1 1613 209 MILITARY-TAILORED YOGA FOR VETERANS WITH POST-TRAUMATIC STRESS DISORDER. INTRODUCTION: AMONG VETERANS OF POST-9/11 CONFLICTS, ESTIMATES OF POST-TRAUMATIC STRESS DISORDER (PTSD) RANGE FROM 9% SHORTLY AFTER RETURNING FROM DEPLOYMENT TO 31% A YEAR AFTER DEPLOYMENT. CLINICAL AND PHARMACEUTICALLY BASED TREATMENTS ARE UNDERUTILIZED. THIS COULD BE DUE TO CONCERNS RELATED TO LOST DUTY DAYS, AS WELL AS PTSD PATIENTS' FEARS OF STIGMA OF HAVING A MENTAL HEALTH CONDITION. YOGA HAS BEEN SHOWN TO REDUCE PTSD SYMPTOMS IN THE CIVILIAN POPULATION, BUT FEW STUDIES HAVE TESTED THE IMPACT OF YOGA ON VETERANS OF POST-9/11 CONFLICTS. THE PURPOSE OF THIS STUDY IS TO TEST THE IMPACT OF YOGA ON POST-9/11 VETERANS DIAGNOSED WITH PTSD. MATERIALS AND METHODS: PARTICIPANTS WERE 18 YR OF AGE OR OLDER AND VETERANS OF POST-9/11 CONFLICTS. THEY HAD SUBTHRESHOLD OR DIAGNOSTIC-LEVEL PTSD RELATED TO THEIR COMBAT MILITARY SERVICE, AS DETERMINED BY A SCORE OF 30 OR HIGHER ON THE PTSD CHECKLIST-MILITARY VERSION (PCL-M). VETERANS PARTICIPATED IN 60-MIN WEEKLY YOGA SESSIONS FOR 6 WK TAUGHT BY A WARRIORS AT EASE-TRAINED YOGA INSTRUCTOR WHO IS A, POST-9/11 VETERAN. THE YOGA SESSIONS INCORPORATED VINYASA-STYLE YOGA AND A TRAUMA-SENSITIVE, MILITARY-CULTURE INFORMED APPROACH ADVOCATED BY TWO SEPARATE ORGANIZATIONS: WARRIORS AT EASE AND MEGHAN'S FOUNDATION. DATA WERE COLLECTED AT BASELINE AND AGAIN AFTER 7 WK. THE PRIMARY OUTCOME WAS PCL-M SCORE. PARTICIPANTS ALSO COMPLETED THE PATIENT HEALTH QUESTIONNAIRE, THE BECK ANXIETY INVENTORY, THE PITTSBURGH SLEEP QUALITY INDEX, AND THE MINDFUL ATTENTION AWARENESS SCALE AT BOTH TIME POINTS. RESULTS: EIGHTEEN OPERATION ENDURING FREEDOM, OPERATION IRAQI FREEDOM, AND OPERATION NEW DAWN VETERANS COMPLETED THE PRE- AND POST-INTERVENTION SELF-REPORT QUESTIONNAIRES. AGE RANGED FROM 26 TO 62 YR (MEDIAN = 43 YR), LENGTH OF SERVICE RANGED FROM 2 TO 34 YR (MEDIAN = 18.8 YR), AND 13 (72.2%) HAD COMPLETED COLLEGE. DECREASED PTSD SYMPTOMATOLOGY WAS DEMONSTRATED IN THE THREE-SYMPTOM CLUSTERS REPRESENTED IN THE PCL-M (I.E., HYPERAROUSAL, RE-EXPERIENCING, AND AVOIDANCE). IN ADDITION, THE TOTAL SCORE ON THE PCL-M DECREASED SIGNIFICANTLY, BY BOTH STATISTICAL AND CLINICAL MEASURES. THE PARTICIPANTS ALSO DEMONSTRATED IMPROVED MINDFULNESS SCORES AND REPORTED DECREASED INSOMNIA, DEPRESSION, AND ANXIETY SYMPTOMS. CONCLUSION: THIS STUDY DEMONSTRATES THAT A TRAUMA-SENSITIVE YOGA INTERVENTION MAY BE EFFECTIVE FOR VETERANS WITH PTSD SYMPTOMS, WHETHER AS STAND-ALONE OR ADJUNCTIVE THERAPY. THE IMPRESSIVE DECREASE IN PTSD SYMPTOMATOLOGY MAY BE DUE TO THE TAILORED MILITARY-SPECIFIC NATURE OF THIS INTERVENTION AND THE FACT THAT IT WAS LED BY A VETERAN OF POST-9/11 CONFLICTS. MORE RESEARCH IS NEEDED WITH A LARGER SAMPLE AND A MORE DIVERSE VETERAN POPULATION.	2018	
                                                                                                                                                               
2   19  53 "WE REALLY NEED THIS": TRAUMA-INFORMED YOGA FOR VETERAN WOMEN WITH A HISTORY OF MILITARY SEXUAL TRAUMA. OBJECTIVES: UP TO 70% OF WOMEN SERVICE MEMBERS IN THE UNITED STATES REPORT MILITARY SEXUAL TRAUMA (MST); MANY DEVELOP POST-TRAUMATIC STRESS DISORDER (PTSD) AND CO-OCCURRING DISORDERS. TRAUMA-INFORMED YOGA (TIY) IS SUGGESTED TO IMPROVE PSYCHIATRIC SYMPTOMS AND SHOWN FEASIBLE AND ACCEPTABLE IN EMERGING RESEARCH, YET NO WORK HAS EVALUATED TIY IN MST SURVIVORS. THE CURRENT QUALITY IMPROVEMENT PROJECT AIMED TO EXAMINE TIY'S FEASIBILITY, ACCEPTABILITY, AND PERCEIVED EFFECTS IN THE CONTEXT OF MST. DESIGN: COLLECTIVE CASE SERIES (N = 7). SETTING: NEW ENGLAND VET CENTER. INTERVENTIONS: EXTANT TIY PROGRAM (MINDFUL YOGA THERAPY) ADAPTED FOR VETERAN WOMEN WITH MST IN CONCURRENT PSYCHOTHERAPY. MAIN OUTCOME MEASURES: ATTRITION AND ATTENDANCE; QUALITATIVE EXIT INTERVIEW; VALIDATED SELF-REPORT MEASURE OF NEGATIVE AFFECT PRE/POST EACH YOGA CLASS, AND