1 2851 163 YOGA, PHYSICAL THERAPY, AND BACK PAIN EDUCATION FOR SLEEP QUALITY IN LOW-INCOME RACIALLY DIVERSE ADULTS WITH CHRONIC LOW BACK PAIN: A SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL. BACKGROUND: POOR SLEEP IS COMMON AMONG ADULTS WITH CHRONIC LOW BACK PAIN (CLBP), BUT THE INFLUENCE OF CLBP TREATMENTS, SUCH AS YOGA AND PHYSICAL THERAPY (PT), ON SLEEP QUALITY IS UNDER STUDIED. OBJECTIVE: EVALUATE THE EFFECTIVENESS OF YOGA AND PT FOR IMPROVING SLEEP QUALITY IN ADULTS WITH CLBP. DESIGN: SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL. SETTING: ACADEMIC SAFETY-NET HOSPITAL AND 7 AFFILIATED COMMUNITY HEALTH CENTERS. PARTICIPANTS: A TOTAL OF 320 ADULTS WITH CLBP. INTERVENTION: TWELVE WEEKLY YOGA CLASSES, 1-ON-1 PT SESSIONS, OR AN EDUCATIONAL BOOK. MAIN MEASURES: SLEEP QUALITY WAS MEASURED USING THE PITTSBURGH SLEEP QUALITY INDEX (PSQI) GLOBAL SCORE (0-21) AT BASELINE, 12 WEEKS, AND 52 WEEKS. ADDITIONALLY, WE ALSO EVALUATED HOW THE PROPORTION OF PARTICIPANTS WHO ACHIEVED A CLINICALLY MEANINGFUL IMPROVEMENT IN SLEEP QUALITY (> 3-POINT REDUCTION IN PSQI) AT 12 WEEKS VARIED BY CHANGES IN PAIN AND PHYSICAL FUNCTION AT 6 WEEKS. KEY RESULTS: AMONG PARTICIPANTS (MEAN AGE = 46.0, 64% FEMALE, 82% NON-WHITE), NEARLY ALL (92%) REPORTED POOR SLEEP QUALITY (PSQI > 5) AT BASELINE. AT 12 WEEKS, MODEST IMPROVEMENTS IN SLEEP QUALITY WERE OBSERVED AMONG THE YOGA (PSQI MEAN DIFFERENCE [MD] = - 1.19, 95% CONFIDENCE INTERVAL [CI] - 1.82, - 0.55) AND PT (PSQI MD = - 0.91, 95% CI - 1.61, - 0.20) GROUPS. PARTICIPANTS WHO REPORTED A >/= 30% IMPROVEMENT IN PAIN OR PHYSICAL FUNCTION AT 6 WEEKS, COMPARED WITH THOSE WHO IMPROVED < 10%, WERE MORE LIKELY TO BE A SLEEP QUALITY RESPONDER AT 12 WEEKS (ODDS RATIO [OR] = 3.51, 95% CI 1.73, 7.11 AND OR = 2.16, 95% CI 1.18, 3.95, RESPECTIVELY). RESULTS WERE SIMILAR AT 52 WEEKS. CONCLUSION: IN A SAMPLE OF ADULTS WITH CLBP, VIRTUALLY ALL WITH POOR SLEEP QUALITY PRIOR TO INTERVENTION, MODEST BUT STATISTICALLY SIGNIFICANT IMPROVEMENTS IN SLEEP QUALITY WERE OBSERVED WITH BOTH YOGA AND PT. IRRESPECTIVE OF TREATMENT, CLINICALLY IMPORTANT SLEEP IMPROVEMENTS AT THE END OF THE INTERVENTION WERE ASSOCIATED WITH MID-INTERVENTION PAIN AND PHYSICAL FUNCTION IMPROVEMENTS. TRIAL REGISTRATION: CLINICALTRIALS.GOV IDENTIFIER: NCT01343927.	2020	
                                                                                                                                                                                                               
2 1602  50 MENOPAUSAL QUALITY OF LIFE: RCT OF YOGA, EXERCISE, AND OMEGA-3 SUPPLEMENTS. OBJECTIVE: THE PURPOSE OF THIS STUDY WAS TO DETERMINE THE EFFICACY OF 3 NONHORMONAL THERAPIES FOR THE IMPROVEMENT OF MENOPAUSE-RELATED QUALITY OF LIFE IN WOMEN WITH VASOMOTOR SYMPTOMS. STUDY DESIGN: WE CONDUCTED A 12-WEEK 3 X 2 RANDOMIZED, CONTROLLED, FACTORIAL DESIGN TRIAL. PERI- AND POSTMENOPAUSAL WOMEN, 40-62 YEARS OLD, WERE ASSIGNED RANDOMLY TO YOGA (N = 107), EXERCISE (N = 106), OR USUAL ACTIVITY (N = 142) AND ALSO ASSIGNED RANDOMLY TO A DOUBLE-BLIND COMPARISON OF OMEGA-3 (N = 177) OR PLACEBO (N = 178) CAPSULES. WE PERFORMED THE FOLLOWING INTERVENTIONS: (1) WEEKLY 90-MINUTE YOGA CLASSES WITH DAILY AT-HOME PRACTICE, (2) INDIVIDUALIZED FACILITY-BASED AEROBIC EXERCISE TRAINING 3 TIMES/WEEK, AND (3) 0.615 G OMEGA-3 SUPPLEMENT, 3 TIMES/DAY. THE OUTCOMES WERE ASSESSED WITH THE FOLLOWING SCORES: MENOPAUSAL QUALITY OF LIFE QUESTIONNAIRE (MENQOL) TOTAL AND DOMAIN (VASOMOTOR SYMPTOMS, PSYCHOSOCIAL, PHYSICAL AND SEXUAL). RESULTS: AMONG 355 RANDOMLY ASSIGNED WOMEN WHO AVERAGE AGE WAS 54.7 YEARS, 338 WOMEN (95%) COMPLETED 12-WEEK ASSESSMENTS. MEAN BASELINE VASOMOTOR SYMPTOMS FREQUENCY WAS 7.6/DAY, AND THE MEAN BASELINE TOTAL MENQOL SCORE WAS 3.8 (RANGE, 1-8 FROM BETTER TO WORSE) WITH NO BETWEEN-GROUP DIFFERENCES. FOR YOGA COMPARED TO USUAL ACTIVITY, BASELINE TO 12-WEEK IMPROVEMENTS WERE SEEN FOR MENQOL TOTAL -0.3 (95% CONFIDENCE INTERVAL, -0.6 TO 0; P = .02), VASOMOTOR SYMPTOM DOMAIN (P = .02), AND SEXUALITY DOMAIN (P = .03) SCORES. FOR WOMEN WHO UNDERWENT EXERCISE AND OMEGA-3 THERAPY COMPARED WITH CONTROL SUBJECTS, IMPROVEMENTS IN BASELINE TO 12-WEEK TOTAL MENQOL SCORES WERE NOT OBSERVED. EXERCISE SHOWED BENEFIT IN THE MENQOL PHYSICAL DOMAIN SCORE AT 12 WEEKS (P = .02). CONCLUSION: ALL WOMEN BECOME MENOPAUSAL, AND MANY OF THEM SEEK MEDICAL ADVICE ON WAYS TO IMPROVE QUALITY OF LIFE; LITTLE EVIDENCE-BASED INFORMATION EXISTS. WE FOUND THAT, AMONG HEALTHY SEDENTARY MENOPAUSAL WOMEN, YOGA APPEARS TO IMPROVE MENOPAUSAL QUALITY OF LIFE; THE CLINICAL SIGNIFICANCE OF OUR FINDING IS UNCERTAIN BECAUSE OF THE MODEST EFFECT.	