The authors explained as background information:
"Despite the availability of numerous treatments for chronic back pain, none have proven highly effective, and few have been evaluated for cost-effectiveness. Self-management strategies, like exercise, are particularly appealing because they are relatively safe, inexpensive, and accessible and may have beneficial effects on health beyond those for back pain.
One form of exercise with at least 'fair' evidence for effectiveness for back pain is yoga, which might be an especially promising form of exercise because it includes a mental component that could enhance the benefits of its physical components."
Karen J. Sherman, Ph.D., M.P.H., and team set out to find out what effect yoga might have on patients with chronic lower back pain, compared to a self-care book for primary care patients or stretching exercises.
The researchers randomly selected 228 adults into three groups (they all suffered from chronic low back pain):
- The yoga group (92 patients) - they had 12 classes, once a week for twelve weeks.
- The stretching group (91 patients) - they had 12 classes, once weekly.
- The Self-care book group (45 patients) - the book also includes information on what causes back pain and the types of exercises that can help, as well as lifestyle tips and what to do when there is a flare up.
The patients were interviewed by telephone at the start of the study, then at 6, 12, and 26 weeks after they were randomly selected into groups.
The authors wrote:
"Back-related dysfunction declined over time in all groups. There were no statistically or clinically significant differences between the yoga and stretching groups (at any point)."
Compared to the self care book group:
- The yoga group had superior function at 12 (-2.5) and 26 (-1.8) weeks
- The stretching group had superior function at 12 (-1.7) and 26 (-2.2) weeks
"We found that physical activity involving stretching, regardless of whether it is achieved using yoga or more conventional exercises, has moderate benefits in individuals with moderately impairing low back pain. Finding similar effects for both approaches suggests that yoga's benefits were largely attributable to the physical benefits of stretching and strengthening the muscles and not to its mental components."
They added that the benefits were found to last for many months.
In the USA, costs of low back pain range between $38 and $50 billion annually and there are 300,000 operations each year
Accompanying CommentaryTimothy S. Carey, M.D., M.P.H., from Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, wrote in an Accompanying Commentary in the same journal:
"The study by Sherman et al in this issue is an excellent example of a pragmatic comparative effectiveness trial.
This research now represents best evidence for stretching therapies. Support by payers for these therapies will be very helpful through partial financial support for the classes. Such support will encourage patients to utilize the classes, representing a value-based reimbursement policy.
We physicians should refer our patients for exercise, practitioners should work to standardize treatments, and payers should encourage these treatments through minimization of copayments for therapies that have both effectiveness and modest cost. Comparative effectiveness research, when well conducted, can assist us in making these clinical and policy recommendations."
Written by Christian Nordqvist