1 633 131 DISC EXTRUSIONS AND BULGES IN NONSPECIFIC LOW BACK PAIN AND SCIATICA: EXPLORATORY RANDOMISED CONTROLLED TRIAL COMPARING YOGA THERAPY AND NORMAL MEDICAL TREATMENT. BACKGROUND: PREVIOUS TRIALS OF YOGA THERAPY FOR NONSPECIFIC LOW BACK PAIN (NSLBP) (WITHOUT SCIATICA) SHOWED BENEFICIAL EFFECTS. OBJECTIVE: TO TEST EFFECTS OF YOGA THERAPY ON PAIN AND DISABILITY ASSOCIATED WITH LUMBAR DISC EXTRUSIONS AND BULGES. METHODS: PARALLEL-GROUP, RANDOMISED, CONTROLLED TRIAL. SIXTY-ONE ADULTS FROM RURAL POPULATION, AGED 20-45, WITH NSLBP OR SCIATICA, AND DISC EXTRUSIONS OR BULGES. RANDOMISED TO YOGA (N=30) AND CONTROL (N=31). YOGA: 3-MONTH YOGA COURSE OF GROUP CLASSES AND HOME PRACTICE, DESIGNED TO ENSURE SAFETY FOR DISC EXTRUSIONS. CONTROL: NORMAL MEDICAL CARE. OUTCOME MEASURES (3-4 MONTHS) PRIMARY: ROLAND MORRIS DISABILITY QUESTIONNAIRE (RMDQ); WORST PAIN IN PAST TWO WEEKS. SECONDARY: ABERDEEN LOW BACK PAIN SCALE; STRAIGHT LEG RAISE TEST; STRUCTURAL CHANGES. RESULTS: DISC PROJECTIONS PER CASE RANGED FROM ONE BULGE OR ONE EXTRUSION TO THREE BULGES PLUS TWO EXTRUSIONS. SIXTY-TWO PERCENT HAD SCIATICA. INTENTION-TO-TREAT ANALYSIS OF THE RMDQ DATA, ADJUSTED FOR AGE, SEX AND BASELINE RMDQ SCORES, GAVE A YOGA GROUP SCORE 3.29 POINTS LOWER THAN CONTROL GROUP (0.98, 5.61; P=0.006) AT 3 MONTHS. NO OTHER SIGNIFICANT DIFFERENCES IN THE ENDPOINTS OCCURRED. NO ADVERSE EFFECTS OF YOGA WERE REPORTED. CONCLUSIONS: YOGA THERAPY CAN BE SAFE AND BENEFICIAL FOR PATIENTS WITH NSLBP OR SCIATICA, ACCOMPANIED BY DISC EXTRUSIONS AND BULGES. 2015 2 2408 27 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 3 137 41 A PRELIMINARY RANDOMISED CONTROL TRIAL OF THE EFFECTS OF DRU YOGA ON PSYCHOLOGICAL WELL-BEING IN NORTHERN IRISH FIRST TIME MOTHERS. BACKGROUND: THE TRANSITION TO MOTHERHOOD CAN BE STRESSFUL, ESPECIALLY FOR FIRST TIME MOTHERS. RECENT RESEARCH HAS SHOWN THAT YOGA CAN BE EFFECTIVE FOR ENHANCING PSYCHOLOGICAL WELL-BEING. OBJECTIVES: THE PURPOSE OF THIS STUDY WAS TO ESTABLISH IF A POSTPARTUM DRU YOGA INTERVENTION IMPROVES PSYCHOLOGICAL WELL-BEING IN FIRST TIME MOTHERS. DESIGN: A RANDOMISED CONTROLLED STUDY WAS CONDUCTED. SETTING AND PARTICIPANTS: FIRST TIME MOTHERS WERE RECRUITED FROM A SURE START COMMUNITY CENTRE AND INCLUDED IN THE STUDY IF THEY HAD A BABY AGED BETWEEN 6 WEEKS TO ONE-YEAR-OLD. EXCLUSION CRITERIA WERE THE PRESENCE OF SCIATICA, BULGING DISCS, HEART DISEASE OR WHIPLASH AND IF THEY ALREADY PRACTICED YOGA. METHODS: PARTICIPANTS WERE RANDOMISED INTO A DRU YOGA GROUP (N=16) WHO RECEIVED A ONE-HOUR DRU YOGA SESSION EACH WEEK FOR 4 WEEKS AND A 20-MINUTE DVD FOR PRACTICE AT HOME. THE CONTROL GROUP (N=16) WHO DID NOT RECEIVE AN INTERVENTION. BASELINE AND FOLLOW UP