2014	
                                                                                                                                                                                                                                                                                                                                                                          
3  430  89 CAN YOGA OR PHYSICAL THERAPY FOR CHRONIC LOW BACK PAIN IMPROVE DEPRESSION AND ANXIETY AMONG ADULTS FROM A RACIALLY DIVERSE, LOW-INCOME COMMUNITY? A SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL. OBJECTIVE: TO DETERMINE AND COMPARE THE EFFECT OF YOGA, PHYSICAL THERAPY (PT), AND EDUCATION ON DEPRESSIVE AND ANXIOUS SYMPTOMS IN PATIENTS WITH CHRONIC LOW BACK PAIN (CLBP). DESIGN: SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL. SETTING: ACADEMIC SAFETY NET HOSPITAL AND 7 COMMUNITY HEALTH CENTERS. PARTICIPANTS: A TOTAL OF 320 ADULTS WITH CLBP. INTERVENTION: YOGA CLASSES, PT SESSIONS, OR AN EDUCATIONAL BOOK. OUTCOME MEASURE: DEPRESSION AND ANXIETY WERE MEASURED USING THE PATIENT HEALTH QUESTIONNAIRE AND GENERALIZED ANXIETY DISORDER 7-ITEM SCALE, RESPECTIVELY, AT BASELINE, 12, AND 52 WEEKS. WE IDENTIFIED BASELINE AND MIDTREATMENT (6-WK) FACTORS ASSOCIATED WITH CLINICALLY MEANINGFUL IMPROVEMENTS IN DEPRESSIVE (>/=3 POINTS) OR ANXIOUS (>/=2 POINTS) SYMPTOMS AT 12 WEEKS. RESULTS: PARTICIPANTS (FEMALE=64%; MEAN AGE, 46.0+/-10.7 YEARS) WERE PREDOMINANTLY NON-WHITE (82%), LOW-INCOME (<$30,000/YEAR, 59%), AND HAD NOT RECEIVED A COLLEGE DEGREE (71%). MOST PARTICIPANTS HAD MILD OR WORSE DEPRESSIVE (60%) AND ANXIOUS (50%) SYMPTOMS. AT 12 WEEKS, YOGA AND PT PARTICIPANTS EXPERIENCED MODEST WITHIN-GROUP IMPROVEMENTS IN DEPRESSIVE SYMPTOMS (MEAN DIFFERENCE [MD]=-1.23 [95% CI, -2.18 TO -0.28]; MD=-1.01 [95% CI, -2.05 TO -0.03], RESPECTIVELY). COMPARED WITH THE EDUCATION GROUP, 12-WEEK DIFFERENCES WERE NOT STATISTICALLY SIGNIFICANT, ALTHOUGH TRENDS FAVORED YOGA (MD=-0.71 [95% CI, -2.22 TO 0.81]) AND PT (MD= -0.32 [95% CI, -1.82 TO 1.18]). AT 12 WEEKS, IMPROVEMENTS IN ANXIOUS SYMPTOMS WERE ONLY FOUND IN PARTICIPANTS WHO HAD MILD OR MODERATE ANXIETY AT BASELINE. INDEPENDENT OF TREATMENT ARM, PARTICIPANTS WHO HAD 30% OR GREATER IMPROVEMENT IN PAIN OR FUNCTION MIDTREATMENT WERE MORE LIKELY TO HAVE A CLINICALLY MEANINGFUL IMPROVEMENT IN DEPRESSIVE SYMPTOMS (ODDS RATIO [OR], 1.82 [95% CI, 1.03-3.22]; OR, 1.79 [95% CI, 1.06-3.04], RESPECTIVELY). CONCLUSIONS: IN OUR SECONDARY ANALYSIS WE FOUND THAT DEPRESSION AND ANXIETY, COMMON IN THIS SAMPLE OF UNDERSERVED ADULTS WITH CLBP, MAY IMPROVE MODESTLY WITH PT AND YOGA. HOWEVER, EFFECTS WERE NOT SUPERIOR TO EDUCATION. IMPROVEMENTS IN PAIN AND FUNCTION ARE ASSOCIATED WITH A DECREASE IN DEPRESSIVE SYMPTOMS. MORE RESEARCH IS NEEDED TO OPTIMIZE THE INTEGRATION OF PHYSICAL AND PSYCHOLOGICAL WELL-BEING IN PT AND YOGA.	2021	

4  518  52 COMPARING ONCE- VERSUS TWICE-WEEKLY YOGA CLASSES FOR CHRONIC LOW BACK PAIN IN PREDOMINANTLY LOW INCOME MINORITIES: A RANDOMIZED DOSING TRIAL. BACKGROUND. PREVIOUS STUDIES HAVE DEMONSTRATED THAT ONCE-WEEKLY YOGA CLASSES ARE EFFECTIVE FOR CHRONIC LOW BACK PAIN (CLBP) IN WHITE ADULTS WITH HIGH SOCIOECONOMIC STATUS. THE COMPARATIVE EFFECTIVENESS OF TWICE-WEEKLY CLASSES AND GENERALIZABILITY TO RACIALLY DIVERSE LOW INCOME POPULATIONS ARE UNKNOWN. METHODS. WE CONDUCTED A 12-WEEK RANDOMIZED, PARALLEL-GROUP, DOSING TRIAL FOR 95 ADULTS RECRUITED FROM AN URBAN SAFETY-NET HOSPITAL AND FIVE COMMUNITY HEALTH CENTERS COMPARING ONCE-WEEKLY (N = 49) VERSUS TWICE-WEEKLY (N = 46) STANDARDIZED YOGA CLASSES SUPPLEMENTED BY HOME PRACTICE. PRIMARY OUTCOMES WERE CHANGE FROM BASELINE TO 12 WEEKS IN PAIN (11-POINT SCALE) AND BACK-RELATED FUNCTION (23-POINT MODIFIED ROLAND-MORRIS DISABILITY QUESTIONNAIRE). RESULTS. 