAINTAINING GAINS, STRENGTHENING, AND PROMOTING PATIENT ENGAGEMENT AND ACTIVATION. YOGA THERAPY IS AN ACTIVE THERAPY WITH PROVEN BENEFIT IN MUSCULOSKELETAL PAIN DISORDERS AND PAIN ASSOCIATED DISABILITY. THE AIM OF THIS QUASI-EXPERIMENTAL PILOT FEASIBILITY TRIAL IS TO TEST THE BUNDLING OF THESE 2 EFFECTIVE CARE OPTIONS FOR CHRONIC PAIN, TO INFORM BOTH THE DESIGN FOR A LARGER RANDOMIZED PRAGMATIC EFFECTIVENESS TRIAL AS WELL AS IMPLEMENTATION STRATEGIES ACROSS UNDERSERVED SETTINGS.	2020	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
14  912  41 EFFECTIVENESS OF IYENGAR YOGA IN TREATING SPINAL (BACK AND NECK) PAIN: A SYSTEMATIC REVIEW. 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.	2015	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
15 2650  30 YOGA IMPROVES BALANCE AND LOW-BACK PAIN, BUT NOT ANXIETY, IN PEOPLE WITH PARKINSON'S DISEASE. INDIVIDUALS WITH PARKINSON'S DISEASE (PD) EXPERIENCE POSTURAL INSTABILITY, LOW-BACK PAIN (LBP), AND ANXIETY. THESE SYMPTOMS INCREASE THE RISK OF FALLS AND DECREASE QUALITY OF LIFE. RESEARCH SHOWS YOGA IMPROVES BALANCE AND DECREASES LBP AND ANXIETY IN HEALTHY ADULTS, BUT ITS EFFECTS IN PD ARE POORLY UNDERSTOOD. ALL PARTICIPANTS WERE PART OF A LARGER INTERVENTION STUDY. PARTICIPANTS RECEIVED PRETEST AND POSTTEST EVALUATIONS, INCLUDING THE BALANCE EVALUATION SYSTEMS TEST (BESTEST), BECK ANXIETY INVENTORY (BAI), AND REVISED OSWESTRY DISABILITY INDEX (ROSW). TOTAL SCORES FOR EACH MEASURE, AS WELL AS INDIVIDUAL BALANCE SYSTEM SECTION SCORES FROM THE BESTEST (BIOMECHANICAL CONSTRAINTS, STABILITY LIMITS/VERTICALITY, TRANSITIONS/ANTICIPATORY, REACTIVE, SENSORY ORIENTATION, AND STABILITY IN GAIT) WERE COMPARED WITHIN GROUPS PRE- TO POSTTEST. PARTICIPANTS IN THE YOGA GROUP (N = 13) COMPLETED A TWICE-WEEKLY 12-WEEK YOGA INTERVE N T I O N , WHEREAS CONTROLS (N = 13) CONTINUED THEIR USUAL ROUTINES FOR 12 WEEKS. BOTH THE YOGA (Z = -3.20, P = 0.001) AND CONTROL (Z = -2.10, P = 0.040) GROUPS IMPROVED ON THE BESTEST TOTAL SCORE. THE CONTROL GROUP SHOWED NO CHANGES IN INDIVIDUAL BALANCE SYSTEMS, WHEREAS THE YOGA GROUP IMPROVED IN STABILITY LIMITS/VERTICALITY (Z = -2.3, P = 0.020), TRANSITIONS/ ANTICIPATORY (Z = -2.50, P = 0.010), REACTIVE (Z = -2.70, P = 0.008), AND SENSORY ORIENTATION (Z = -2.30, P = 0.020). ROSW DECREASED IN THE YOGA GROUP ONLY (Z = -2.10, P = 0.030). BAI DID NOT CHANGE IN EITHER GROUP. YOGA IS A NONPHARMACOLOGICAL INTERVENTION THAT CAN IMPROVE BALANCE AND LBP IN PEOPLE WITH PD. THIS STUDY DEMONSTRATED THAT YOGA IS FEASIBLE FOR PEOPLE WITH PD, AND PARTICIPANTS REPORTED HIGH LEVELS OF ENJOYMENT AND INTENT TO PRACTICE YOGA AFTER THE STUDY.	2020	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