MEASURES OF PERCEIVED STRESS, MOOD AND COPING WERE ASSESSED IN EACH GROUP. RESULTS: A REPEATED MEASURES FACTORIAL ANALYSIS OF VARIANCE SHOWED THAT IN COMPARISON TO THE CONTROL GROUP, THE DRU YOGA INTERVENTION GROUP HAD IMPROVED PSYCHOLOGICAL WELL-BEING AS INDICATED BY REDUCTIONS IN STRESS, NEGATIVE AFFECT, AND DYSFUNCTIONAL COPING AND INCREASES IN PROBLEM FOCUSED COPING AT FOLLOW UP (P<0.05). CONCLUSION: THE CURRENT STUDY SHOWS THAT DRU YOGA IS BENEFICIAL FOR THE PSYCHOLOGICAL WELL-BEING OF FIRST TIME MOTHERS. FURTHER RESEARCH IS NEEDED USING LARGE SCALE REPLICATION STUDIES WITH A LONGER FOLLOW UP PERIOD AND INCLUDING MULTIPAROUS WOMEN. THIS STUDY EXTENDS THE SUPPORT FOR YOGA WITH POSTPARTUM MOTHERS. 2017 4 2831 41 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 5 2852 49 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 6 162 55 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 2610 44 YOGA FOR REDUCING PERCEIVED STRESS AND BACK PAIN AT WORK. BACKGROUND: STRESS AND BACK PAIN ARE TWO KEY FACTORS LEADING TO SICKNESS ABSENCE AT WORK. RECENT RESEARCH INDICATES THAT YOGA CAN BE EFFECTIVE FOR REDUCING PERCEIVED STRESS, ALLEVIATING BACK PAIN, AND IMPROVING PSYCHOLOGICAL WELL-BEING. AIMS: TO DETERMINE THE EFFECTIVENESS OF A YOGA-BASED INTERVENTION FOR REDUCING PERCEIVED STRESS AND BACK PAIN AT WORK. METHODS: PARTICIPANTS WERE RECRUITED FROM A BRITISH LOCAL GOVERNMENT AUTHORITY AND RANDOMIZED INTO A YOGA GROUP WHO RECEIVED ONE 50 MIN DRU YOGA SESSION EACH WEEK FOR 8 WEEKS AND A 20 MIN DVD FOR HOME PRACTICE AND A CONTROL GROUP WHO RECEIVED NO INTERVENTION. BASELINE AND END-PROGRAMME MEASUREMENTS OF SELF-REPORTED STRESS, BACK PAIN AND PSYCHOLOGICAL WELL-BEING WERE ASSESSED WITH THE PERCEIVED STRESS SCALE, ROLAND MORRIS DISABILITY QUESTIONNAIRE AND THE POSITIVE AND NEGATIVE AFFECT SCALE. RESULTS: THERE WERE 37 PARTICIPANTS IN EACH GROUP. ANALYSIS OF VARIANCE AND MULTIPLE LINEAR REGRESSION SHOWED THAT IN COMPARISON TO THE CONTROL GROUP, THE YOGA GROUP REPORTED SIGNIFICANT REDUCTIONS IN PERCEIVED STRESS AND BACK PAIN, AND A SUBSTANTIAL IMPROVEMENT IN PSYCHOLOGICAL WELL-BEING. WHEN COMPARED WITH THE CONTROL GROUP AT THE END OF THE PROGRAMME, THE YOGA GROUP SCORES WERE SIGNIFICANTLY LOWER FOR PERCEIVED STRESS, BACK PAIN, SADNESS AND HOSTILITY, AND SUBSTANTIALLY HIGHER FOR FEELING SELF-ASSURED, ATTENTIVE AND SERENE. CONCLUSIONS: THE RESULTS INDICATE THAT A WORKPLACE YOGA INTERVENTION CAN REDUCE PERCEIVED STRESS AND BACK PAIN AND IMPROVE PSYCHOLOGICAL WELL-BEING. LARGER RANDOMIZED CONTROLLED TRIALS ARE NEEDED TO DETERMINE THE BROADER EFFICACY OF YOGA FOR IMPROVING WORKPLACE PRODUCTIVITY AND REDUCING SICKNESS ABSENCE. 