82% OF PARTICIPANTS WERE NONWHITE; 77% HAD ANNUAL HOUSEHOLD INCOMES <$40,000. THE SAMPLE'S BASELINE MEAN PAIN INTENSITY [6.9 (SD 1.6)] AND FUNCTION [13.7 (SD 5.0)] REFLECTED MODERATE TO SEVERE BACK PAIN AND IMPAIRMENT. PAIN AND BACK-RELATED FUNCTION IMPROVED WITHIN BOTH GROUPS (P < 0.001). HOWEVER, THERE WERE NO DIFFERENCES BETWEEN ONCE-WEEKLY AND TWICE-WEEKLY GROUPS FOR PAIN REDUCTION [-2.1 (95% CI -2.9, -1.3) VERSUS -2.4 (95% CI -3.1, -1.8), P = 0.62] OR BACK-RELATED FUNCTION [-5.1 (95% CI -7.0, -3.2) VERSUS -4.9 (95% CI -6.5, -3.3), P = 0.83]. CONCLUSIONS. TWELVE WEEKS OF ONCE-WEEKLY OR TWICE-WEEKLY YOGA CLASSES WERE SIMILARLY EFFECTIVE FOR PREDOMINANTLY LOW INCOME MINORITY ADULTS WITH MODERATE TO SEVERE CHRONIC LOW BACK PAIN. THIS TRIAL IS REGISTERED WITH CLINICALTRIALS.GOV NCT01761617.	2013	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
5  193  50 A RANDOMIZED TRIAL COMPARING YOGA, STRETCHING, AND A SELF-CARE BOOK FOR CHRONIC LOW BACK PAIN. BACKGROUND: CHRONIC LOW BACK PAIN IS A COMMON PROBLEM LACKING HIGHLY EFFECTIVE TREATMENT OPTIONS. SMALL TRIALS SUGGEST THAT YOGA MAY HAVE BENEFITS FOR THIS CONDITION. THIS TRIAL WAS DESIGNED TO DETERMINE WHETHER YOGA IS MORE EFFECTIVE THAN CONVENTIONAL STRETCHING EXERCISES OR A SELF-CARE BOOK FOR PRIMARY CARE PATIENTS WITH CHRONIC LOW BACK PAIN. METHODS: A TOTAL OF 228 ADULTS WITH CHRONIC LOW BACK PAIN WERE RANDOMIZED TO 12 WEEKLY CLASSES OF YOGA (92 PATIENTS) OR CONVENTIONAL STRETCHING EXERCISES (91 PATIENTS) OR A SELF-CARE BOOK (45 PATIENTS). BACK-RELATED FUNCTIONAL STATUS (MODIFIED ROLAND DISABILITY QUESTIONNAIRE, A 23-POINT SCALE) AND BOTHERSOMENESS OF PAIN (AN 11-POINT NUMERICAL SCALE) AT 12 WEEKS WERE THE PRIMARY OUTCOMES. OUTCOMES WERE ASSESSED AT BASELINE, 6, 12, AND 26 WEEKS BY INTERVIEWERS UNAWARE OF TREATMENT GROUP. RESULTS: AFTER ADJUSTMENT FOR BASELINE VALUES, 12-WEEK OUTCOMES FOR THE YOGA GROUP WERE SUPERIOR TO THOSE FOR THE SELF-CARE GROUP (MEAN DIFFERENCE FOR FUNCTION, -2.5 [95% CI, -3.7 TO -1.3]; P < .001; MEAN DIFFERENCE FOR SYMPTOMS, -1.1 [95% CI, -1.7 TO -0.4]; P < .001). AT 26 WEEKS, FUNCTION FOR THE YOGA GROUP REMAINED SUPERIOR (MEAN DIFFERENCE, -1.8 [95% CI, -3.1 TO -0.5]; P < .001). YOGA WAS NOT SUPERIOR TO CONVENTIONAL STRETCHING EXERCISES AT ANY TIME POINT. CONCLUSION: YOGA CLASSES WERE MORE EFFECTIVE THAN A SELF-CARE BOOK, BUT NOT MORE EFFECTIVE THAN STRETCHING CLASSES, IN IMPROVING FUNCTION AND REDUCING SYMPTOMS DUE TO CHRONIC LOW BACK PAIN, WITH BENEFITS LASTING AT LEAST SEVERAL MONTHS. TRIAL REGISTRATION: CLINICALTRIALS.GOV IDENTIFIER: NCT00447668.	2011	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
6  461  67 CHANGES IN PERCEIVED STRESS AFTER YOGA, PHYSICAL THERAPY, AND EDUCATION INTERVENTIONS FOR CHRONIC LOW BACK PAIN: A SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL. OBJECTIVE: PERCEIVED STRESS AND MUSCULOSKELETAL PAIN ARE COMMON, ESPECIALLY IN LOW-INCOME POPULATIONS. STUDIES EVALUATING TREATMENTS TO REDUCE STRESS IN PATIENTS WITH CHRONIC PAIN ARE LACKING. WE AIMED TO QUANTIFY THE EFFECT OF TWO EVIDENCE-BASED INTERVENTIONS FOR CHRONIC LOW BACK PAIN (CLBP), YOGA AND PHYSICAL THERAPY (PT), ON PERCEIVED STRESS IN ADULTS WITH CLBP. METHODS: WE USED DATA FROM AN ASSESSOR-BLINDED, PARALLEL-GROUP RANDOMIZED CONTROLLED TRIAL, WHICH RECRUITED PREDOMINANTLY LOW-INCOME AND RACIALLY DIVERSE ADULTS WITH CLBP. PARTICIPANTS (N = 320) WERE RANDOMLY ASSIGNED TO 12 WEEKS OF YOGA, PT, OR BACK PAIN EDUCATION. WE COMPARED CHANGES IN THE 10-ITEM PERCEIVED STRESS SCALE (PSS-10) FROM BASELINE TO 12- AND 52-WEEK FOLLOW-UP AMONG YOGA AND PT PARTICIPANTS WITH THOSE RECEIVING EDUCATION. SUBANALYSES WERE CONDUCTED FOR PARTICIPANTS WITH ELEVATED PRE-INTERVENTION PERCEIVED STRESS (PSS-10 SCORE >/=17). WE CONDUCTED SENSITIVITY ANALYSES USING VARIOUS IMPUTATION METHODS TO ACCOUNT FOR POTENTIAL BIASES IN OUR ESTIMATES DUE TO MISSING DATA. RESULTS: AMONG 248 PARTICIPANTS (MEAN AGE = 46.4 YEARS, 80% NONWHITE) COMPLETING ALL THREE SURVEYS, YOGA AND PT SHOWED GREATER REDUCTIONS IN PSS-10 SCORES COMPARED WITH EDUCATION AT 12 WEEKS (MEAN BETWEEN-GROUP DIFFERENCE = -2.6, 95% CONFIDENCE INTERVAL [CI] = -4.5 TO -0.66, AND MEAN BETWEEN-GROUP DIFFERENCE = -2.4, 95% CI = -4.4 TO -0.48, RESPECTIVELY). THIS EFFECT WAS STRONGER AMONG PARTICIPANTS WITH ELEVATED PRE-INTERVENTION PERCEIVED STRESS. BETWEEN-GROUP EFFECTS HAD ATTENUATED BY 52 WEEKS. RESULTS WERE SIMILAR IN SENSITIVITY ANALYSES. CONCLUSIONS: YOGA AND PT WERE MORE EFFECTIVE THAN BACK PAIN EDUCATION FOR REDUCING PERCEIVED STRESS AMONG LOW-INCOME ADULTS WITH CLBP.	2020	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