SYMPTOM SEVERITY ASSESSMENTS AND SURVEYS BEFORE (T1; TIME 1) AND AFTER THE YOGA PROGRAM (T2; TIME 2). RESULTS: FEASIBILITY WAS DEMONSTRATED AND WOMEN REPORTED TIY WAS ACCEPTABLE. IN QUALITATIVE INTERVIEWS, WOMEN REPORTED IMPROVED SYMPTOM SEVERITY, DIET, EXERCISE, ALCOHOL USE, SLEEP, AND PAIN; REDUCED MEDICATION USE; AND THEMES RELATED TO STRESS REDUCTION, MINDFULNESS, AND SELF-COMPASSION. REGARDING QUANTITATIVE CHANGE, RESULTS SUGGEST ACUTE REDUCTIONS IN NEGATIVE AFFECT FOLLOWING YOGA SESSIONS ACROSS PARTICIPANTS, AS WELL AS IMPROVED AFFECT DYSREGULATION, SHAME, AND MINDFULNESS T1 TO T2. CONCLUSIONS: TIY IS BOTH FEASIBLE AND ACCEPTABLE TO VETERAN WOMEN MST SURVIVORS IN ONE SPECIFIC VET CENTER, WITH PERCEIVED BEHAVIORAL HEALTH BENEFITS. RESULTS SUGGEST TIY MAY TARGET PSYCHOSOCIAL MECHANISMS IMPLICATED IN HEALTH BEHAVIOR CHANGE (STRESS REDUCTION, MINDFULNESS, AFFECT REGULATION, SHAME). FORMAL RESEARCH SHOULD BE CONDUCTED TO CONFIRM THESE QI PROJECT RESULTS.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
3 1541  51 KRIPALU YOGA FOR MILITARY VETERANS WITH PTSD: A RANDOMIZED TRIAL. OBJECTIVES: THIS RANDOMIZED CONTROLLED TRIAL OF YOGA FOR MILITARY VETERANS AND ACTIVE DUTY PERSONNEL WITH POSTTRAUMATIC STRESS DISORDER (PTSD) EVALUATED THE EFFICACY OF A 10-WEEK YOGA INTERVENTION ON PTSD. METHOD: FIFTY-ONE PARTICIPANTS WERE RANDOMIZED INTO YOGA OR NO-TREATMENT ASSESSMENT-ONLY CONTROL GROUPS. PRIMARY OUTCOME MEASURES INCLUDED QUESTIONNAIRES AND THE CLINICIAN ADMINISTERED PTSD SCALE. RESULTS: BOTH YOGA (N = 9) AND CONTROL (N = 6) PARTICIPANTS SHOWED SIGNIFICANT DECREASES IN REEXPERIENCING SYMPTOMS, WITH NO SIGNIFICANT BETWEEN-GROUP DIFFERENCES. SECONDARY WITHIN-GROUP ANALYSES OF A SELF-SELECTED WAIT-LIST YOGA GROUP (N = 7) SHOWED SIGNIFICANT REDUCTIONS IN PTSD SYMPTOMS AFTER YOGA PARTICIPATION, IN CONTRAST TO THEIR CONTROL GROUP PARTICIPATION. CONSISTENT WITH CURRENT LITERATURE REGARDING HIGH RATES OF PTSD TREATMENT DROPOUT FOR VETERANS, THIS STUDY FACED CHALLENGES RETAINING PARTICIPANTS ACROSS CONDITIONS. CONCLUSION: THESE RESULTS ARE CONSISTENT WITH RECENT LITERATURE INDICATING THAT YOGA MAY HAVE POTENTIAL AS A PTSD THERAPY IN A VETERAN OR MILITARY POPULATION. HOWEVER, ADDITIONAL LARGER SAMPLE SIZE TRIALS ARE NECESSARY TO CONFIRM THIS CONCLUSION.	2018	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
4 2641  54 YOGA FOR WARRIORS: AN INTERVENTION FOR VETERANS WITH COMORBID CHRONIC PAIN AND PTSD. OBJECTIVE: COMORBID CHRONIC PAIN AND POSTTRAUMATIC STRESS DISORDER (PTSD) IS COMMON IN VETERANS; THIS COMORBIDITY IS ASSOCIATED WITH INCREASED SEVERITY AND POORER PROGNOSIS WHEN COMPARED TO EACH OUTCOME ALONE. YOGA HAS BEEN SHOWN TO BE EFFECTIVE FOR CHRONIC PAIN AND PROMISING FOR PTSD, BUT YOGA FOR COMORBID PAIN AND PTSD HAS NOT BEEN EXAMINED. THIS ARTICLE OFFERS EMPIRICAL SUPPORT FOR A YOGA INTERVENTION FOR COMORBID CHRONIC PAIN AND PTSD IN A VETERAN POPULATION. METHOD: RESULTS ARE PRESENTED FROM A 4-YEAR PILOT YOGA INTERVENTION FOR COMORBID CHRONIC PAIN AND PTSD AT A LARGE, URBAN VETERANS AFFAIRS MEDICAL CENTER. BASED ON THE FEAR AVOIDANCE MODEL OF PAIN, THE INTERVENTION USED A CROSS-SECTIONAL, OPEN-TRIAL DESIGN WITH PRE- AND POSTMEASURES. T TEST ANALYSES WERE CONDUCTED ON PROGRAM COMPLETERS (N = 49; OUT OF 87 INITIALLY ENROLLED, 44% ATTRITION RATE), WHO WERE PRIMARILY AFRICAN AMERICAN (69%) AND MALE (61%) AND HAD A MEAN AGE OF 51.41 YEARS (SD = 11.32). RESULTS: RESULTS INDICATED TREND-LEVEL REDUCTIONS IN OVERALL PTSD SYMPTOMS, AS MEASURED BY THE PTSD CHECKLIST FOR DSM-5 (P = .02, D = 0.38) AND IN SYMPTOM CLUSTER SCORES OF NEGATIVE ALTERATIONS OF COGNITIONS AND MOOD (P = .03, D = 0.36) AND AROUSAL AND REACTIVITY (P = .03, D = 0.35). VETERANS REPORTED SIGNIFICANT IMPROVEMENT IN ABILITY TO PARTICIPATE IN SOCIAL ACTIVITIES (P < .001, D = 0.44) AND SIGNIFICANT REDUCTIONS IN KINESIOPHOBIA (FEAR OF MOVEMENT OR PHYSICAL ACTIVITY; P < .001, D = 0.85). ON A SATISFACTION MEASURE WITH A RANGE OF 1 (QUITE DISSATISFIED) TO 4 (EXTREMELY SATISFIED), THE MEAN RATING WAS 3.74 (SD = 0.33). CONCLUSION: YOGA IS A FEASIBLE AND EFFECTIVE INTERVENTION FOR VETERANS WITH COMORBID CHRONIC PAIN AND PTSD. (PSYCINFO DATABASE RECORD (C) 2020 APA, ALL RIGHTS RESERVED).	2020	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