2012 8 2824 47 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 9 2813 20 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 10 2560 54 YOGA FOR CHRONIC LOW BACK PAIN: A RANDOMIZED TRIAL. BACKGROUND: PREVIOUS STUDIES INDICATE THAT YOGA MAY BE AN EFFECTIVE TREATMENT FOR CHRONIC OR RECURRENT LOW BACK PAIN. OBJECTIVE: TO COMPARE THE EFFECTIVENESS OF YOGA AND USUAL CARE FOR CHRONIC OR RECURRENT LOW BACK PAIN. DESIGN: PARALLEL-GROUP, RANDOMIZED, CONTROLLED TRIAL USING COMPUTER-GENERATED RANDOMIZATION CONDUCTED FROM APRIL 2007 TO MARCH 2010. OUTCOMES WERE ASSESSED BY POSTAL QUESTIONNAIRE. (INTERNATIONAL STANDARD RANDOMISED CONTROLLED TRIAL NUMBER REGISTER: ISRCTN 81079604) SETTING: 13 NON-NATIONAL HEALTH SERVICE PREMISES IN THE UNITED KINGDOM. PATIENTS: 313 ADULTS WITH CHRONIC OR RECURRENT LOW BACK PAIN. INTERVENTION: YOGA (N = 156) OR USUAL CARE (N = 157). ALL PARTICIPANTS RECEIVED A BACK PAIN EDUCATION BOOKLET. THE INTERVENTION GROUP WAS OFFERED A 12-CLASS, GRADUALLY PROGRESSING YOGA PROGRAM DELIVERED BY 12 TEACHERS OVER 3 MONTHS. MEASUREMENTS: SCORES ON THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE (RMDQ) AT 3 (PRIMARY OUTCOME), 6, AND 12 (SECONDARY OUTCOMES) MONTHS; PAIN, PAIN SELF-EFFICACY, AND GENERAL HEALTH MEASURES AT 3, 6, AND 12 MONTHS (SECONDARY OUTCOMES). RESULTS: 93 (60%) PATIENTS OFFERED YOGA ATTENDED AT LEAST 3 OF THE FIRST 6 SESSIONS AND AT LEAST 3 OTHER SESSIONS. THE YOGA GROUP HAD BETTER BACK FUNCTION AT 3, 6, AND 12 MONTHS THAN THE USUAL CARE GROUP. THE ADJUSTED MEAN RMDQ SCORE WAS 2.17 POINTS (95% CI, 1.03 TO 3.31 POINTS) LOWER IN THE YOGA GROUP AT 3 MONTHS, 1.48 POINTS (CI, 0.33 TO 2.62 POINTS) LOWER AT 6 MONTHS, AND 1.57 POINTS (CI, 0.42 TO 2.71 POINTS) LOWER AT 12 MONTHS. THE YOGA AND USUAL CARE GROUPS HAD SIMILAR BACK PAIN AND GENERAL HEALTH SCORES AT 3, 6, AND 12 MONTHS, AND THE YOGA GROUP HAD HIGHER PAIN SELF-EFFICACY SCORES AT 3 AND 6 MONTHS BUT NOT AT 12 MONTHS. TWO OF THE 157 USUAL CARE PARTICIPANTS AND 12 OF THE 156 YOGA PARTICIPANTS REPORTED ADVERSE EVENTS, MOSTLY INCREASED PAIN. LIMITATION: THERE WERE MISSING DATA FOR THE PRIMARY OUTCOME (YOGA GROUP, N = 21; USUAL CARE GROUP, N = 18) AND DIFFERENTIAL MISSING DATA (MORE IN THE YOGA GROUP) FOR SECONDARY OUTCOMES. CONCLUSION: OFFERING A 12-WEEK YOGA PROGRAM TO ADULTS WITH CHRONIC OR RECURRENT LOW BACK PAIN LED TO GREATER IMPROVEMENTS IN BACK FUNCTION THAN DID USUAL CARE. PRIMARY FUNDING SOURCE: ARTHRITIS RESEARCH UK. 2011 11 2638 41 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 12 2596 52 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 13 193 41 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 14 521 45 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 15 1699 44 