7  521  53 COMPARING YOGA, EXERCISE, AND A SELF-CARE BOOK FOR CHRONIC LOW BACK PAIN: A RANDOMIZED, CONTROLLED TRIAL. BACKGROUND: CHRONIC LOW BACK PAIN IS A COMMON PROBLEM THAT HAS ONLY MODESTLY EFFECTIVE TREATMENT OPTIONS. OBJECTIVE: TO DETERMINE WHETHER YOGA IS MORE EFFECTIVE THAN CONVENTIONAL THERAPEUTIC EXERCISE OR A SELF-CARE BOOK FOR PATIENTS WITH CHRONIC LOW BACK PAIN. DESIGN: RANDOMIZED, CONTROLLED TRIAL. SETTING: A NONPROFIT, INTEGRATED HEALTH CARE SYSTEM. PATIENTS: 101 ADULTS WITH CHRONIC LOW BACK PAIN. INTERVENTION: 12-WEEK SESSIONS OF YOGA OR CONVENTIONAL THERAPEUTIC EXERCISE CLASSES OR A SELF-CARE BOOK. MEASUREMENTS: PRIMARY OUTCOMES WERE BACK-RELATED FUNCTIONAL STATUS (MODIFIED 24-POINT ROLAND DISABILITY SCALE) AND "BOTHERSOMENESS" OF PAIN (11-POINT NUMERICAL SCALE). THE PRIMARY TIME POINT WAS 12 WEEKS. CLINICALLY SIGNIFICANT CHANGE WAS CONSIDERED TO BE 2.5 POINTS ON THE FUNCTIONAL STATUS SCALE AND 1.5 POINTS ON THE BOTHERSOMENESS SCALE. SECONDARY OUTCOMES WERE DAYS OF RESTRICTED ACTIVITY, GENERAL HEALTH STATUS, AND MEDICATION USE. RESULTS: AFTER ADJUSTMENT FOR BASELINE VALUES, BACK-RELATED FUNCTION IN THE YOGA GROUP WAS SUPERIOR TO THE BOOK AND EXERCISE GROUPS AT 12 WEEKS (YOGA VS. BOOK: MEAN DIFFERENCE, -3.4 [95% CI, -5.1 TO - 1.6] [P < 0.001]; YOGA VS. EXERCISE: MEAN DIFFERENCE, -1.8 [CI, -3.5 TO - 0.1] [P = 0.034]). NO SIGNIFICANT DIFFERENCES IN SYMPTOM BOTHERSOMENESS WERE FOUND BETWEEN ANY 2 GROUPS AT 12 WEEKS; AT 26 WEEKS, THE YOGA GROUP WAS SUPERIOR TO THE BOOK GROUP WITH RESPECT TO THIS MEASURE (MEAN DIFFERENCE, -2.2 [CI, -3.2 TO - 1.2]; P < 0.001). AT 26 WEEKS, BACK-RELATED FUNCTION IN THE YOGA GROUP WAS SUPERIOR TO THE BOOK GROUP (MEAN DIFFERENCE, -3.6 [CI, -5.4 TO - 1.8]; P < 0.001). LIMITATIONS: PARTICIPANTS IN THIS STUDY WERE FOLLOWED FOR ONLY 26 WEEKS AFTER RANDOMIZATION. ONLY 1 INSTRUCTOR DELIVERED EACH INTERVENTION. CONCLUSIONS: YOGA WAS MORE EFFECTIVE THAN A SELF-CARE BOOK FOR IMPROVING FUNCTION AND REDUCING CHRONIC LOW BACK PAIN, AND THE BENEFITS PERSISTED FOR AT LEAST SEVERAL MONTHS.	2005	
                                                                                                                                                                                                                                                                                                                                                                                                                                                       
8 2852  74 YOGA, PHYSICAL THERAPY, OR EDUCATION FOR CHRONIC LOW BACK PAIN: A RANDOMIZED NONINFERIORITY TRIAL. 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.	2017	
                                                                                                                               
9 1953  48 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	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
10 1252  41 FEASIBILITY, ACCEPTABILITY AND EVALUATION OF MEDITATION TO AUGMENT YOGA PRACTICE AMONG PERSONS DIAGNOSED WITH SCHIZOPHRENIA. OBJECTIVE: TO DESIGN A MEDITATION PROTOCOL AND TEST ITS FEASIBILITY, ACCEPTABILITY AND EFFICACY IN CONJUNCTION WITH YT FOR PERSONS WITH SCHIZOPHRENIA (SZ). METHODS: THE MEDITATION PROTOCOL CONSISTED OF ANAPANA (OBSERVING NORMAL RESPIRATION) AND YOGA NIDRA (SUPINE, RESTFUL AWARENESS). IN A SINGLE BLIND RANDOMIZED CONTROLLED TRIAL, MEDICATED AND CLINICALLY STABLE OUTPATIENTS DIAGNOSED WITH SZ WERE RANDOMIZED TO RECEIVE TREATMENT AS USUAL (TAU), TAU AUGMENTED WITH YOGA TRAINING (YT), OR TAU AUGMENTED WITH MEDITATION AND YOGA TRAINING (MYT) FOR THREE WEEKS (N=145). ACCEPTABILITY, CLINICAL, SOCIAL AND COGNITIVE FUNCTIONS WERE ASSESSED AFTER 3 WEEKS AND 3 MONTHS POST RANDOMIZATION USING WITHIN GROUP AND BETWEEN GROUPS ANALYSES WITH REPEATED MEASURES