5  252  47 A YOGA PROGRAM FOR THE SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER IN VETERANS. THE PURPOSE OF THIS PILOT STUDY WAS TO EVALUATE THE FEASIBILITY AND EFFECTIVENESS OF A YOGA PROGRAM AS AN ADJUNCTIVE THERAPY FOR IMPROVING POST-TRAUMATIC STRESS DISORDER (PTSD) SYMPTOMS IN VETERANS WITH MILITARY-RELATED PTSD. VETERANS (N = 12) PARTICIPATED IN A 6 WEEK YOGA INTERVENTION HELD TWICE A WEEK. THERE WAS SIGNIFICANT IMPROVEMENT IN PTSD HYPERAROUSAL SYMPTOMS AND OVERALL SLEEP QUALITY AS WELL AS DAYTIME DYSFUNCTION RELATED TO SLEEP. THERE WERE NO SIGNIFICANT IMPROVEMENTS IN THE TOTAL PTSD, ANGER, OR QUALITY OF LIFE OUTCOME SCORES. THESE RESULTS SUGGEST THAT THIS YOGA PROGRAM MAY BE AN EFFECTIVE ADJUNCTIVE THERAPY FOR IMPROVING HYPERAROUSAL SYMPTOMS OF PTSD INCLUDING SLEEP QUALITY. THIS STUDY DEMONSTRATES THAT THE YOGA PROGRAM IS ACCEPTABLE, FEASIBLE, AND THAT THERE IS GOOD ADHERENCE IN A VETERAN POPULATION.	2013	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
6 2638  52 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	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
7 2316  73 TRAUMA-SENSITIVE YOGA FOR POST-TRAUMATIC STRESS DISORDER IN WOMEN VETERANS WHO EXPERIENCED MILITARY SEXUAL TRAUMA: INTERIM RESULTS FROM A RANDOMIZED CONTROLLED TRIAL. OBJECTIVE: TO CONDUCT AN INTERIM ANALYSIS OF DATA COLLECTED FROM AN ONGOING MULTISITE RANDOMIZED CLINICAL TRIAL (RCT) ASSESSING THE EFFECTIVENESS OF TRAUMA CENTER TRAUMA-SENSITIVE YOGA (TCTSY) FOR POST-TRAUMATIC STRESS DISORDER (PTSD) AMONG WOMEN VETERANS WITH PTSD RELATED TO MILITARY SEXUAL TRAUMA (MST). THE PURPOSE OF THE INTERIM ANALYSIS WAS TO ASSESS OUTCOMES FROM THE PRIMARY SITE, WHICH IS GEOGRAPHICALLY, DEMOGRAPHICALLY, CULTURALLY, AND PROCEDURALLY DISTINCT FROM THE SECOND SITE. DESIGN: RCT WAS CONDUCTED WITHIN A VETERANS ADMINISTRATION HEALTH CARE SYSTEM. DATA COLLECTION INCLUDED PREINTERVENTION THROUGH 3 MONTHS POSTINTERVENTION. PARTICIPANTS: ENROLLMENT FOR THE MAIN SITE WAS 152 WOMEN. THE SAMPLE SIZE FOR THE INTENT-TO-TREAT ANALYSIS WAS 104. THE MAJORITY WERE AFRICAN AMERICAN (91.3%) WITH A MEAN AGE OF 48.46 YEARS. INTERVENTION: THE TCTSY INTERVENTION (N = 58) WAS CONDUCTED BY TCTSY-CERTIFIED YOGA FACILITATORS AND CONSISTED OF 10 WEEKLY 60-MIN GROUP SESSIONS. THE CONTROL INTERVENTION, COGNITIVE PROCESSING THERAPY (CPT; N = 46), CONSISTED OF 12 90-MIN WEEKLY GROUP SESSIONS CONDUCTED PER VETERANS ADMINISTRATION PROTOCOL BY CLINICIANS IN THE PTSD CLINIC. OUTCOME MEASURES: THE CLINICIAN ADMINISTERED PTSD SCALE FOR DSM-5 (CAPS-5) WAS USED TO ASSESS CURRENT PTSD DIAGNOSIS AND SYMPTOM SEVERITY, INCLUDING OVERALL PTSD AND FOUR SYMPTOM CLUSTERS. THE PTSD CHECKLIST FOR DSM-5 (PCL-5) WAS USED TO OBTAIN SELF-REPORT OF PTSD SYMPTOM SEVERITY, INCLUDING TOTAL SCORE AND FOUR SYMPTOM CLUSTERS. RESULTS: THE FINDINGS REPORTED HERE ARE INTERIM RESULTS FROM ONE CLINICAL SITE. FOR BOTH THE CAPS-5 AND PCL-5, TOTAL SCORES AND ALL FOUR CRITERION SCORES DECREASED SIGNIFICANTLY (P < 0.01) OVER TIME IN ALL FIVE MULTILEVEL LINEAR MODELS WITHIN BOTH TCTSY AND CPT GROUPS, WITHOUT SIGNIFICANT DIFFERENCES BETWEEN GROUPS. THERE WERE CLINICALLY MEANINGFUL IMPROVEMENTS SEEN FOR BOTH TCTSY AND CPT WITH 51.1%-64.3% OF TCTSY SUBJECTS AND 43.5%-73.7% OF CPT DECREASING THEIR CAPS-5 SCORES BY 10 POINTS OR MORE. EFFECT SIZES FOR TOTAL SYMPTOM SEVERITY WERE LARGE FOR TCTSY (COHEN'S D = 1.10-1.18) AND CPT (COHEN'S D = 0.90-1.40). INTERVENTION COMPLETION WAS HIGHER IN TCTSY (60.3%) THAN IN CPT (34.8%). SYMPTOM IMPROVEMENT OCCURRED EARLIER FOR TCTSY (MIDINTERVENTION) THAN FOR CPT (2 WEEKS POSTINTERVENTION). SAFETY: THERE WERE NO UNANTICIPATED ADVERSE EVENTS IN THIS STUDY. CONCLUSION: THE RESULTS OF THIS STUDY DEMONSTRATE THAT TCTSY MAY BE AN EFFECTIVE TREATMENT FOR PTSD THAT YIELDS SYMPTOM IMPROVEMENT MORE QUICKLY, HAS HIGHER RETENTION THAN CPT, AND HAS A SUSTAINED EFFECT. TCTSY MAY BE AN EFFECTIVE ALTERNATIVE TO TRAUMA-FOCUSED THERAPY FOR WOMEN VETERANS WITH PTSD RELATED TO MST. THE STUDY IS REGISTERED IN CLINICALTRIALS.GOV (CTR NO.: NCT02640690).	2021	

