Abstract
Objective: The aim of the study was to assess randomized-control trials (RCTs) to ascertain whether yoga is an effective treatment in the management of patients with chronic low back pain (cLBP) compared with other care modalities.
Methods: A search strategy was formulated with key concepts identified using the PICO process. Four databases were searched in June 2012. Appropriate eligibility criteria were set and implemented.
Results: Four randomized control trials met the inclusion criteria. All four papers found that yoga lead to a significant improvement in back function, and three demonstrated a significant improvement in back pain when compared with certain care modalities. All papers had significant limitations identified, however.
Conclusions: Given the limitations identified within the studies, the conclusions drawn must be considered conservatively. Although early results appear promising, but further well-designed RCTs are warranted, with multiple, specified comparator care modalities before firm conclusions can be gained.
Appendix: Literature Search Strategies
All searches performed 26 June 2012.
EMBASE
yoga.mp. or exp yoga/ 3052
back pain.mp. or exp backache/ 67066
1 and 2 163
Limit 3 to English language 155
Limit 4 to human 145
Limit 5 to randomized control trial 20
Limit 6 to exclude trial protocol/pilot study 14
Limit 7 to remove duplication 13
Limit 8 to last 5 years 7
CINAHL:
Yoga 1883
back pain 15692
1 and 2 129
Limit 3 to English language 127
Limit 4 to human 23
Limit 5 to randomized control trial 4
Limit 6 to exclude trial protocol/pilot study 2
Limit 7 to last 5 years 1
AMED:
exp Yoga/ or yoga.mp. 458
exp Backache/ or exp Low back pain/ or back pain.mp. 6142
1 and 2 25
Limit 3 to English language 25
Limit 4 to last 5 years 11
Limit 5 to randomized control trial 7
Limit 6 to exclude trial protocol/pilot study 4
References
1. EhrlichGE. Low back pain. Bull World Health Organ2003;81:671–6.Search in Google Scholar
2. Von KorffM, MooreJC. Stepped care for back pain: activating approaches for primary care. Ann Intern Med2001;134:911–7.10.7326/0003-4819-134-9_Part_2-200105011-00016Search in Google Scholar
3. HeffernanJJ. Low back pain. In: NobleJ, GreeneHL editors. Textbook of primary care medicine. St Louis, MO: Mosby, 2001:1919Search in Google Scholar
4. AnderssonGB. Epidemiological features of chronic low-back pain. Lancet1999;354:581–5.10.1016/S0140-6736(99)01312-4Search in Google Scholar
5. ManiadakisN, GrayA. The economic burden of back pain in the UK. Pain2000;84:95–103.10.1016/S0304-3959(99)00187-6Search in Google Scholar
6. FrankJW, KerrMS, BrookerAS, et al.. Disability resulting from occupational low back pain. Part I: what do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine (Philadelphia, PA, 1976) 1996;21:2908–17.10.1097/00007632-199612150-00024Search in Google Scholar PubMed
7. DeyoRA, WeinsteinJN. Low back pain. N Engl J Med2001;344:363–70.10.1056/NEJM200102013440508Search in Google Scholar PubMed
8. National Institute for Health and Clinical Excellence. Low back pain: early management of persistent non-specific low back pain. London: NICE Vol 2009;88:1–9. Online PDF available at: http://www.nice.org.uk/nicemedia/live/11887/44343/44343.pdf. Accessed: 14July2012.Search in Google Scholar
9. WaddellG. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine (Philadelphia, PA, 1976) 1987;12:632–44.10.1097/00007632-198709000-00002Search in Google Scholar PubMed
10. GatchelRJ, PengYB, PetersML, et al.. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull2007;133:581–624.10.1037/0033-2909.133.4.581Search in Google Scholar PubMed
11. NielsonWR, WeirR. Biopsychosocial approaches to the treatment of chronic pain. Clin J Pain2001;17:114–27.10.1097/00002508-200112001-00020Search in Google Scholar PubMed
12. EisenbergDM, DavisRB, EttnerSL, et al.. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA1998;280:1569–75.10.1001/jama.280.18.1569Search in Google Scholar PubMed
13. BarnesPM, BloomB, NahinRL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Rep2008;12:1–23.10.1037/e623942009-001Search in Google Scholar
14. SaperRB, EisenbergDM, DavisRB, et al.. Prevalence and patterns of adult yoga use in the United States: results of a national survey. Altern Ther Health Med2004;10:44–9.Search in Google Scholar
15. BirdeeGS, LegedzaAT, SaperRB, et al.. Characteristics of yoga users: results of a national survey. J Gen Intern Med2008;23:1653–8.10.1007/s11606-008-0735-5Search in Google Scholar PubMed PubMed Central
16. RaubJA. Psychophysiologic effects of Hatha Yoga on musculoskeletal and cardiopulmonary function: a literature review. J Altern Complement Med2002;8:797–812.10.1089/10755530260511810Search in Google Scholar PubMed
