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

Abstract

Purpose: Chronic low back pain (CLBP) causes substantial morbidity and cost to societywhile disproportionately impacting low income andminorities. RCTs show yoga is effective for CLBP. However, the comparative effectiveness of yoga to physical therapy (PT), a common mainstream CLBP treatment, is unknown. Methods: From June 2012–October 2014 we conducted a one year RCT (n=320) comparing yoga, PT, and education for CLBP in predominantly low-income minority adults recruited from diverse Boston, USA neighborhoods. Inclusion criteria were adult s 18-64 with non-specific CLBP lasting >12 weeks and self-reported average pain >4 on a 0-10 scale. Participants were randomized in a 2:2:1 ratio into (1) a standardized weekly hatha yoga class supplemented with a DVD for home practice; (2) a standardized PT protocol adapted from the Treatment Based Classification method, individually delivered by a physical therapist and supplemented by home practice; and (3) education delivered through a self-care book. Co-primary outcome measures were 12 week pain intensity measured on an 11 point numerical rating scale and backspecific function measured using the modified Roland Morris Disability Questionnaire (RMDQ).We usedmultiple regression and intent-to-treat to test non-inferiority of yoga to PT at 12 weeks. Non-inferiority margins for pain were established a priori as -1 and 1.5 for pain and RMDQ, respectively. Results: Participant mean age was 47 years; 64% were female; 77% were non-white; 41% had high school education or less; and 53%had an annual income≤$20,000. Baseline pain intensity 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 for PT. RMDQ improved -3.9 and -3.6 for yoga and PT, respectively. Conclusion: For chronic LBP, yogawas non-inferior to physical therapy for reduction inpain and improvement in function at 12 weeks. Contact: Robert Saper, Robert.Saper@bmc.org