8 2824  57 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 2830  47 YOGA VS STRETCHING IN VETERANS WITH CHRONIC LOWER BACK PAIN AND THE ROLE OF MINDFULNESS: A PILOT RANDOMIZED CONTROLLED TRIAL. OBJECTIVE: THE PURPOSE OF THIS STUDY WAS TO INVESTIGATE THE FEASIBILITY OF RECRUITING, RANDOMIZING, ENROLLING, AND COLLECTING OUTCOME DATA ON VETERAN PATIENTS WITH CHRONIC LOW BACK PAIN (CLBP) WHO UNDERGO AN 8-WEEK, ACTIVE EXERCISE CLASS WITH MINDFULNESS (YOGA CLASS) AND WITHOUT (STRETCHING CLASS). METHODS: UNITED STATES VETERANS WITH CLBP BASED ON INCLUSION/EXCLUSION CRITERIA WERE RANDOMIZED TO 1 OF 2 GROUPS. THE STUDY DESIGN WAS A PILOT RANDOMIZED CONTROLLED TRIAL. TWENTY CLBP PATIENTS ATTENDED A YOGA CLASS OR STRETCHING CLASS ONCE PER WEEK FOR 8 WEEKS AT THE VETERANS AFFAIRS ROCHESTER OUTPATIENT CENTER, ROCHESTER, NEW YORK. THE FOLLOWING MEASUREMENTS WERE OBTAINED: RECRUITMENT OR ENROLLMENT DATA, COMPLIANCE DATA TO INCLUDE CLASS ATTENDANCE AND HOME EXERCISE, AND COMPLIANCE DATA REGARDING ABILITY TO COLLECT OUTCOME MEASURES AT BASELINE AND AT COMPLETION. OUTCOME MEASURES INCLUDED PAIN (PEG), QUALITY OF LIFE (PROMIS GLOBAL HEALTH SURVEY), SELF-EFFICACY (2-ITEM QUESTIONNAIRE), FEAR AVOIDANCE BELIEF, CATASTROPHIZING, AND SOCIAL ENGAGEMENT IN ADDITION TO QUALITATIVE CLINICIAN OPEN-ENDED QUESTIONS POSTINTERVENTION. RESULTS: FORTY-FIVE VETERANS WERE QUERIED REGARDING INTEREST IN PARTICIPATION. OF THESE, 34 (76%) MET THE STUDY'S CRITERIA. TWENTY (44%) AGREED TO PARTICIPATE AND WERE CONSENTED, RANDOMIZED, AND ENROLLED IN THE STUDY. INITIAL AND FINAL OUTCOME MEASURES WERE OBTAINED FOR EACH PARTICIPANT (100%). FORTY PERCENT ATTENDED MORE THAN 80% OF THE SESSIONS FOR BOTH YOGA AND STRETCHING GROUPS. CONCLUSION: THIS PILOT STUDY DEMONSTRATED FEASIBILITY OF RECRUITING, ENROLLING, AND COLLECTING OUTCOME DATA ON CLBP VETERAN PATIENTS PARTICIPATING IN YOGA AND STRETCHING CLASS. THE DATA FROM THIS PILOT WILL INFORM THE DEVELOPMENT OF A RANDOMIZED, COMPARATIVE EFFECTIVENESS STUDY OF YOGA WITH AND WITHOUT MINDFULNESS IN THE MANAGEMENT OF CLBP.	2020	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
10 2019  37 SYNCHRONOUS TELEHEALTH YOGA AND COGNITIVE PROCESSING GROUP THERAPIES FOR WOMEN VETERANS WITH POSTTRAUMATIC STRESS DISORDER: A MULTISITE RANDOMIZED CONTROLLED TRIAL ADAPTED FOR COVID-19. BACKGROUND: PROVIDING CARE OVER TELEHEALTH GREW SLOWLY UNTIL THE COVID-19 PANDEMIC. SINCE THE ONSET OF THE COVID-19 PANDEMIC, PROVIDING MENTAL HEALTH CARE WAS READILY ADAPTED TO VIRTUAL MEANS; HOWEVER, CLINICAL TRIAL RESEARCH IS NASCENT IN ADAPTING METHODS AND PROCEDURES TO THE VIRTUAL WORLD. METHODS: WE PRESENT PROTOCOL MODIFICATIONS TO PIVOT A MULTISITE RANDOMIZED CONTROLLED TRIAL STUDY, CONDUCTED AT SOUTHEASTERN AND PACIFIC NORTHWESTERN VETERANS AFFAIRS HEALTH CARE SYSTEMS, FROM BEING CONDUCTED IN-PERSON TO VIRTUALLY, FOLLOWING THE ONSET OF THE COVID-19 PANDEMIC. WE MEASURED OUTCOMES OF POSTTRAUMATIC STRESS DISORDER (PTSD) SYMPTOMS AND PSYCHOPHYSIOLOGICAL MARKERS OF STRESS AMONG FEMALE VETERANS WITH PTSD SECONDARY TO MILITARY SEXUAL TRAUMA. WE COLLECTED QUALITATIVE DATA ABOUT PROVIDER AND PARTICIPANT EXPERIENCES WITH TELEHEALTH. RESULTS: ACROSS SITES, 200 PARTICIPANTS WERE CONSENTED (48 VIRTUALLY), 132 WERE RANDOMIZED (28 TO VIRTUAL GROUPS), AND 117 COMPLETED DATA COLLECTION AND TREATMENT (69 COMPLETED ALL OR SOME DATA COLLECTION OR TREATMENT VIRTUALLY). CONCLUSIONS: THE PIVOTS MADE FOR THIS STUDY WERE IN RESPONSE TO THE COVID-19 PANDEMIC AND OFFER INNOVATIVE PROCEDURES LEVERAGING TECHNOLOGY AND CONTRIBUTING TO THE BROADER LANDSCAPE OF CONDUCTING RESEARCH VIRTUALLY. CLINICAL TRIALS NUMBER: NCT02640690.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