16 1953  43 SECONDARY OUTCOMES FROM A RANDOMIZED CONTROLLED TRIAL OF YOGA FOR VETERANS WITH CHRONIC LOW-BACK PAIN. CHRONIC LOW-BACK PAIN (CLBP) IS A PREVALENT CONDITION, AND RATES ARE HIGHER AMONG MILITARY VETERANS. CLBP IS A PERSISTENT CONDITION, AND TREATMENT OPTIONS HAVE EITHER MODEST EFFECTS OR A SIGNIFICANT RISK OF SIDE-EFFECTS, WHICH HAS LED TO RECENT EFFORTS TO EXPLORE MIND-BODY INTERVENTION OPTIONS AND REDUCE OPIOID MEDICATION USE. PRIOR STUDIES OF YOGA FOR CLBP IN COMMUNITY SAMPLES, AND THE MAIN RESULTS OF A RECENT TRIAL WITH MILITARY VETERANS, INDICATE THAT YOGA CAN REDUCE BACK-RELATED DISABILITY AND PAIN INTENSITY. SECONDARY OUTCOMES FROM THE TRIAL OF YOGA WITH MILITARY VETERANS ARE PRESENTED HERE. IN THE STUDY, 150 MILITARY VETERANS (VETERANS ADMINISTRATION PATIENTS) WITH CLBP WERE RANDOMIZED TO EITHER YOGA OR A DELAYED-TREATMENT GROUP RECEIVING USUAL CARE BETWEEN 2013 AND 2015. ASSESSMENTS OCCURRED AT BASELINE, 6 WEEKS, 12 WEEKS, AND 6 MONTHS. INTENT-TO-TREAT ANALYSES WERE CONDUCTED. YOGA CLASSES LASTING 60 MINUTES EACH WERE OFFERED TWICE WEEKLY FOR 12 WEEKS. YOGA SESSIONS CONSISTED OF PHYSICAL POSTURES, MOVEMENT, FOCUSED ATTENTION, AND BREATHING TECHNIQUES. HOME PRACTICE GUIDED BY A MANUAL WAS STRONGLY RECOMMENDED. THE PRIMARY OUTCOME MEASURE WAS ROLAND-MORRIS DISABILITY QUESTIONNAIRE SCORES AFTER 12 WEEKS. SECONDARY OUTCOMES INCLUDED PAIN INTENSITY, PAIN INTERFERENCE, DEPRESSION, FATIGUE, QUALITY OF LIFE, SELF-EFFICACY, AND MEDICATION USAGE. YOGA PARTICIPANTS IMPROVED MORE THAN DELAYED-TREATMENT PARTICIPANTS ON PAIN INTERFERENCE, FATIGUE, QUALITY OF LIFE, AND SELF-EFFICACY AT 12 WEEKS AND/OR 6 MONTHS. YOGA PARTICIPANTS HAD GREATER IMPROVEMENTS ACROSS A NUMBER OF IMPORTANT SECONDARY HEALTH OUTCOMES COMPARED TO CONTROLS. BENEFITS EMERGED DESPITE SOME VETERANS FACING CHALLENGES WITH ATTENDING YOGA SESSIONS IN PERSON. THE FINDINGS SUPPORT WIDER IMPLEMENTATION OF YOGA PROGRAMS FOR VETERANS, WITH ATTENTION TO INCREASING ACCESSIBILITY OF YOGA PROGRAMS IN THIS POPULATION.	2020	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