MULTIVARIATE TESTS. RESULTS: NO GROUP-WISE DIFFERENCES IN COMPLIANCE, STUDY DISCONTINUATION, MAJOR/SERIOUS SIDE EFFECTS OR ADVERSE EVENTS WERE NOTED. FOR SIX ASSESSED CLINICAL VARIABLES, THE DIRECTION OF CHANGES WERE IN THE DESIRED DIRECTION AND THE EFFECT SIZES WERE GREATER IN THE MYT GROUP COMPARED WITH THE TAU GROUP AT BOTH TIME POINTS. CHANGES IN SOCIAL FUNCTION VARIABLES WERE GREATER AT 3 MONTHS THAN AT 3 WEEKS. NOMINALLY SIGNIFICANT IMPROVEMENT IN INDIVIDUAL COGNITIVE DOMAINS WERE NOTED IN ALL GROUPS AT BOTH TIME POINTS. ALL EFFECT SIZES WERE IN THE SMALL TO MEDIUM RANGE. CONCLUSION: MYT IS FEASIBLE, ACCEPTABLE AND SHOWS MODEST BENEFITS FOR PERSONS WITH SZ. MYT CAN ALSO IMPROVE QUALITY OF LIFE AND CLINICAL SYMPTOMS. LARGER STUDIES OF LONGER DURATION ARE WARRANTED.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
11 2596  63 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	
                                                                                                                                                          
12 1699  61 PARTICIPANT CHARACTERISTICS ASSOCIATED WITH SYMPTOMATIC IMPROVEMENT FROM YOGA FOR CHRONIC LOW BACK PAIN. CONTEXT: STUDIES SUGGEST THAT YOGA IS EFFECTIVE FOR MODERATE TO SEVERE CHRONIC LOW BACK PAIN (CLBP) IN DIVERSE PREDOMINANTLY LOWER SOCIOECONOMIC STATUS POPULATIONS. HOWEVER, LITTLE IS KNOWN ABOUT FACTORS ASSOCIATED WITH BENEFIT FROM THE YOGA INTERVENTION. OBJECTIVE: IDENTIFY FACTORS AT BASELINE INDEPENDENTLY ASSOCIATED WITH GREATER EFFICACY AMONG PARTICIPANTS IN A STUDY OF YOGA FOR CLBP. DESIGN: FROM SEPTEMBER-DECEMBER 2011, A 12-WEEK RANDOMIZED DOSING TRIAL WAS CONDUCTED COMPARING WEEKLY VS. TWICE-WEEKLY 75-MINUTE HATHA YOGA CLASSES FOR 95 PREDOMINANTLY LOW-INCOME MINORITY ADULTS WITH NONSPECIFIC CLBP. PARTICIPANT CHARACTERISTICS COLLECTED AT BASELINE WERE USED TO DETERMINE FACTORS BEYOND TREATMENT ASSIGNMENT (REPORTED IN THE INITIAL STUDY) THAT PREDICTED OUTCOME. WE USED BIVARIATE TESTING TO IDENTIFY BASELINE CHARACTERISTICS ASSOCIATED WITH IMPROVEMENT IN FUNCTION AND PAIN, AND INCLUDED SELECT FACTORS IN A MULTIVARIATE LINEAR REGRESSION. SETTING: RECRUITMENT AND CLASSES OCCURRED IN AN ACADEMIC SAFETY-NET HOSPITAL AND FIVE AFFILIATED COMMUNITY HEALTH CENTERS IN BOSTON, MASSACHUSETTS. PARTICIPANTS: NINETY-FIVE ADULTS WITH NONSPECIFIC CLBP, AGES RANGING FROM 20-64 (MEAN 48) YEARS; 72 WOMEN AND 23 MEN. OUTCOME MEASURES: PRIMARY OUTCOMES WERE CHANGES IN BACK-RELATED FUNCTION (MODIFIED ROLAND-MORRIS DISABILITY QUESTIONNAIRE, RMDQ; 0-23) AND MEAN LOW BACK PAIN INTENSITY (0-10) IN THE PREVIOUS WEEK, FROM BASELINE TO WEEK 12. RESULTS: ADJUSTING FOR GROUP ASSIGNMENT, BASELINE RMDQ, AGE, AND GENDER, FOREIGN NATIONALITY AND LOWER BASELINE SF36 PHYSICAL COMPONENT SCORE (PCS) WERE INDEPENDENTLY ASSOCIATED WITH IMPROVEMENT IN RMDQ. GREATER THAN HIGH SCHOOL EDUCATION LEVEL, CLBP LESS THAN 1 YEAR, AND LOWER BASELINE SF36 PCS WERE INDEPENDENTLY ASSOCIATED WITH IMPROVEMENT IN PAIN INTENSITY. OTHER DEMOGRAPHICS INCLUDING RACE, INCOME, GENDER, BMI, AND USE OF PAIN MEDICATIONS WERE NOT ASSOCIATED WITH EITHER OUTCOME. CONCLUSIONS: POOR PHYSICAL HEALTH AT BASELINE IS ASSOCIATED WITH GREATER IMPROVEMENT FROM YOGA IN BACK-RELATED FUNCTION AND PAIN. RACE, INCOME, AND BODY MASS INDEX DO NOT AFFECT THE POTENTIAL FOR A PERSON WITH LOW BACK PAIN TO EXPERIENCE BENEFIT FROM YOGA.	2014	
                                                                                                                                                                                         
13 2638  46 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	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
14  465  52 CHARACTERISTICS AND PREDICTORS OF SHORT-TERM OUTCOMES IN INDIVIDUALS SELF-SELECTING YOGA OR PHYSICAL THERAPY FOR TREATMENT OF CHRONIC LOW BACK PAIN. OBJECTIVE: 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. DESIGN: DESCRIPTIVE, LONGITUDINAL STUDY. SETTINGS: A HOSPITAL-BASED CLINIC THAT OFFERS MODIFIED INTEGRAL YOGA CLASSES FOR CLBP AND 2 OUTPATIENT PT CLINICS THAT OFFER EXERCISE-BASED PT. PARTICIPANTS: ADULTS (N=53) WITH CLBP>/=12 WEEKS: YOGA (N=27), PT (N=26). METHODS: 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 CHI2 AND INDEPENDENT SAMPLES T-TESTS. HIERARCHICAL LINEAR REGRESSION WAS USED TO PREDICT TREATMENT OUTCOMES. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSION: 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.	2010	
                                                                                                                                                                                                                                                                        