11  181  48 A RANDOMIZED CONTROLLED TRIAL OF YOGA VS NONAEROBIC EXERCISE FOR VETERANS WITH PTSD: UNDERSTANDING EFFICACY, MECHANISMS OF CHANGE, AND MODE OF DELIVERY. BACKGROUND AND OBJECTIVES: POSTTRAUMATIC STRESS DISORDER (PTSD) IS A CHRONIC, DISABLING, AND PREVALENT MENTAL HEALTH DISORDER AMONG VETERANS. DESPITE THE AVAILABILITY OF EMPIRICALLY SUPPORTED PSYCHOTHERAPIES, MANY VETERANS REMAIN SYMPTOMATIC AFTER TREATMENT AND/OR PREFER TO SEEK COMPLEMENTARY AND INTEGRATIVE HEALTH APPROACHES, INCLUDING YOGA, TO MANAGE PTSD. THE RANDOMIZED CONTROLLED TRIAL (RCT) DESCRIBED HEREIN WILL EVALUATE THE EFFICACY OF A MANUALIZED YOGA PROGRAM AS COMPARED TO NONAEROBIC EXERCISE IN REDUCING PTSD SEVERITY AMONG VETERANS. A SECONDARY AIM OF THIS STUDY IS TO BETTER UNDERSTAND THE MECHANISMS OF CHANGE. METHODS: VETERANS (N = 192) WITH PTSD WILL BE RANDOMIZED TO HATHA YOGA OR NONAEROBIC PHYSICAL ACTIVITY CONTROL; BOTH GROUPS CONSIST OF 12 WEEKLY, 60-MIN GROUP OR ONLINE TRAINING SESSIONS WITH 15-20 MIN OF DAILY AT-HOME PRACTICE. OUTCOME MEASURES WILL BE ADMINISTERED AT BASELINE, MID-TREATMENT, POSTTREATMENT, AND 12-WEEK FOLLOW-UP. PROJECTED OUTCOMES: THIS STUDY WILL EVALUATE CHANGES IN PTSD SEVERITY (PRIMARY OUTCOME) AS WELL AS DEPRESSION, ANXIETY, ANGER, SLEEP PROBLEMS, AND PSYCHOSOCIAL DISABILITY (SECONDARY OUTCOMES). WE WILL ALSO USE MULTIPLE MEDIATION TO EXAMINE TWO POTENTIAL MODELS OF THE MECHANISMS OF CLINICAL EFFECT: THE ATTENTION MODEL (I.E., YOGA INCREASES ATTENTIONAL CONTROL, WHICH REDUCES PTSD SYMPTOMS), THE COPING MODEL (I.E., YOGA INCREASES DISTRESS TOLERANCE, WHICH IMPROVES COPING, WHICH REDUCES PTSD SYMPTOMS), AND THE COMBINATION OF THESE MODELS. THIS ASPECT OF THE STUDY IS INNOVATIVE AND IMPORTANT GIVEN THE ABSENCE OF AN EXISTING, COMPREHENSIVE MODEL FOR UNDERSTANDING YOGA'S IMPACT ON PTSD. ULTIMATELY, WE HOPE TO DEVELOP GUIDELINES FOR APPLICATION OF YOGA TO PTSD RECOVERY.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
12  258  44 ACCEPTABILITY AND FEASIBILITY OF A 12-WEEK YOGA VS. EDUCATIONAL FILM PROGRAM FOR THE MANAGEMENT OF RESTLESS LEGS SYNDROME (RLS): STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL. BACKGROUND: RESTLESS LEGS SYNDROME (RLS) IS A COMMON AND BURDENSOME SLEEP DISORDER ASSOCIATED WITH PROFOUND IMPAIRMENT OF HEALTH, WELL-BEING, AND QUALITY OF LIFE. UNFORTUNATELY, THE MEDICATIONS USED FOR RLS MANAGEMENT CARRY RISK OF SERIOUS SIDE EFFECTS, INCLUDING AUGMENTATION OF SYMPTOMS. YOGA, AN ANCIENT MIND-BODY DISCIPLINE DESIGNED TO PROMOTE PHYSICAL, EMOTIONAL, AND MENTAL WELL-BEING, MAY OFFER A VIABLE, LOW-RISK NEW TREATMENT. THE PRIMARY OBJECTIVES OF THIS PILOT, PARALLEL-ARM, RANDOMIZED CONTROLLED TRIAL (RCT) ARE TO ASSESS THE ACCEPTABILITY AND FEASIBILITY OF A 12-WEEK YOGA VS. EDUCATIONAL FILM PROGRAM FOR THE MANAGEMENT OF RLS. METHODS: FORTY-FOUR ADULTS WITH CONFIRMED MODERATE TO SEVERE RLS WILL BE RECRUITED AND RANDOMIZED TO A 12-WEEK YOGA (N = 22) OR STANDARDIZED EDUCATIONAL FILM PROGRAM (N = 22). YOGA GROUP PARTICIPANTS WILL ATTEND TWO 75-MIN IYENGAR YOGA CLASSES PER WEEK FOR THE FIRST 4 WEEKS, THEN ONE 75-MIN CLASS PER WEEK FOR THE REMAINING 8 WEEKS, AND WILL COMPLETE A 30-MIN HOMEWORK ROUTINE ON NON-CLASS DAYS. EDUCATIONAL FILM GROUP PARTICIPANTS WILL ATTEND ONE 75-MIN CLASS PER WEEK FOR 12 WEEKS AND COMPLETE A DAILY RLS TREATMENT LOG; CLASSES WILL INCLUDE INFORMATION ON: RLS MANAGEMENT, INCLUDING SLEEP HYGIENE PRACTICES; OTHER SLEEP DISORDERS; AND COMPLEMENTARY THERAPIES LIKELY TO BE OF INTEREST TO THOSE PARTICIPATING IN A YOGA AND SLEEP EDUCATION STUDY. YOGA AND TREATMENT LOGS WILL BE COLLECTED WEEKLY. FEASIBILITY OUTCOMES WILL INCLUDE