17 2518  48 YOGA COMPARED TO NON-EXERCISE OR PHYSICAL THERAPY EXERCISE ON PAIN, DISABILITY, AND QUALITY OF LIFE FOR PATIENTS WITH CHRONIC LOW BACK PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. BACKGROUND: CHRONIC LOW BACK PAIN (CLBP) IS A COMMON AND OFTEN DISABLING MUSCULOSKELETAL CONDITION. YOGA HAS BEEN PROVEN TO BE AN EFFECTIVE THERAPY FOR CHRONIC LOW BACK PAIN. HOWEVER, THERE ARE STILL CONTROVERSIES ABOUT THE EFFECTS OF YOGA AT DIFFERENT FOLLOW-UP PERIODS AND COMPARED WITH OTHER PHYSICAL THERAPY EXERCISES. OBJECTIVE: TO CRITICALLY COMPARE THE EFFECTS OF YOGA FOR PATIENTS WITH CHRONIC LOW BACK PAIN ON PAIN, DISABILITY, QUALITY OF LIFE WITH NON-EXERCISE (E.G. USUAL CARE, EDUCATION), PHYSICAL THERAPY EXERCISE. METHODS: THIS STUDY WAS REGISTERED IN PROSPERO, AND THE REGISTRATION NUMBER WAS CRD42020159865. RANDOMIZED CONTROLLED TRIALS (RCTS) OF ONLINE DATABASES INCLUDED PUBMED, WEB OF SCIENCE, COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS, EMBASE WHICH EVALUATED EFFECTS OF YOGA FOR PATIENTS WITH CHRONIC LOW BACK PAIN ON PAIN, DISABILITY, AND QUALITY OF LIFE WERE SEARCHED FROM INCEPTION TIME TO NOVEMBER 1, 2019. STUDIES WERE ELIGIBLE IF THEY ASSESSED AT LEAST ONE IMPORTANT OUTCOME, NAMELY PAIN, BACK-SPECIFIC DISABILITY, QUALITY OF LIFE. THE COCHRANE RISK OF BIAS TOOL WAS USED TO ASSESS THE METHODOLOGICAL QUALITY OF INCLUDED RANDOMIZED CONTROLLED TRIALS. THE CONTINUOUS OUTCOMES WERE ANALYZED BY CALCULATING THE MEAN DIFFERENCE (MD) OR STANDARDIZED MEAN DIFFERENCE (SMD) WITH 95% CONFIDENCE INTERVALS (CI) ACCORDING TO WHETHER COMBINING OUTCOMES MEASURED ON DIFFERENT SCALES OR NOT. RESULTS: A TOTAL OF 18 RANDOMIZED CONTROLLED TRIALS WERE INCLUDED IN THIS META-ANALYSIS. YOGA COULD SIGNIFICANTLY REDUCE PAIN AT 4 TO 8 WEEKS (MD = -0.83, 95% CI = -1.19 TO -0.48, P<0.00001, I2 = 0%), 3 MONTHS (MD = -0.43, 95% CI = -0.64 TO -0.23, P<0.0001, I2 = 0%), 6 TO 7 MONTHS (MD = -0.56, 95% CI = -1.02 TO -0.11, P = 0.02, I2 = 50%), AND WAS NOT SIGNIFICANT IN 12 MONTHS (MD = -0.52, 95% CI = -1.64 TO 0.59, P = 0.36, I2 = 87%) COMPARED WITH NON-EXERCISE. YOGA WAS BETTER THAN NON-EXERCISE ON DISABILITY AT 4 TO 8 WEEKS (SMD = -0.30, 95% CI = -0.51 TO -0.10, P = 0.003, I2 = 0%), 3 MONTHS (SMD = -0.31, 95% CI = -0.45 TO -0.18, P<0.00001, I2 = 30%), 6 MONTHS (SMD = -0.38, 95% CI = -0.53 TO -0.23, P<0.00001, I2 = 0%), 12 MONTHS (SMD = -0.33, 95% CI = -0.54 TO -0.12, P = 0.002, I2 = 9%). THERE WAS NO SIGNIFICANT DIFFERENCE ON PAIN, DISABILITY COMPARED WITH