15  638  51 DO PHYSICAL THERAPY AND YOGA IMPROVE PAIN AND DISABILITY THROUGH PSYCHOLOGICAL MECHANISMS? A CAUSAL MEDIATION ANALYSIS OF ADULTS WITH CHRONIC LOW BACK PAIN. OBJECTIVE: TO INVESTIGATE WHETHER INDIRECT EFFECTS VIA PSYCHOLOGICAL MECHANISMS EXPLAIN THE EFFECTS OF PHYSICAL THERAPY (PT) OR YOGA, VERSUS EDUCATION, ON BACK-RELATED OUTCOMES. DESIGN: MEDIATION ANALYSES USING DATA FROM A RANDOMIZED CONTROLLED TRIAL OF PT, YOGA, AND EDUCATION INTERVENTIONS FOR CHRONIC LOW BACK PAIN. METHODS: PRIMARY OUTCOMES WERE CHANGES IN BACK-RELATED PAIN ON THE 11-POINT NUMERICAL RATING SCALE AND DISABILITY ON THE MODIFIED 23-POINT ROLAND MORRIS DISABILITY QUESTIONNAIRE, MEASURED AT 52-WEEKS POST-RANDOMIZATION. HYPOTHESIZED MEDIATORS WERE 12-WEEK CHANGES IN PAIN SELF-EFFICACY, FEAR AVOIDANCE BELIEFS, DEPRESSION, ANXIETY, PERCEIVED STRESS, AND SLEEP QUALITY. WE USED CAUSAL MEDIATION ANALYSIS TO ESTIMATE THE TOTAL EFFECT, DIRECT EFFECT, INDIRECT EFFECT, AND PROPORTION MEDIATED. RESULTS: WE ANALYZED DATA FROM 230 ADULTS (MEAN AGE = 46.2 YEARS, 69.6% FEMALE, 79.6% NON-WHITE). IN THE PT VERSUS EDUCATION MODEL, WHEN THE MEDIATOR WAS PERCEIVED STRESS, THE TOTAL EFFECT ON DISABILITY WAS 2.6 POINTS (95% CI: 0.3, 4.9) AND DECOMPOSED INTO A DIRECT EFFECT OF 1.7 POINTS (95% CI: -0.4, 3.8) AND AN INDIRECT EFFECT 0.9 POINTS (95% CI: 0.1, 2.0; PROPORTION MEDIATED 34%). NO OTHER PSYCHOLOGICAL CONSTRUCT WAS A SIGNIFICANT MEDIATOR. CONCLUSION: IMPROVEMENTS IN PERCEIVED STRESS MEDIATED IMPROVEMENTS IN DISABILITY AFTER PT TREATMENT COMPARED TO EDUCATION. OTHER PSYCHOLOGICAL OUTCOMES DID NOT MEDIATE THE EFFECT OF YOGA OR PT ON PAIN OR DISABILITY OUTCOMES COMPARED TO EDUCATION. J ORTHOP SPORTS PHYS THER, EPUB 18 MAY 2022. DOI:10.2519/JOSPT.2022.10813.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
16  388  49 BENEFITS OF THE RESTORATIVE EXERCISE AND STRENGTH TRAINING FOR OPERATIONAL RESILIENCE AND EXCELLENCE YOGA PROGRAM FOR CHRONIC LOW BACK PAIN IN SERVICE MEMBERS: A PILOT RANDOMIZED CONTROLLED TRIAL. OBJECTIVE: TO EXAMINE THE FEASIBILITY AND PRELIMINARY EFFECTIVENESS OF AN INDIVIDUALIZED YOGA PROGRAM. DESIGN: PILOT RANDOMIZED CONTROLLED TRIAL. SETTING: MILITARY MEDICAL CENTER. PARTICIPANTS: PATIENTS (N=68) WITH CHRONIC LOW BACK PAIN. INTERVENTIONS: RESTORATIVE EXERCISE AND STRENGTH TRAINING FOR OPERATIONAL RESILIENCE AND EXCELLENCE (RESTORE) PROGRAM (9-12 INDIVIDUAL YOGA SESSIONS) OR TREATMENT AS USUAL (CONTROL) FOR AN 8-WEEK PERIOD. MAIN OUTCOME MEASURES: THE PRIMARY OUTCOME WAS PAST 24-HOUR PAIN (DEFENSE & VETERANS PAIN RATING SCALE 2.0). SECONDARY OUTCOMES INCLUDED DISABILITY (ROLAND-MORRIS DISABILITY QUESTIONNAIRE) AND PHYSICAL FUNCTIONING AND SYMPTOM BURDEN (PATIENT-REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM-29 SUBSCALES). ASSESSMENT OCCURRED AT BASELINE, WEEK 4, WEEK 8, 3-MONTH FOLLOW-UP, AND 6-MONTH FOLLOW-UP. EXPLORATORY OUTCOMES INCLUDED THE PROPORTION OF PARTICIPANTS IN EACH GROUP REPORTING CLINICALLY MEANINGFUL CHANGES AT 3- AND 6-MONTH FOLLOW-UPS. RESULTS: GENERALIZED LINEAR MIXED MODELS WITH SEQUENTIAL BONFERRONI-ADJUSTED PAIRWISE SIGNIFICANCE TESTS AND CHI-SQUARE ANALYSES EXAMINED LONGITUDINAL OUTCOMES. SECONDARY OUTCOME SIGNIFICANCE TESTS WERE BONFERRONI ADJUSTED FOR MULTIPLE OUTCOMES. THE RESTORE GROUP REPORTED IMPROVED PAIN COMPARED WITH THE CONTROL GROUP. SECONDARY OUTCOMES DID NOT RETAIN SIGNIFICANCE AFTER BONFERRONI ADJUSTMENTS FOR MULTIPLE OUTCOMES, ALTHOUGH A HIGHER PROPORTION OF RESTORE PARTICIPANTS REPORTED CLINICALLY MEANINGFULLY CHANGES IN ALL OUTCOMES AT 3-MONTH FOLLOW-UP AND IN SYMPTOM BURDEN AT 6-MONTH FOLLOW-UP. CONCLUSIONS: RESTORE MAY BE A VIABLE NONPHARMACOLOGICAL TREATMENT FOR LOW BACK PAIN WITH MINIMAL SIDE EFFECTS, AND RESEARCH EFFORTS ARE NEEDED TO COMPARE THE EFFECTIVENESS OF RESTORE DELIVERY FORMATS (EG, GROUP VS INDIVIDUAL) WITH THAT OF OTHER TREATMENT MODALITIES.	2018	
                                                                                                                                                                                                                                                                                                                                                                                                                                                    