RECRUITMENT, ENROLLMENT, AND RANDOMIZATION RATES, RETENTION, ADHERENCE, AND PROGRAM SATISFACTION. PROGRAM EVALUATION AND YOGA-DOSING QUESTIONNAIRES WILL BE COLLECTED AT WEEK 12; DATA ON EXPLORATORY OUTCOMES (E.G., RLS SYMPTOM SEVERITY (IRLS), SLEEP QUALITY (PSQI), MOOD (POMS, PSS), AND HEALTH-RELATED QUALITY OF LIFE (SF-36)) WILL BE GATHERED AT BASELINE AND WEEK 12. DISCUSSION: THIS STUDY WILL LAY THE ESSENTIAL GROUNDWORK FOR A PLANNED LARGER RCT TO DETERMINE THE EFFICACY OF A YOGA PROGRAM FOR REDUCING SYMPTOMS AND ASSOCIATED BURDEN OF RLS. IF THE FINDINGS OF THE CURRENT TRIAL AND THE SUBSEQUENT LARGER RCTS ARE POSITIVE, THIS STUDY WILL ALSO HELP SUPPORT A NEW APPROACH TO CLINICAL TREATMENT OF THIS CHALLENGING DISORDER, HELP FOSTER IMPROVED UNDERSTANDING OF RLS ETIOLOGY, AND ULTIMATELY CONTRIBUTE TO REDUCING THE INDIVIDUAL, SOCIETAL, AND ECONOMIC BURDEN ASSOCIATED WITH THIS CONDITION. TRIAL REGISTRATION: CLINICALTRIALS.GOV, ID: NCT03570515 . RETROSPECTIVELY REGISTERED ON 1 FEBRUARY 2017.	2019	
                                                                                                                                                                                                                                                                              
13 1635  39 MODERATORS OF TREATMENT EFFICACY IN A RANDOMIZED CONTROLLED TRIAL OF TRAUMA-SENSITIVE YOGA AS AN ADJUNCTIVE TREATMENT FOR POSTTRAUMATIC STRESS DISORDER. OBJECTIVE: THIS STUDY IS A FOLLOW-UP TO VAN DER KOLK ET AL. (2014), A TRIAL CONDUCTED THROUGH THE TRAUMA CENTER AT JUSTICE RESOURCE INSTITUTE, WHICH DEMONSTRATED TREATMENT EFFICACY AND REMAINS THE ONLY RANDOMIZED CONTROLLED TRIAL OF TRAUMA-SENSITIVE YOGA. THE PRESENT PROCESS STUDY EXTENDS THE OUTCOMES STUDY BY EXAMINING TREATMENT MODERATORS OF THE ORIGINAL TRIAL. METHOD: SIXTY-FOUR WOMEN WITH CHILDHOOD INTERPERSONAL TRAUMA HISTORIES AND POSTTRAUMATIC STRESS DISORDER PARTICIPATED IN THE INTERVENTIONS: TRAUMA CENTER TRAUMA-SENSITIVE YOGA (TCTSY) VERSUS ACTIVE CONTROL (WOMEN'S HEALTH EDUCATION). ANALYSES EXPLORED IF ADULT-ONSET INTERPERSONAL TRAUMA AND BASELINE PSYCHOLOGICAL MEASURES (CLINICIAN-RATED AND SELF-REPORTED PTSD, DISSOCIATION, DEPRESSION, PSYCHOLOGICAL FUNCTIONING) MODERATED PTSD CHANGES. RESULTS: THREE OF SIX MEASURES HAD SMALL EFFECTS IN MODERATING THE RELATIONSHIP BETWEEN ADULT-ONSET INTERPERSONAL TRAUMA AND TCTSY EFFICACY, IN WHICH TCTSY WAS MOST EFFICACIOUS FOR THOSE WITH FEWER ADULT-ONSET INTERPERSONAL TRAUMAS. WITHIN THIS SUBGROUP, VARIOUS LEVELS OF ALL BASELINE MEASURES EXCEPT DEPRESSION INDICATED THAT TCTSY WAS MORE EFFECTIVE IN REDUCING PTSD THAN THE ACTIVE CONTROL CONDITION. CONCLUSIONS: BY DELINEATING CLIENT CHARACTERISTICS MOST ASSOCIATED WITH PTSD IMPROVEMENTS, PRACTITIONERS MAY BEST TARGET YOGA INTERVENTIONS TO INCREASE EFFECTIVENESS. (PSYCINFO DATABASE RECORD (C) 2020 APA, ALL RIGHTS RESERVED).	2020	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
14 1903  40 RESULTS FROM A CLINICAL YOGA PROGRAM FOR VETERANS: YOGA VIA TELEHEALTH PROVIDES COMPARABLE SATISFACTION AND HEALTH IMPROVEMENTS TO IN-PERSON YOGA. BACKGROUND: YOGA IS INCREASINGLY POPULAR, THOUGH LITTLE DATA REGARDING ITS IMPLEMENTATION IN HEALTHCARE SETTINGS IS AVAILABLE. SIMILARLY, TELEHEALTH IS BEING UTILIZED MORE FREQUENTLY TO INCREASE ACCESS TO HEALTHCARE; HOWEVER WE KNOW OF NO RESEARCH ON THE ACCEPTABILITY OR EFFECTIVENESS OF YOGA DELIVERED THROUGH TELEHEALTH. THEREFORE, WE EVALUATED THE FEASIBILITY, ACCEPTABILITY, AND PATIENT-REPORTED EFFECTIVENESS OF A CLINICAL YOGA PROGRAM AT A VETERANS AFFAIRS MEDICAL CENTER AND ASSESSED WHETHER THESE OUTCOMES DIFFERED BETWEEN THOSE PARTICIPATING IN-PERSON AND THOSE PARTICIPATING VIA TELEHEALTH. METHODS: VETERANS WHO ATTENDED A YOGA CLASS AT THE VA PALO ALTO HEALTH CARE SYSTEM WERE INVITED TO COMPLETE AN ANONYMOUS PROGRAM EVALUATION SURVEY. RESULTS: 64 VETERANS COMPLETED THE SURVEY. PARTICIPANTS