Adam P Goode1, Remy R Coeytaux2, Jennifer McDuffie3, Wei Duan-Porter4, Poonam Sharma5, Hillary Mennella6, Avishek Nagi7, John W Williams8. 1. Department of Orthopedic Surgery, Duke University Medical Center, 2200 West Main Street, Durham, NC 27705, United States; Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, United States. Electronic address: adam.goode@dm.duke.edu. 2. Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, United States. Electronic address: remy.coeytaux@duke.edu. 3. Durham Center for Health Services Research in Primary Care and Evidence Synthesis Program, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, United States; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, United States. Electronic address: mcduf.j@dm.duke.edu. 4. Durham Center for Health Services Research in Primary Care and Evidence Synthesis Program, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, United States; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, United States. Electronic address: wei.duan-porter@dm.duke.edu. 5. Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, United States. Electronic address: poonam.sharma@dm.duke.edu. 6. Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, United States. Electronic address: hmennella@yahoo.com. 7. Durham Center for Health Services Research in Primary Care and Evidence Synthesis Program, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, United States. Electronic address: avishek.nagi@va.gov. 8. Durham Center for Health Services Research in Primary Care and Evidence Synthesis Program, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, United States; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, United States. Electronic address: jw.williams@dm.duke.edu.
Abstract
OBJECTIVE: Yoga is being increasingly studied as a treatment strategy for a variety of different clinical conditions, including low back pain (LBP). We set out to conduct an evidence map of yoga for the treatment, prevention and recurrence of acute or chronic low back pain (cLBP). METHODS: We searched Medline, Cochrane Database of Systematic Reviews, EMBASE, Allied and Complementary Medicine Database and ClinicalTrials.gov for randomized controlled trials (RCT), systematic reviews or planned studies on the treatment or prevention of acute back pain or cLBP. Two independent reviewers screened papers for inclusion, extracted data and assessed the quality of included studies. RESULTS: Three eligible systematic reviews were identified that included 10 RCTs (n=956) that evaluated yoga for non-specific cLBP. We did not identify additional RCTs beyond those included in the systematic reviews. Our search of ClinicalTrials.gov identified one small (n=10) unpublished trial and one large (n=320) planned clinical trial. The most recent good quality systematic review indicated significant effects for short- and long-term pain reduction (n=6 trials; standardized mean difference [SMD] -0.48; 95% CI, -0.65 to -0.31; I(2)=0% and n=5; SMD -0.33; 95% CI, -0.59 to -0.07; I(2)=48%, respectively). Long-term effects for back specific disability were also identified (n=5; SMD -0.35; 95% CI, -0.55 to -0.15; I(2)=20%). No studies were identified evaluating yoga for prevention or treatment of acute LBP. CONCLUSION: Evidence suggests benefit of yoga in midlife adults with non-specific cLBP for short- and long-term pain and back-specific disability, but the effects of yoga for health-related quality of life, well- being and acute LBP are uncertain. Without additional studies, further systematic reviews are unlikely to be informative.
OBJECTIVE: Yoga is being increasingly studied as a treatment strategy for a variety of different clinical conditions, including low back pain (LBP). We set out to conduct an evidence map of yoga for the treatment, prevention and recurrence of acute or chronic low back pain (cLBP). METHODS: We searched Medline, Cochrane Database of Systematic Reviews, EMBASE, Allied and Complementary Medicine Database and ClinicalTrials.gov for randomized controlled trials (RCT), systematic reviews or planned studies on the treatment or prevention of acute back pain or cLBP. Two independent reviewers screened papers for inclusion, extracted data and assessed the quality of included studies. RESULTS: Three eligible systematic reviews were identified that included 10 RCTs (n=956) that evaluated yoga for non-specific cLBP. We did not identify additional RCTs beyond those included in the systematic reviews. Our search of ClinicalTrials.gov identified one small (n=10) unpublished trial and one large (n=320) planned clinical trial. The most recent good quality systematic review indicated significant effects for short- and long-term pain reduction (n=6 trials; standardized mean difference [SMD] -0.48; 95% CI, -0.65 to -0.31; I(2)=0% and n=5; SMD -0.33; 95% CI, -0.59 to -0.07; I(2)=48%, respectively). Long-term effects for back specific disability were also identified (n=5; SMD -0.35; 95% CI, -0.55 to -0.15; I(2)=20%). No studies were identified evaluating yoga for prevention or treatment of acute LBP. CONCLUSION: Evidence suggests benefit of yoga in midlife adults with non-specific cLBP for short- and long-term pain and back-specific disability, but the effects of yoga for health-related quality of life, well- being and acute LBP are uncertain. Without additional studies, further systematic reviews are unlikely to be informative.
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