17 2877  37 YOGA-SPECIFIC ENHANCEMENT OF QUALITY OF LIFE AMONG WOMEN WITH BREAST CANCER: SYSTEMATIC REVIEW AND EXPLORATORY META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. PHYSICAL ACTIVITIES DURING AND AFTER CANCER TREATMENT HAVE FAVORABLE PSYCHOSOCIAL EFFECTS. INCREASINGLY, YOGA HAS BECOME A POPULAR APPROACH TO IMPROVING THE QUALITY OF LIFE (QOL) OF WOMEN WITH BREAST CANCER. HOWEVER, THE EXTANT SYNTHETIC EVIDENCE ON YOGA HAS NOT USED OTHER EXERCISE COMPARISON CONDITIONS. THIS META-ANALYSIS AIMED TO SYSTEMATICALLY ASSESS YOGA-SPECIFIC EFFECTS RELATIVE TO ANY OTHER PHYSICAL EXERCISE INTERVENTION (EG, AEROBICS) FOR WOMEN WITH BREAST CANCER. QOL WAS THE PRIMARY OUTCOME OF INTEREST. EIGHT RANDOMIZED CONTROLLED TRIALS WITH 545 PARTICIPANTS WERE INCLUDED. THE SAMPLE-WEIGHTED SYNTHESIS AT IMMEDIATE POSTINTERVENTION REVEALED MARGINALLY STATISTICALLY AND MODEST PRACTICALLY SIGNIFICANT DIFFERENCES SUGGESTING YOGA'S POTENTIALLY GREATER EFFECTIVENESS: D = 0.14, P = .10. HOWEVER, AT LONGER TERM FOLLOW-UP, NO STATISTICALLY OR PRACTICALLY SIGNIFICANT BETWEEN-GROUP DIFFERENCE WAS OBSERVED. THIS META-ANALYSIS PRELIMINARILY DEMONSTRATED THAT YOGA IS PROBABLY AS EFFECTIVE AS OTHER EXERCISE MODALITIES IN IMPROVING THE QOL OF WOMEN WITH BREAST CANCER. BOTH INTERVENTIONS WERE ASSOCIATED WITH CLINICALLY SIGNIFICANT IMPROVEMENTS IN QOL. NEARLY ALL OF THE YOGA INTERVENTION PROGRAMS, HOWEVER, WERE VERY POORLY RESOURCED. LARGER AND BETTER CONTROLLED TRIALS OF WELL-ENDOWED YOGA PROGRAMS ARE NEEDED.	2019	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
18  161  42 A RANDOMISED CONTROLLED TRIAL OF ADJUNCTIVE YOGA AND ADJUNCTIVE PHYSICAL EXERCISE TRAINING FOR COGNITIVE DYSFUNCTION IN SCHIZOPHRENIA. BACKGROUND: YOGA AND PHYSICAL EXERCISE HAVE BEEN USED AS ADJUNCTIVE INTERVENTION FOR COGNITIVE DYSFUNCTION IN SCHIZOPHRENIA (SZ), BUT CONTROLLED COMPARISONS ARE LACKING. AIMS A SINGLE-BLIND RANDOMISED CONTROLLED TRIAL WAS DESIGNED TO EVALUATE WHETHER YOGA TRAINING OR PHYSICAL EXERCISE TRAINING ENHANCE COGNITIVE FUNCTIONS IN SZ, BASED ON A PRIOR PILOT STUDY. METHODS: CONSENTING, CLINICALLY STABLE, ADULT OUTPATIENTS WITH SZ (N=286) COMPLETED BASELINE ASSESSMENTS AND WERE RANDOMISED TO TREATMENT AS USUAL (TAU), SUPERVISED YOGA TRAINING WITH TAU (YT) OR SUPERVISED PHYSICAL EXERCISE TRAINING WITH TAU (PE). BASED ON THE PILOT STUDY, THE PRIMARY OUTCOME MEASURE WAS SPEED INDEX FOR THE COGNITIVE DOMAIN OF 'ATTENTION' IN THE PENN COMPUTERISED NEUROCOGNITIVE BATTERY. USING MIXED MODELS AND CONTRASTS, COGNITIVE FUNCTIONS AT BASELINE, 21 DAYS (END OF TRAINING), 3 AND 6 MONTHS POST-TRAINING WERE EVALUATED WITH INTENTION-TO-TREAT PARADIGM. RESULTS: SPEED INDEX OF ATTENTION DOMAIN IN THE YT GROUP SHOWED GREATER IMPROVEMENT THAN PE AT 6 MONTHS FOLLOW-UP (P<0.036, EFFECT SIZE 0.51). IN THE PE GROUP, 'ACCURACY INDEX OF ATTENTION DOMAIN SHOWED GREATER IMPROVEMENT THAN TAU ALONE AT 6-MONTH FOLLOW-UP (P<0.025, EFFECT SIZE 0.61). FOR SEVERAL OTHER COGNITIVE DOMAINS, SIGNIFICANT IMPROVEMENTS WERE OBSERVED WITH YT OR PE COMPARED WITH TAU ALONE (P<0.05, EFFECT SIZES 0.30-1.97). CONCLUSIONS: BOTH YT AND PE IMPROVED ATTENTION AND ADDITIONAL COGNITIVE DOMAINS WELL PAST THE TRAINING PERIOD, SUPPORTING OUR PRIOR REPORTED BENEFICIAL EFFECT OF YT ON SPEED INDEX OF ATTENTION DOMAIN. AS ADJUNCTS, YT OR PE CAN BENEFIT INDIVIDUALS WITH SZ.	2017	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