REPORTED HIGH SATISFACTION WITH THE CLASSES AND THE INSTRUCTORS. MORE THAN 80% OF PARTICIPANTS WHO ENDORSED A PROBLEM WITH PAIN, ENERGY LEVEL, DEPRESSION, OR ANXIETY REPORTED IMPROVEMENT IN THESE SYMPTOMS. THOSE WHO PARTICIPATED VIA TELEHEALTH DID NOT DIFFER FROM THOSE WHO PARTICIPATED IN-PERSON IN ANY MEASURE OF SATISFACTION, OVERALL IMPROVEMENT (P = .40), OR IMPROVEMENT IN ANY OF 16 SPECIFIC HEALTH PROBLEMS. CONCLUSIONS: DELIVERING YOGA TO A WIDE RANGE OF PATIENTS WITHIN A HEALTHCARE SETTING APPEARS TO BE FEASIBLE AND ACCEPTABLE, BOTH WHEN DELIVERED IN-PERSON AND VIA TELEHEALTH. PATIENTS IN THIS CLINICAL YOGA PROGRAM REPORTED HIGH LEVELS OF SATISFACTION AND IMPROVEMENT IN MULTIPLE PROBLEM AREAS. THIS PRELIMINARY EVIDENCE FOR THE EFFECTIVENESS OF A CLINICAL YOGA PROGRAM COMPLEMENTS PRIOR EVIDENCE FOR THE EFFICACY OF YOGA AND SUPPORTS THE USE OF YOGA IN HEALTHCARE SETTINGS.	2017	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
15 1953  54 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	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
16 2596  59 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	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
17  155  45 A QUALITATIVE STUDY EXPLORING YOGA IN VETERANS WITH PTSD SYMPTOMS. QUANTITATIVE STUDIES OF YOGA HAVE REPORTED REDUCED POSTTRAUMATIC STRESS DISORDER (PTSD) SYMPTOMS IN VETERANS, BUT LITTLE IS KNOWN ABOUT HOW AND WHY VETERANS ARE ATTRACTED TO AND STICK WITH A YOGA PRACTICE. GUIDED BY THE HEALTH BELIEF MODEL, THIS STUDY EXAMINED VETERANS' PERCEPTIONS OF THE BENEFITS, BARRIERS, AND MOTIVATIONS TO CONTINUE PRACTICING TRAUMA-SENSITIVE YOGA. INTERVIEWS WERE CONDUCTED WITH NINE INDIVIDUALS, FIVE OF WHOM COMPLETED A 6-WEEK TRAUMA-SENSITIVE YOGA INTERVENTION DESIGNED FOR VETERANS AND FOUR WHO DID NOT COMPLETE THE INTERVENTION. TRANSCRIPTS WERE ANALYZED FOR THEMES. THE BENEFITS IDENTIFIED BY VETERANS WERE FINDING MENTAL STILLNESS, BODY AWARENESS, AND SOCIAL CONNECTION. THE BARRIERS WERE PERCEPTIONS THAT YOGA IS SOCIALLY UNACCEPTABLE, ESPECIALLY FOR MEN, AND PHYSICALLY UNCHALLENGING. UNDERSTANDING THESE BENEFITS AND BARRIERS CAN HELP TO MAKE YOGA MORE ATTRACTIVE TO SERVICE MEMBERS AND VETERANS. FOR EXAMPLE, MEDICAL PERSONNEL CAN REFER SERVICE MEMBERS AND VETERANS TO YOGA NOT ONLY FOR PTSD SYMPTOMS, BUT ALSO TO ADDRESS BACK PAIN AND TO REDUCE ISOLATION. ACCESS TO MALE YOGA INSTRUCTORS, ESPECIALLY THOSE WHO ARE THEMSELVES SERVICE MEMBERS OR VETERANS, COULD BE EXPANDED, AND CLASSES COULD BE INTEGRATED INTO PHYSICAL ACTIVITY ROUTINES REQUIRED OF ACTIVE-DUTY PERSONNEL. PROMOTIONAL MATERIALS CAN FEATURE MALE SERVICE MEMBERS AND VETERANS WITH CAPTIONS RELATED TO YOGA AS A WAY TO INCREASE RESILIENCY, SELF-SUFFICIENCY, AND PHYSICAL AND MENTAL MISSION READINESS. FINDINGS FROM THIS STUDY CAN HELP THE DEPARTMENT OF DEFENSE AND THE VETERANS HEALTH ADMINISTRATION IMPLEMENT YOGA AS AN ADJUNCT OR ALTERNATIVE TREATMENT FOR VETERANS WITH PTSD SYMPTOMS.	2018	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
18 1998  40 STRENGTH AND AWARENESS IN ACTION: FEASIBILITY OF A YOGA-BASED INTERVENTION FOR POST-ACUTE MILD TBI HEADACHES AMONG VETERANS. BACKGROUND: MILD TRAUMATIC BRAIN INJURY (MTBI) IS A SIGNATURE INJURY SUSTAINED BY VETERANS DURING RECENT CONFLICTS. FOR SOME, MTBI/CONCUSSION IS ASSOCIATED WITH DISABLING SYMPTOMS, INCLUDING POST-CONCUSSIVE HEADACHES (PCH). HOWEVER, THERE ARE LIMITED EVIDENCE-BASED TREATMENTS FOR PERSISTENT PCH. OBJECTIVE: INVESTIGATORS ASSESSED THE FEASIBILITY OF DESIGN ELEMENTS OF A YOGA-BASED INTERVENTIONAL TRIAL FOR PCH AMONG VETERANS, AS WELL AS THE ACCEPTABILITY OF THE INTERVENTION. METHODS: THIS RANDOMIZED CONTROLLED ACCEPTABILITY AND FEASIBILITY TRIAL WAS IMPLEMENTED USING A WAITLIST-CONTROL DESIGN. DESIGN ELEMENTS OF INTEREST INCLUDED: AN EXERCISE RUN-IN CLASS; RECRUITMENT AND RETENTION STRATEGIES; AND, ECOLOGICAL MOMENTARY ASSESSMENT (EMA) MODALITIES TO TRACK