A randomized controlled trial comparing yoga, physical, therapy, and education for chronic low back pain in predominantly low income minorities

摘要

Purpose: Chronic low back pain (CLBP) causes substantialmorbidity and cost to society while disproportionately impactinglowincome and minorities. RCTs showyoga is effective forCLBP. However, the comparative effectiveness of yoga to physicaltherapy (PT), a common mainstream CLBP treatment, isunknown.Methods: From June 2012–October 2014 we conducted aone year RCT (n=320) comparing yoga, PT, and education forCLBP in predominantly low-income minority adults recruitedfrom diverse Boston, USA neighborhoods. Inclusion criteriawere adult s 18-64 with non-specific CLBP lasting >12 weeksand self-reported average pain >4 on a 0-10 scale. Participantswere randomized in a 2:2:1 ratio into (1) a standardizedweekly hatha yoga class supplemented with a DVD for homepractice; (2) a standardized PT protocol adapted from theTreatment Based Classification method, individually deliveredby a physical therapist and supplemented by homepractice; and (3) education delivered through a self-care book.Co-primary outcome measures were 12 week pain intensitymeasured on an 11 point numerical rating scale and backspecificfunction measured using the modified Roland MorrisDisability Questionnaire (RMDQ).We usedmultiple regressionand intent-to-treat to test non-inferiority of yoga to PT at 12weeks. Non-inferiority margins for pain were established apriori as -1 and - 1.5 for pain and RMDQ, respectively.Results: Participant mean age was 47 years; 64% werefemale; 77% were non-white; 41% had high school educationor less; and 53% had an annual income≤$20,000. Baseline painintensity and RMDQ were 7.1 (1.4) and 14.8 (5.3), respectively.At 12 weeks, LBP intensity decreased -1.7 compared to -2.3 forPT. RMDQ improved -3.9 and -3.6 for yoga and PT, respectively.Conclusion: For chronic LBP, yogawas non-inferior to physicaltherapy for reduction in pain and improvement in functionat 12 weeks.