19 1866  42 RANDOMIZED TRIAL OF TIBETAN YOGA IN PATIENTS WITH BREAST CANCER UNDERGOING CHEMOTHERAPY. BACKGROUND: THE CURRENT RANDOMIZED TRIAL EXAMINED THE EFFECTS OF A TIBETAN YOGA PROGRAM (TYP) VERSUS A STRETCHING PROGRAM (STP) AND USUAL CARE (UC) ON SLEEP AND FATIGUE IN WOMEN WITH BREAST CANCER WHO WERE UNDERGOING CHEMOTHERAPY. METHODS: WOMEN WITH STAGE (AMERICAN JOINT COMMITTEE ON CANCER (AJCC) TNM) I TO III BREAST CANCER WHO WERE UNDERGOING CHEMOTHERAPY WERE RANDOMIZED TO TYP (74 WOMEN), STP (68 WOMEN), OR UC (85 WOMEN). PARTICIPANTS IN THE TYP AND STP GROUPS PARTICIPATED IN 4 SESSIONS DURING CHEMOTHERAPY, FOLLOWED BY 3 BOOSTER SESSIONS OVER THE SUBSEQUENT 6 MONTHS, AND WERE ENCOURAGED TO PRACTICE AT HOME. SELF-REPORT MEASURES OF SLEEP DISTURBANCES (PITTSBURGH SLEEP QUALITY INDEX), FATIGUE (BRIEF FATIGUE INVENTORY), AND ACTIGRAPHY WERE COLLECTED AT BASELINE; 1 WEEK AFTER TREATMENT; AND AT 3, 6, AND 12 MONTHS. RESULTS: THERE WERE NO GROUP DIFFERENCES NOTED IN TOTAL SLEEP DISTURBANCES OR FATIGUE LEVELS OVER TIME. HOWEVER, PATIENTS IN THE TYP GROUP REPORTED FEWER DAILY DISTURBANCES 1 WEEK AFTER TREATMENT COMPARED WITH THOSE IN THE STP (DIFFERENCE, -0.43; 95% CONFIDENCE INTERVAL [95% CI], -0.82 TO -0.04 [P = .03]) AND UC (DIFFERENCE, -0.41; 95% CI, -0.77 TO -0.05 [P = .02]) GROUPS. GROUP DIFFERENCES AT THE OTHER TIME POINTS WERE MAINTAINED FOR TYP VERSUS STP. ACTIGRAPHY DATA REVEALED GREATER MINUTES AWAKE AFTER SLEEP ONSET FOR PATIENTS IN THE STP GROUP 1 WEEK AFTER TREATMENT VERSUS THOSE IN THE TYP (DIFFERENCE, 15.36; 95% CI, 7.25-23.48 [P = .0003]) AND UC (DIFFERENCE, 14.48; 95% CI, 7.09-21.87 [P = .0002]) GROUPS. PATIENTS IN THE TYP GROUP WHO PRACTICED AT LEAST 2 TIMES A WEEK DURING FOLLOW-UP REPORTED BETTER PITTSBURGH SLEEP QUALITY INDEX AND ACTIGRAPHY OUTCOMES AT 3 MONTHS AND 6 MONTHS AFTER TREATMENT COMPARED WITH THOSE WHO DID NOT AND BETTER OUTCOMES COMPARED WITH THOSE IN THE UC GROUP. CONCLUSIONS: PARTICIPATING IN TYP DURING CHEMOTHERAPY RESULTED IN MODEST SHORT-TERM BENEFITS IN SLEEP QUALITY, WITH LONG-TERM BENEFITS EMERGING OVER TIME FOR THOSE WHO PRACTICED TYP AT LEAST 2 TIMES A WEEK. CANCER 2018;124:36-45. (C) 2017 AMERICAN CANCER SOCIETY.	2018	
                                                                                                                                                                                                                                                                                                             
20 1240  37 FEASIBILITY OF A MINDFUL YOGA PROGRAM FOR WOMEN WITH METASTATIC BREAST CANCER: RESULTS OF A RANDOMIZED PILOT STUDY. PURPOSE: PATIENTS WITH METASTATIC BREAST CANCER (MBC) EXPERIENCE HIGH LEVELS OF SYMPTOMS. YOGA INTERVENTIONS HAVE SHOWN PROMISE FOR IMPROVING CANCER SYMPTOMS BUT HAVE RARELY BEEN TESTED IN PATIENTS WITH ADVANCED DISEASE. THIS STUDY EXAMINED THE ACCEPTABILITY OF A COMPREHENSIVE YOGA PROGRAM FOR MBC AND THE FEASIBILITY OF CONDUCTING A RANDOMIZED TRIAL TESTING THE INTERVENTION. METHODS: SIXTY-THREE WOMEN WITH MBC WERE RANDOMIZED WITH A 2:1 ALLOCATION TO YOGA OR A SUPPORT GROUP COMPARISON CONDITION. BOTH INTERVENTIONS INVOLVED EIGHT WEEKLY GROUP SESSIONS. FEASIBILITY WAS QUANTIFIED USING RATES OF ACCRUAL, ATTRITION, AND SESSION ATTENDANCE. ACCEPTABILITY WAS ASSESSED WITH A STANDARDIZED SELF-REPORT MEASURE. PAIN, FATIGUE, SLEEP QUALITY, PSYCHOLOGICAL DISTRESS, MINDFULNESS, AND FUNCTIONAL CAPACITY WERE ASSESSED AT BASELINE, POST-INTERVENTION, AND 3 AND 6 MONTHS POST-INTERVENTION. RESULTS: WE MET GOALS FOR ACCRUAL AND RETENTION, WITH 50% OF ELIGIBLE PATIENTS ENROLLED AND 87% OF RANDOMIZED PARTICIPANTS COMPLETING POST-INTERVENTION SURVEYS. SIXTY-FIVE PERCENT OF WOMEN IN THE YOGA CONDITION AND 90% IN THE SUPPORT GROUP ATTENDED >/= 4 SESSIONS. EIGHTY PERCENT OF PARTICIPANTS IN THE YOGA CONDITION AND 65% IN THE SUPPORT GROUP INDICATED THAT THEY WERE HIGHLY SATISFIED WITH THE INTERVENTION. FOLLOWING TREATMENT, WOMEN IN THE YOGA INTERVENTION HAD MODEST IMPROVEMENTS IN SOME OUTCOMES; HOWEVER, OVERALL SYMPTOM LEVELS WERE LOW FOR WOMEN IN BOTH CONDITIONS. CONCLUSIONS: FINDINGS SUGGEST THAT THE YOGA INTERVENTION CONTENT WAS HIGHLY ACCEPTABLE TO PATIENTS WITH MBC, BUT THAT THERE ARE CHALLENGES TO IMPLEMENTING AN INTERVENTION INVOLVING EIGHT GROUP-BASED IN-PERSON SESSIONS. ALTERNATIVE MODES OF DELIVERY MAY BE NECESSARY TO REACH PATIENTS MOST IN NEED OF INTERVENTION.	2019