PHYSICAL THERAPY EXERCISE GROUP. FURTHERMORE, IT SUGGESTED THAT THERE WAS A NON-SIGNIFICANT DIFFERENCE ON PHYSICAL AND MENTAL QUALITY OF LIFE BETWEEN YOGA AND ANY OTHER INTERVENTIONS. CONCLUSION: THIS META-ANALYSIS PROVIDED EVIDENCE FROM VERY LOW TO MODERATE INVESTIGATING THE EFFECTIVENESS OF YOGA FOR CHRONIC LOW BACK PAIN PATIENTS AT DIFFERENT TIME POINTS. YOGA MIGHT DECREASE PAIN FROM SHORT TERM TO INTERMEDIATE TERM AND IMPROVE FUNCTIONAL DISABILITY STATUS FROM SHORT TERM TO LONG TERM COMPARED WITH NON-EXERCISE (E.G. USUAL CARE, EDUCATION). YOGA HAD THE SAME EFFECT ON PAIN AND DISABILITY AS ANY OTHER EXERCISE OR PHYSICAL THERAPY. YOGA MIGHT NOT IMPROVE THE PHYSICAL AND MENTAL QUALITY OF LIFE BASED ON THE RESULT OF A MERGING.	2020	

18  222  37 A SYSTEMATIC REVIEW AND META-ANALYSIS OF YOGA FOR LOW BACK PAIN. OBJECTIVES: TO SYSTEMATICALLY REVIEW AND META-ANALYZE THE EFFECTIVENESS OF YOGA FOR LOW BACK PAIN. METHODS: MEDLINE, THE COCHRANE LIBRARY, EMBASE, CAMBASE, AND PSYCINFO, WERE SCREENED THROUGH JANUARY 2012. RANDOMIZED CONTROLLED TRIALS COMPARING YOGA TO CONTROL CONDITIONS IN PATIENTS WITH LOW BACK PAIN WERE INCLUDED. TWO AUTHORS INDEPENDENTLY ASSESSED RISK OF BIAS USING THE RISK OF BIAS TOOL RECOMMENDED BY THE COCHRANE BACK REVIEW GROUP. MAIN OUTCOME MEASURES WERE PAIN, BACK-SPECIFIC DISABILITY, GENERIC DISABILITY, HEALTH-RELATED QUALITY OF LIFE, AND GLOBAL IMPROVEMENT. FOR EACH OUTCOME, STANDARDIZED MEAN DIFFERENCES (SMD) AND 95% CONFIDENCE INTERVALS (CI) WERE CALCULATED. RESULTS: TEN RANDOMIZED CONTROLLED TRIALS WITH A TOTAL OF 967 CHRONIC LOW BACK PAIN PATIENTS WERE INCLUDED. EIGHT STUDIES HAD LOW RISK OF BIAS. THERE WAS STRONG EVIDENCE FOR SHORT-TERM EFFECTS ON PAIN (SMD=-0.48; 95% CI, -0.65 TO -0.31; P<0.01), BACK-SPECIFIC DISABILITY (SMD=-0.59; 95% CI, -0.87 TO -0.30; P<0.01), AND GLOBAL IMPROVEMENT (RISK RATIO=3.27; 95% CI, 1.89-5.66; P<0.01). THERE WAS STRONG EVIDENCE FOR A LONG-TERM EFFECT ON PAIN (SMD=-0.33; 95% CI, -0.59 TO -0.07; P=0.01) AND MODERATE EVIDENCE FOR A LONG-TERM EFFECT ON BACK-SPECIFIC DISABILITY (SMD=-0.35; 95% CI, -0.55 TO -0.15; P<0.01). THERE WAS NO EVIDENCE FOR EITHER SHORT-TERM OR LONG-TERM EFFECTS ON HEALTH-RELATED QUALITY OF LIFE. YOGA WAS NOT ASSOCIATED WITH SERIOUS ADVERSE EVENTS. DISCUSSION: THIS SYSTEMATIC REVIEW FOUND STRONG EVIDENCE FOR SHORT-TERM EFFECTIVENESS AND MODERATE EVIDENCE FOR LONG-TERM EFFECTIVENESS OF YOGA FOR CHRONIC LOW BACK PAIN IN THE MOST IMPORTANT PATIENT-CENTERED OUTCOMES. YOGA CAN BE RECOMMENDED AS AN ADDITIONAL THERAPY TO CHRONIC LOW BACK PAIN PATIENTS.	2013	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
