Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial
Abstract
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.
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Information & Authors
Information
Published In
Annals of Internal Medicine
Volume 167 • Number 2 • 18 July 2017
Pages: 85 - 94
History
Published online: 20 June 2017
Published in issue: 18 July 2017
Keywords
- Adverse events
- Diagnostic medicine
- Exercise
- Health care
- Hospital medicine
- Medical conditions
- Pain
- Population statistics
- Prevention, policy, and public health
- Rehabilitation medicine
- Research and reporting methods
- Research design
- Signs and symptoms
- Social status
- Sports and exercise medicine
- Statistical data
- Statistical methods
- Survey research
Copyright
© 2017 American College of Physicians.
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Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med.2017;167:85-94. [Epub 20 June 2017]. doi:10.7326/M16-2579
Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med.2017;167:85-94. [Epub 20 June 2017]. doi:10.7326/M16-2579
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