HEADACHES AND YOGA PRACTICE. VETERAN SATISFACTION REGARDING THE INTERVENTION WAS ALSO EVALUATED. A DESCRIPTIVE ANALYSIS WAS CONDUCTED ON CANDIDATE OUTCOMES INCLUDING PCH, POST-CONCUSSIVE SYMPTOMS, PAIN, AND DAILY FUNCTIONING. RESULTS: TWENTY-SEVEN PARTICIPANTS (OUT OF 70 CONSENTED AND ELIGIBLE AFTER STUDY VISIT 1) COMPLETED EACH EVALUATION TIMEPOINT AND REGULARLY ATTENDED YOGA SESSIONS, WITH 89% OF THESE VETERANS REPORTING MODERATE TO HIGH LEVELS OF SATISFACTION WITH THE INTERVENTION AT STUDY COMPLETION. QUALITATIVELY, PARTICIPANTS ENDORSED IMPROVEMENTS IN HEADACHES, CHRONIC PAIN, AND MOOD. FEASIBILITY RESULTS WERE MIXED. INITIAL FEASIBILITY CRITERION REGARDING YOGA ATTENDANCE WAS NOT MET; HOWEVER, MODIFICATIONS, SUCH AS EXPANSION TO AN ADDITIONAL CLINIC SITE AND REDUCTION OF IN-PERSON YOGA SESSIONS WITH INCREASED ENCOURAGEMENT TO USE STUDY-CREATED ONLINE YOGA VIDEOS IMPROVED FEASIBILITY OF THE STUDY DESIGN. PARTICIPANTS MOST FREQUENTLY USED MOBILE AND WEB-BASED EMA MODALITIES TO TRACK YOGA PRACTICE. CONCLUSIONS: ALTHOUGH CHALLENGES WITH FEASIBILITY OF THE STUDY DESIGN ELEMENTS WERE NOTED, RESULTS SUGGESTED ACCEPTABILITY OF THE YOGA-BASED INTERVENTION FOR VETERANS WITH PERSISTENT PCH. ADDITIONAL EXPLORATION REGARDING THE FREQUENCY AND MODALITY OF YOGA DELIVERY (E.G., IN-PERSON, TELEHEALTH) IS WARRANTED. IMPACT: VETERANS FOUND THE YOGA-BASED INTERVENTION ACCEPTABLE, HOWEVER EXPLORATION OF NOVEL MODALITIES OF INTERVENTION DELIVERY WILL LIKELY BE NECESSARY TO ENHANCE THE FEASIBILITY OF INTERVENTION IMPLEMENTATION DURING FUTURE TRIALS.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
19 2831  38 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	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
20  420  46 BRIDGING BODY AND MIND: CASE SERIES OF A 10-WEEK TRAUMA-INFORMED YOGA PROTOCOL FOR VETERANS. THIS CASE SERIES EXPLORED THE FEASIBILITY AND PRELIMINARY EFFICACY OF THERAPEUTIC YOGA AS A COMPLEMENTARY FORM OF TREATMENT FOR COMBAT-RELATED TRAUMA. THE SERIES RECRUITED FOR AND IMPLEMENTED A 10-WEEK TRAUMA-INFORMED YOGA PROTOCOL FOR VETERANS IN AN INTERPROFESSIONAL COMMUNITY HEALTH TREATMENT SETTING. PARTICIPANTS WERE ENROLLED IN A SERIES OF 90-MINUTE THERAPEUTIC YOGA CLASSES ADAPTED TO BE TRAUMA-INFORMED. FEASIBILITY WAS MEASURED BY RECRUITMENT, RETENTION, AND LEVEL OF PARTICIPATION IN THE STUDY. PRELIMINARY EFFICACY WAS EXPLORED VIA THE POSTTRAUMATIC STRESS DISORDER CHECKLIST, SCALE OF BODY CONNECTION, PROMIS-29, PROMIS ALCOHOL USE, PROMIS SUBSTANCE USE, DIFFICULTIES IN EMOTIONAL REGULATION SCALE, AND SELF-COMPASSION SCALE-SHORT FORM. ALL MEASURES WERE ADMINISTERED AT BASELINE, WEEK 5, WEEK 10, AND AT A 5-WEEK FOLLOW-UP. A QUALITATIVE FEASIBILITY QUESTIONNAIRE WAS ADMINISTERED WEEKLY AND AT THE 5-WEEK FOLLOW-UP TO ASSESS BARRIERS AND MOTIVATORS FOR HOME PRACTICE AND TO COLLECT FEEDBACK ABOUT SESSION CONTENT. RECRUITMENT CHALLENGES RESULTED IN ONLY SEVEN INTERESTED INDIVIDUALS. FOUR PARTICIPANTS (THREE MALES, ONE FEMALE) WERE SUCCESSFULLY ENROLLED IN THE STUDY AFTER SEVEN PHONE SCREENINGS AND FIVE IN-PERSON INTERVIEWS. THE FOUR ENROLLED CLIENTS HAD A 100% FOLLOW-UP RETENTION RATE, REPORTED NO ADVERSE EVENTS, AND ON AVERAGE PARTICIPATED IN 85% OF CLASSES. CLINICALLY SIGNIFICANT ENHANCEMENTS WERE OBSERVED ON TRAUMA- AND BODY CONNECTION-RELATED SCALES FOR THREE PARTICIPANTS FROM BASELINE TO FOLLOW-UP. QUALITATIVE DATA REVEALED THAT MOTIVATORS TO PRACTICE INCLUDE IN-SESSION PHILOSOPHICAL DISCUSSIONS BASED ON PSYCHOLOGICAL THEMES; BREATHWORK; MINDFULNESS; AND PHYSICAL, SOCIAL, WORK/ACADEMIC, AND MENTAL HEALTH IMPACT. BARRIERS INCLUDED MOTIVATION, TIME, AND LOCATION. IMPORTANT THEMES EMERGED RELATED TO CULTURAL CONSIDERATIONS FOR VETERANS. ALTHOUGH THIS 10-WEEK TRAUMA-INFORMED PROTOCOL FACED CHALLENGES TO RECRUITMENT, RETENTION AND PARTICIPATION WERE HIGH. EFFICACY MEASURES YIELDED PROMISING RESULTS FOR REDUCING TRAUMA-RELATED SYMPTOMS.	2019