19 2596  46 YOGA FOR MILITARY VETERANS WITH CHRONIC LOW BACK PAIN: A RANDOMIZED CLINICAL TRIAL. INTRODUCTION: CHRONIC LOW BACK PAIN (CLBP) IS PREVALENT, ESPECIALLY AMONG MILITARY VETERANS. MANY CLBP TREATMENT OPTIONS HAVE LIMITED BENEFITS AND ARE ACCOMPANIED BY SIDE EFFECTS. MAJOR EFFORTS TO REDUCE OPIOID USE AND EMBRACE NONPHARMACOLOGICAL PAIN TREATMENTS HAVE RESULTED. RESEARCH WITH COMMUNITY CLBP PATIENTS INDICATES THAT YOGA CAN IMPROVE HEALTH OUTCOMES AND HAS FEW SIDE EFFECTS. THE BENEFITS OF YOGA AMONG MILITARY VETERANS WERE EXAMINED. DESIGN: PARTICIPANTS WERE RANDOMIZED TO EITHER YOGA OR DELAYED YOGA TREATMENT IN 2013-2015. OUTCOMES WERE ASSESSED AT BASELINE, 6 WEEKS, 12 WEEKS, AND 6 MONTHS. INTENTION-TO-TREAT ANALYSES OCCURRED IN 2016. SETTING/PARTICIPANTS: ONE HUNDRED AND FIFTY MILITARY VETERANS WITH CLBP WERE RECRUITED FROM A MAJOR VETERANS AFFAIRS MEDICAL CENTER IN CALIFORNIA. INTERVENTION: YOGA CLASSES (WITH HOME PRACTICE) WERE LED BY A CERTIFIED INSTRUCTOR TWICE WEEKLY FOR 12 WEEKS, AND CONSISTED PRIMARILY OF PHYSICAL POSTURES, MOVEMENT, AND BREATHING TECHNIQUES. MAIN OUTCOME MEASURES: THE PRIMARY OUTCOME WAS ROLAND-MORRIS DISABILITY QUESTIONNAIRE SCORES AFTER 12 WEEKS. PAIN INTENSITY WAS IDENTIFIED AS AN IMPORTANT SECONDARY OUTCOME. RESULTS: PARTICIPANT CHARACTERISTICS WERE MEAN AGE 53 YEARS, 26% WERE FEMALE, 35% WERE UNEMPLOYED OR DISABLED, AND MEAN BACK PAIN DURATION WAS 15 YEARS. IMPROVEMENTS IN ROLAND-MORRIS DISABILITY QUESTIONNAIRE SCORES DID NOT DIFFER BETWEEN THE TWO GROUPS AT 12 WEEKS, BUT YOGA PARTICIPANTS HAD GREATER REDUCTIONS IN ROLAND-MORRIS DISABILITY QUESTIONNAIRE SCORES THAN DELAYED TREATMENT PARTICIPANTS AT 6 MONTHS -2.48 (95% CI= -4.08, -0.87). YOGA PARTICIPANTS IMPROVED MORE ON PAIN INTENSITY AT 12 WEEKS AND AT 6 MONTHS. OPIOID MEDICATION USE DECLINED AMONG ALL PARTICIPANTS, BUT GROUP DIFFERENCES WERE NOT FOUND. CONCLUSIONS: YOGA IMPROVED HEALTH OUTCOMES AMONG VETERANS DESPITE EVIDENCE THEY HAD FEWER RESOURCES, WORSE HEALTH, AND MORE CHALLENGES ATTENDING YOGA SESSIONS THAN COMMUNITY SAMPLES STUDIED PREVIOUSLY. THE MAGNITUDE OF PAIN INTENSITY DECLINE WAS SMALL, BUT OCCURRED IN THE CONTEXT OF REDUCED OPIOID USE. THE FINDINGS SUPPORT WIDER IMPLEMENTATION OF YOGA PROGRAMS FOR VETERANS. TRIAL REGISTRATION: THIS STUDY IS REGISTERED AT WWW.CLINICALTRIALS.GOV NCT02524158.	2017	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