17. CorlissR. The power of yoga. Time Magazine, 2001. New York City: Time Inc. July Edition.Search in Google Scholar
18. EvansS, TsaoJCI, SternliebB, ZeltzerLK. Using the biopsychosocial model to understand the health benefits of yoga. J Complement Integr Med2009;6:1–22.10.2202/1553-3840.1183Search in Google Scholar
19. FeuersteinG. The Yoga tradition: its history, literature, philosophy and practice. Prescott: Hohm Press, 2001.Search in Google Scholar
20. PilkingtonK, KirkwoodG, RampesH, RichardsonJ. Yoga for depression: the research evidence. J Affect Disord2005;89:13–24.10.1016/j.jad.2005.08.013Search in Google Scholar PubMed
21. KirkwoodG, RampesH, TuffreyV, et al.. Yoga for anxiety: a systematic review of the research evidence. Br J Sports Med2005;39:884–91; discussion 891.10.1136/bjsm.2005.018069Search in Google Scholar PubMed PubMed Central
22. ShermanKJ, CherkinDC, WellmanRD, et al.. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med2011;171:2019–26.10.1001/archinternmed.2011.524Search in Google Scholar PubMed PubMed Central
23. LeeSW, MancusoCA, CharlsonME. Prospective study of new participants in a community-based mind-body training program. J Gen Intern Med2004;19:760–5.10.1111/j.1525-1497.2004.30011.xSearch in Google Scholar PubMed PubMed Central
24. YangK. A review of yoga programs for four leading risk factors of chronic diseases. Evid Based Complement Altern Med2007;4:487–91.10.1093/ecam/nem154Search in Google Scholar PubMed PubMed Central
25. MurugesanR, GovindarajuluN, BeraTK. Effect of selected yogic practices on the management of hypertension. Indian J Physiol Pharmacol2000;44:207–10.Search in Google Scholar
26. MalhotraV, SinghS, TandonOP, SharmaSB. The beneficial effect of yoga in diabetes. Nepal Med Coll J2005;7:145–7.Search in Google Scholar
27. TanejaI, DeepakKK, PoojaryG, et al.. Yogic versus conventional treatment in diarrhea-predominant irritable bowel syndrome: a randomized control study. Appl Psychophysiol Biofeedback2004;29:19–33.10.1023/B:APBI.0000017861.60439.95Search in Google Scholar
28. VedanthanPK, KesavaluLN, MurthyKC, et al.. Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy Asthma Proc1998;19:3–9.10.2500/108854198778557971Search in Google Scholar PubMed
29. EvansS, SubramanianS, SternliebB. Yoga as treatment for chronic pain conditions: a literature review. Int J Disabil Hum Dev2008;7:25–32.10.1515/IJDHD.2008.7.1.25Search in Google Scholar
30. SackettDL, RosenbergWM, GrayJA, et al.. Evidence based medicine: what it is and what it isn’t. Br Med J1996;312:71–2.10.1136/bmj.312.7023.71Search in Google Scholar
31. OxmanAD, SackettDL, GuyattGH. Users’ guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group. JAMA1993;270:2093–5.10.1001/jama.270.17.2093Search in Google Scholar
32. AndersonLW, KrathwohlD. A taxonomy for learning, teaching and assessing: a revision of Bloom’s taxonomy of educational objectives. New York: Longman, 2001.Search in Google Scholar
33. SoodA, GhoshAK. Literature search using PubMed: an essential tool for practising evidence- based medicine. J Assoc Phys India2006;54:303–8.Search in Google Scholar
34. DawesM, DaviesP, GrayA, et al.. Evidence-based practice: a primer for health care professionals. Churchill Livingston: Elsevier, 2005.Search in Google Scholar
35. MotschallE, Falck-YtterY. Searching the MEDLINE literature database through PubMed: a short guide. Onkologie2005;28:517–22.10.1159/000087186Search in Google Scholar PubMed
36. DoigGS, SimpsonF. Efficient literature searching: a core skill for the practice of evidence-based medicine. Intensive Care Med2003;29:2119–27.10.1007/s00134-003-1942-5Search in Google Scholar PubMed
37. GreenhalghT. How to read a paper. Getting your bearings (deciding what the paper is about). Br Med J1997;315:243–6.10.1136/bmj.315.7102.243Search in Google Scholar PubMed PubMed Central
38. ShermanKJ, CherkinDC, ErroJ, et al.. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med2005;143:849–56.10.7326/0003-4819-143-12-200512200-00003Search in Google Scholar PubMed
39. WilliamsKA, PetronisJ, SmithD, et al.. Effect of Iyengar yoga therapy for chronic low back pain. Pain2005;115:107–17.10.1016/j.pain.2005.02.016Search in Google Scholar PubMed
40. Critical Appraisal Skills Programme (CASP). 10 questions to help you make sense of qualitative research. Oxford: Public Health Resource Unit, 2006:1–4. Available from: www.phru.nhs.uk/Doc_Links/Qualitative_ Appraisal_Tool.pdf.Accessed: 28July2012.Search in Google Scholar
41. ManM-S., TilbrookHE, JayakodyS, et al.. Electronic reminders did not improve postal questionnaire response rates or response times: a randomized controlled trial. J Clin Epidemiol2011;64:1001–4.10.1016/j.jclinepi.2010.10.013Search in Google Scholar PubMed