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 16 724 39 EFFECT OF LAUGHTER YOGA ON MOOD AND HEART RATE VARIABILITY IN PATIENTS AWAITING ORGAN TRANSPLANTATION: A PILOT STUDY. CONTEXT: RESEARCH SHOWS THAT LAUGHTER HAS MYRIAD HEALTH BENEFITS, YET THE MEDICAL COMMUNITY HAS NOT IMPLEMENTED IT FORMALLY AS A TREATMENT. PATIENTS AWAITING ORGAN TRANSPLANTATION HAVE SIGNIFICANT PHYSICAL DISABILITIES AND ARE AT RISK FOR PSYCHOLOGICAL DISTRESS. ATTENUATED HEART RATE VARIABILITY (HRV) IS A RISK FACTOR FOR A NEGATIVE LONG-TERM OUTCOME IN SOME PATIENTS. OBJECTIVE: THE STUDY INTENDED TO EVALUATE THE CLINICAL UTILITY OF LAUGHTER YOGA IN IMPROVING PSYCHOLOGICAL AND PHYSIOLOGICAL MEASURES IN OUTPATIENTS AWAITING ORGAN TRANSPLANTATION. POSITIVE RESULTS WOULD INDICATE PROMISING AREAS TO PURSUE IN A FOLLOW-UP STUDY. DESIGN: SIX PARTICIPANTS MET FOR 10 SESSIONS OVER 4 WEEKS. THE RESEARCH TEAM MEASURED EACH PARTICIPANT'S HEART RATE, HRV, BLOOD PRESSURE (BP), AND IMMEDIATE MOOD BEFORE AND AFTER THE LAUGHTER AND CONTROL INTERVENTIONS. THE TEAM ASSESSED PARTICIPANTS' LONGER-TERM MOOD (ANXIETY AND DEPRESSION) AT THE STUDY'S INITIATION, AFTER A NO-TREATMENT CONTROL WEEK, AND AT THE END OF THE STUDY. SETTING: THE STUDY OCCURRED AT THE DEPARTMENT OF SURGERY AND MEDICINE AT THE UNIVERSITY OF ARIZONA HEALTH SCIENCES CENTER, TUCSON. PARTICIPANTS: PARTICIPANTS WERE PATIENTS AWAITING TRANSPLANTS (THREE HEART AND THREE LUNG), TWO WOMEN AND FOUR MEN (AGES 51-69 Y). PARTICIPANTS HAD RECEIVED NO MAJOR SURGERY IN THE 3 MONTHS PRIOR TO THE INTERVENTION, DID NOT HAVE A HERNIA OR UNCONTROLLED HYPERTENSION, AND DID NOT FALL INTO THE NEW YORK HEART ASSOCIATION FUNCTION CLASS 4. INTERVENTION: THE 20-MINUTE LAUGHTER INTERVENTION INVOLVED BREATHING AND STRETCHING EXERCISES, SIMULATED LAUGHTER (IE, UNCONDITIONAL LAUGHTER THAT IS NOT CONTINGENT ON THE ENVIRONMENT), CHANTING, CLAPPING, AND A MEDITATION. THE 20-MINUTE CONTROL INTERVENTION INVOLVED THE STUDY'S PERSONNEL DISCUSSING HEALTH AND STUDY-RELATED TOPICS WITH THE PARTICIPANTS. OUTCOME MEASURES: THE RESEARCH TEAM MEASURED BP, HEART RATE, AND HRV AND ADMINISTERED THE PROFILE OF MOOD STATES, BECK ANXIETY INVENTORY, AND BECK DEPRESSION INVENTORY-II TO EVALUATE IMMEDIATE AND LONGER-TERM MOOD. THE TEAM HAD PLANNED QUANTITATIVE STATISTICAL ANALYSIS OF THE DATA AT THE STUDY'S INITIATION BUT DID NOT COMPLETE IT BECAUSE THE NUMBER OF ENROLLED PARTICIPANTS WAS TOO LOW FOR THE ANALYSIS TO BE MEANINGFUL. THE TEAM VISUALLY EXAMINED THE DATA, HOWEVER, FOR TRENDS THAT WOULD INDICATE AREAS TO EXAMINE FURTHER IN A FOLLOW-UP STUDY. RESULTS: PARTICIPANTS SHOWED IMPROVED IMMEDIATE MOOD (VIGOR-ACTIVITY AND FRIENDLINESS) AND INCREASED HRV AFTER THE LAUGHTER INTERVENTION. BOTH THE LAUGHTER AND CONTROL INTERVENTIONS APPEARED TO IMPROVE LONGER-TERM ANXIETY. TWO PARTICIPANTS AWAITING A LUNG TRANSPLANT DROPPED OUT OF THE STUDY, AND NO ADVERSE EVENTS OCCURRED. CONCLUSION: THIS PILOT STUDY SUGGESTS THAT LAUGHTER YOGA MAY IMPROVE HRV AND SOME ASPECTS OF MOOD, AND THIS TOPIC WARRANTS FURTHER RESEARCH. 