20  536  45 COMPARISON OF YOGA VERSUS STRETCHING FOR CHRONIC LOW BACK PAIN: PROTOCOL FOR THE YOGA EXERCISE SELF-CARE (YES) TRIAL. BACKGROUND: BACK PAIN, ONE OF THE MOST PREVALENT CONDITIONS AFFLICTING AMERICAN ADULTS, IS THE LEADING REASON FOR USING COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) THERAPIES. YOGA IS AN INCREASINGLY POPULAR "MIND-BODY" CAM THERAPY OFTEN USED FOR RELIEVING BACK PAIN AND SEVERAL SMALL STUDIES HAVE FOUND YOGA EFFECTIVE FOR THIS CONDITION. THIS STUDY WILL ASSESS WHETHER YOGA IS EFFECTIVE FOR TREATING CHRONIC LOW BACK PAIN COMPARED WITH SELF CARE AND EXERCISE AND WILL EXPLORE THE MECHANISMS RESPONSIBLE FOR ANY OBSERVED BENEFITS. METHODS/DESIGN: A TOTAL OF 210 PARTICIPANTS WITH LOW BACK PAIN LASTING AT LEAST 3 MONTHS WILL BE RECRUITED FROM PRIMARY CARE CLINICS OF A LARGE HEALTHCARE SYSTEM BASED IN SEATTLE. THEY WILL BE RANDOMIZED IN A 2:2:1 RATIO TO RECEIVE 12 WEEKLY YOGA CLASSES, 12 WEEKLY CONVENTIONAL THERAPEUTIC EXERCISE CLASSES OF COMPARABLE PHYSICAL EXERTION, OR A SELF-CARE BOOK. INTERVIEWERS MASKED TO PARTICIPANTS' TREATMENT GROUP WILL ASSESS OUTCOMES AT BASELINE AND 6, 12 AND 26 WEEKS AFTER RANDOMIZATION. PRIMARY OUTCOMES WILL BE BACK-RELATED DYSFUNCTION AND SYMPTOM BOTHERSOMENESS. IN ADDITION, DATA WILL BE COLLECTED ON PHYSICAL MEASUREMENTS (E.G., FLEXION) AT BASELINE AND 12 WEEKS AND SALIVA SAMPLES WILL BE OBTAINED AT BASELINE, 6 AND 12 WEEKS. INFORMATION WILL BE COLLECTED ON SPECIFIC PHYSICAL, PSYCHOLOGICAL, AND PHYSIOLOGICAL FACTORS TO ALLOW EXPLORATION OF POSSIBLE MECHANISMS OF ACTION THROUGH WHICH YOGA COULD RELIEVE BACK PAIN AND DYSFUNCTION. THE EFFECTIVENESS OF YOGA WILL BE ASSESSED USING ANALYSIS OF COVARIANCE (USING GENERAL ESTIMATING EQUATIONS - GEE) WITHIN AN INTENTION-TO-TREAT CONTEXT. IF YOGA IS FOUND EFFECTIVE, FURTHER ANALYSES WILL EXPLORE WHETHER YOGA'S BENEFITS ARE ATTRIBUTABLE TO PHYSICAL, PSYCHOLOGICAL AND/OR PHYSIOLOGICAL FACTORS. CONCLUSIONS: THIS STUDY WILL PROVIDE THE CLEAREST EVIDENCE TO DATE ABOUT THE VALUE OF YOGA AS A THERAPEUTIC OPTION FOR TREATING CHRONIC BACK PAIN, AND IF THE RESULTS ARE POSITIVE, WILL HELP FOCUS FUTURE, MORE IN-DEPTH, RESEARCH ON THE MOST PROMISING POTENTIAL MECHANISMS OF ACTION IDENTIFIED BY THIS STUDY.	2010