42. PosadzkiP, ErnstE, TerryR, LeeMS. Is yoga effective for pain? A systematic review of randomized clinical trials. Complement Ther Med2011;19:281–7.10.1016/j.ctim.2011.07.004Search in Google Scholar PubMed
43. ShermanKJ, CherkinDC, IchikawaL, et al.. Treatment expectations and preferences as predictors of outcome of acupuncture for chronic back pain. Spine2010;35:1471–7.10.1097/BRS.0b013e3181c2a8d3Search in Google Scholar PubMed PubMed Central
44. BroxJI, StorheimK, GrotleM, et al.. Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain. Spine J2008;8:948–58.10.1016/j.spinee.2007.07.389Search in Google Scholar PubMed
45. ChouR, HuffmanLH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med2007;147:492–504.10.7326/0003-4819-147-7-200710020-00007Search in Google Scholar PubMed
46. FieldT, DiegoM, Hernandez-ReifM, et al.. Yoga and massage therapy reduce prenatal depression and prematurity. J Bodywork Mov Ther2012;16:204–9.10.1016/j.jbmt.2011.08.002Search in Google Scholar PubMed PubMed Central
47. GroesslEJ, WeingartKR, AschbacherK, et al.. Yoga for veterans with chronic low-back pain. J Altern Complement Med2008;14:1123–9.10.1089/acm.2008.0020Search in Google Scholar
48. TilbrookHE, CoxH, HewittCE, et al.. Yoga for chronic low back pain: a randomized trial. Ann Intern Med2011;155:569–78.10.7326/0003-4819-155-9-201111010-00003Search in Google Scholar PubMed
49. WilliamsK, AbildsoC, SteinbergL, et al.. Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine2009;34:2066–76.10.1097/BRS.0b013e3181b315ccSearch in Google Scholar PubMed PubMed Central
50. TekurP, SingphowC, NagendraHR, RaghuramN. Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med2008;14:637–44.10.1089/acm.2007.0815Search in Google Scholar PubMed
51. AjetunmobiO. Making sense of critical appraisal. London and New York: Arnold; Distributed in the USA by Oxford University Press, 2002s.Search in Google Scholar
52. HartmanJM, ForsenJW, WallaceMS, NeelyJG. Tutorials in clinical research: part IV: recognizing and controlling bias. Laryngoscope2002;112:23–31.10.1097/00005537-200201000-00005Search in Google Scholar PubMed
53. JohnsonB, TurnerL. Data collection strategies in mixed methods reserch. In: TashakkoriA, TeddlieC, editors. Handbook of mixed methods in social and behavioural research. Washington, DC: Sage, 2003:768.Search in Google Scholar
54. ArmstrongJS, OvertonTS. Estimating non response bias in mail surveys. J Mark Res1977;14:396–402.10.1177/002224377701400320Search in Google Scholar
55. RolandM, FairbankJ. The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine (Philadelphia, PA, 1976) 2000;25:3115–24.10.1097/00007632-200012150-00006Search in Google Scholar PubMed
56. FrickRW. The appropriate use of null hypothesis testing. Psychol Methods1996;1:379–90.10.1037/1082-989X.1.4.379Search in Google Scholar
57. JüniP, AltmanDG, EggerM. Systematic reviews in health care: assessing the quality of controlled clinical trials. Br Med J2001;323:42–6.10.1136/bmj.323.7303.42Search in Google Scholar PubMed PubMed Central
58. KimaniP. What do the results mean? “Statistical thinking”. Understanding research and critical appraisal MSc module course material: The University of Warwick, 2011.Search in Google Scholar
59. PetherickM, RheaultW, KimbleS, et al.. Concurrent validity and intertester reliability of universal and fluid-based goniometers for active elbow range of motion. Phys Ther1988;68:966–9.10.1093/ptj/68.6.966Search in Google Scholar PubMed
60. WeisbergMB, ClavelAL. Why is chronic pain so difficult to treat? Psychological considerations from simple to complex care. Postgrad Med1999;106:141–2, 145–8, 157–60; passim.10.3810/pgm.1999.11.771Search in Google Scholar PubMed
61. PaiciusRM, BernsteinCA, Lempert-CohenC. Peripheral nerve field stimulation for the treatment of chronic low back pain: preliminary results of long-term follow-up: a case series. Neuromodulation2007;10:279–90.10.1111/j.1525-1403.2007.00116.xSearch in Google Scholar PubMed
62. DagenaisS, TriccoAC, HaldemanS. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J2010;10:514–29.10.1016/j.spinee.2010.03.032Search in Google Scholar PubMed
63. O’DowdJ. “The complex back”. Evidence based musculoskeletal care: managing back pain MSc module course material. The University of Warwick, 2012.Search in Google Scholar
64. EvansDD. Characteristics and outcomes of individuals self-selecting yoga versus physical therapy for the treatment of chronic low back pain. Thesis for Doctor of Philosophy, the University of Tennessee, Memphis, 2009:1–117.Search in Google Scholar
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