2012 17 131 32 A PRAGMATIC MULTI-CENTRED RANDOMISED CONTROLLED TRIAL OF YOGA FOR CHRONIC LOW BACK PAIN: TRIAL PROTOCOL. UNLABELLED: A SYSTEMATIC REVIEW REVEALED THREE SMALL RANDOMISED CONTROLLED TRIALS OF YOGA FOR LOW BACK PAIN, ALL OF WHICH SHOWED EFFECTS ON BACK PAIN THAT FAVOURED THE YOGA GROUP. TO BUILD ON THESE STUDIES A LARGER TRIAL, WITH LONGER TERM FOLLOW-UP, AND A NUMBER OF DIFFERENT YOGA TEACHERS DELIVERING THE INTERVENTION IS REQUIRED. THIS STUDY PROTOCOL DESCRIBES THE DETAILS OF A RANDOMISED CONTROLLED TRIAL (RCT) TO DETERMINE THE EFFECTIVENESS AND COST-EFFECTIVENESS OF YOGA FOR CHRONIC LOW BACK PAIN, WHICH IS FUNDED BY ARTHRITIS RESEARCH CAMPAIGN (ARC) AND IS BEING CONDUCTED BY THE UNIVERSITY OF YORK. 262 PATIENTS WILL BE RECRUITED FROM GP PRACTICES IN 5 CENTRES IN ENGLAND. PATIENTS WILL BE RANDOMISED TO RECEIVE USUAL CARE OR 12 WEEKLY CLASSES OF YOGA. A YOGA PROGRAMME WILL BE DEVISED THAT CAN BE DELIVERED BY YOGA TEACHERS OF THE TWO MAIN NATIONAL YOGA ORGANISATIONS IN THE UK (BRITISH WHEEL OF YOGA AND IYENGAR YOGA ASSOCIATION (UK)). TRIAL REGISTRATION: CURRENT CONTROLLED TRIALS REGISTRY ISRCTN81079604 (DATE REGISTERED 30/03/2007). 2010 18 132 37 A PRAGMATIC MULTICENTERED RANDOMIZED CONTROLLED TRIAL OF YOGA FOR CHRONIC LOW BACK PAIN: ECONOMIC EVALUATION. STUDY DESIGN: MULTICENTERED RANDOMIZED CONTROLLED TRIAL WITH QUALITY OF LIFE AND RESOURCE USE DATA COLLECTED. OBJECTIVE: THE OBJECTIVE OF THIS STUDY WAS TO EVALUATE THE COST-EFFECTIVENESS OF YOGA INTERVENTION PLUS USUAL CARE COMPARED WITH USUAL CARE ALONE FOR CHRONIC OR RECURRENT LOW BACK PAIN. SUMMARY OF BACKGROUND DATA: YOGA HAS BEEN SHOWN AS AN EFFECTIVE INTERVENTION FOR TREATING CHRONIC OR RECURRENT LOW BACK PAIN. HOWEVER, THERE IS LITTLE EVIDENCE ON ITS COST-EFFECTIVENESS. THE DATA ARE EXTRACTED FROM A PRAGMATIC, MULTICENTERED, RANDOMIZED CONTROLLED TRIAL THAT HAS BEEN CONDUCTED TO EVALUATE THE EFFECTIVENESS AND COST-EFFECTIVENESS OF A 12-WEEK PROGRESSIVE PROGRAM OF YOGA PLUS USUAL CARE IN PATIENTS WITH CHRONIC OR RECURRENT LOW BACK PAIN. METHODS: WITH THIS TRIAL DATA, A COST-EFFECTIVENESS ANALYSIS DURING THE TIME PERIOD OF 12 MONTHS FROM BOTH PERSPECTIVES OF THE UK NATIONAL HEALTH SERVICE AND THE SOCIETAL IS PRESENTED. MAIN OUTCOME MEASURE IS AN INCREMENTAL COST PER QUALITY-ADJUSTED LIFE-YEAR (QALY). RESULTS: FROM THE PERSPECTIVE OF THE U.K. NATIONAL HEALTH