Yoga

Dr. Robert Saper has been studying the effect of Yoga on pain, particularly low back pain, for several years. He has has conducted several studies investigating different areas surrounding the numerous intersections of yoga and pain with encouraging results.

Back to Health was a randomized controlled trial for 320 adults recruited from many Boston neighborhoods. The study compared the effectiveness of yoga, physical therapy, and education for chronic low back pain. The 52-week study had an initial 12-week Treatment Phase where participants were randomly assigned to one of three groups: (1) a standardized weekly hatha yoga class with home practice; (2) standardized one-on-one physical therapy sessions with home practice; and (3) education delivered with a self-care book and newsletters. During the subsequent 40-week Maintenance Phase, participants in the yoga group were re-randomized to either continued weekly yoga classes or home practice only. The PT participants similarly were re-randomized to receive either five booster sessions or home practice only. The education participants were encouraged to continue to read and review their materials. The study protocol, participant, and instructor manuals were published in Trials and are available at http://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1321-5.   The study concluded in November 2014. The main results are expected to be published soon.  Cost-effectiveness and additional exploratory analyses are in progress.

The Yoga Dosing Study was a randomized dosing trial for 95 adults recruited from diverse Boston neighborhoods. The study compared once-weekly vs. twice-weekly standardized yoga classes for chronic low back pain. Participants’ pain and back-related function were measured at the beginning of the study and after the 12-week treatment phase. The study concluded in December 2011. The study showed that 12 weeks of once-weekly or twice-weekly yoga classes were similarly effective for a population of predominantly low income minority patients with moderate to severe chronic low back pain. The results were published in Evidence-Based Complementary and Alternative Medicine and are available online at http://www.hindawi.com/journals/ecam/2013/658030/

Yoga for low back pain has been demonstrated to be effective for civilians in randomized controlled trials, but it is unknown if these results can be generalized to military populations. This study is a randomized controlled trial comparing yoga vs. education for 120 Veterans with chronic low back pain. The study is 24-weeks long with an initial 12-week intervention period where participants are randomly assigned to either: (1) a standardized weekly group yoga class with home practice; or (2) education delivered with a self-care book and newsletters. After the intervention period, yoga participants are encouraged to continue home yoga practice and education participants continue following recommendations from the book. Final follow-up occurs at 24 weeks. Qualitative interviews with Veterans in the yoga group and their partners explore the impact of chronic low back pain and yoga on family relationships. The study protocol, participant, and instructor manuals were published in Trials and are available at http://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-15-67.  All interventions and follow-up were completed in June 2016.  Results are anticipated to be published in 2017.

The TARGET Trial is a multi-site pragmatic cluster randomized controlled trial funded by the Patient-Centered Outcomes Research Institute. TARGET will compare the impact of psychologically informed physical therapy (PIPT) vs. guideline based care on the rate of transition from acute to chronic low back pain.  Five national sites are participating in TARGET – University of Pittsburgh (Pittsburgh, PA), Boston Medical Center (Boston, MA), Intermountain Healthcare (Salt Lake City, UT), Johns Hopkins University (Baltimore, MD), and Medical University of South Carolina (Charleston, SC). The study will be comparing guideline-based care vs. guideline-based care plus PIPT for patients presenting to primary care centers with acute back pain. The STarT Back Screening Tool will stratify patients into low, medium, or high risk for progression to chronic back pain. Approximately 12,000 patients will be enrolled in this trial nation-wide. More information is available on the study website at http://targettrial.pitt.edu/.