SERVICE, YOGA INTERVENTION YIELDS AN INCREMENTAL COST-EFFECTIVENESS RATIO OF POUND13,606 PER QALY. GIVEN A WILLINGNESS TO PAY FOR AN ADDITIONAL QALY OF POUND20,000, THE PROBABILITY OF YOGA INTERVENTION BEING COST-EFFECTIVE IS 72%. FROM THE PERSPECTIVE OF THE SOCIETY, YOGA INTERVENTION IS A DOMINANT TREATMENT COMPARED WITH USUAL CARE ALONE. THIS RESULT IS SURROUNDED BY FEWER UNCERTAINTIES-THE PROBABILITY OF YOGA BEING COST-EFFECTIVE REACHES 95% AT A WILLINGNESS TO PAY FOR AN ADDITIONAL QALY OF POUND20,000. SENSITIVE ANALYSES SUGGEST THE SAME RESULTS THAT YOGA INTERVENTION IS LIKELY TO BE COST-EFFECTIVE IN BOTH PERSPECTIVES. CONCLUSION: ON THE BASIS OF THIS TRIAL, 12 WEEKLY GROUP CLASSES OF SPECIALIZED YOGA ARE LIKELY TO BE A COST-EFFECTIVE INTERVENTION FOR TREATING PATIENTS WITH CHRONIC OR RECURRENT LOW BACK PAIN. 2012 19 536 40 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 20 557 44 COST-EFFECTIVENESS OF YOGA FOR CHRONIC LOW BACK PAIN IN VETERANS. BACKGROUND: YOGA INTERVENTIONS CAN IMPROVE FUNCTION AND REDUCE PAIN IN PERSONS WITH CHRONIC LOW BACK PAIN (CLBP). OBJECTIVE: USING DATA FROM A RECENT TRIAL OF YOGA FOR MILITARY VETERANS WITH CLBP, WE ANALYZED THE INCREMENTAL COST-EFFECTIVENESS OF YOGA COMPARED WITH USUAL CARE. METHODS: PARTICIPANTS (N=150) WERE RANDOMIZED TO EITHER 2X WEEKLY, 60-MINUTE YOGA SESSIONS FOR 12 WEEKS, OR TO DELAYED TREATMENT (DT). OUTCOMES WERE MEASURED AT 12 WEEKS, AND 6 MONTHS. QUALITY-ADJUSTED LIFE YEARS (QALYS) WERE MEASURED USING THE EQ-5D SCALE. A 30% IMPROVEMENT ON THE ROLAND-MORRIS DISABILITY QUESTIONNAIRE (PRIMARY OUTCOME) SERVED AS AN ADDITIONAL EFFECTIVENESS MEASURE. INTERVENTION COSTS INCLUDING PERSONNEL, MATERIALS, AND TRANSPORTATION WERE TRACKED DURING THE STUDY. HEALTH CARE COSTS WERE OBTAINED FROM PATIENT MEDICAL RECORDS. HEALTH CARE ORGANIZATION AND SOCIETAL PERSPECTIVES WERE EXAMINED WITH A 12-MONTH HORIZON. RESULTS: INCREMENTAL QALYS GAINED BY THE YOGA GROUP OVER 12 MONTHS WERE 0.043. INTERVENTION COSTS TO DELIVER YOGA WERE $307/PARTICIPANT. NEGLIGIBLE DIFFERENCES IN HEALTH CARE COSTS WERE FOUND BETWEEN GROUPS. FROM THE HEALTH CARE ORGANIZATION PERSPECTIVE, THE INCREMENTAL COST-EFFECTIVENESS RATIO TO PROVIDE YOGA WAS $4488/QALY. FROM THE SOCIETAL PERSPECTIVE, YOGA WAS "DOMINANT" PROVIDING BOTH HEALTH BENEFIT AND COST SAVINGS. PROBABILISTIC SENSITIVITY ANALYSIS INDICATES AN 89% CHANCE OF YOGA BEING COST-EFFECTIVE AT A WILLINGNESS-TO-PAY OF $50,000. A SCENARIO COMPARING THE COSTS OF YOGA AND PHYSICAL THERAPY SUGGEST THAT YOGA MAY PRODUCE SIMILAR RESULTS AT A MUCH LOWER COST. DISCUSSION/CONCLUSIONS: YOGA IS A COST-EFFECTIVE TREATMENT FOR REDUCING PAIN AND DISABILITY AMONG MILITARY VETERANS WITH CLBP. 2020