REVIEW QUESTION

What is the effect of yoga compared with no treatment and other treatments on chronic nonspecific low back pain?

TYPE OF REVIEW

This is a systematic review of 12 trials involving 1,080 participants.

RELEVANCE FOR NURSING

Low back pain is a common health problem. In many people, low back pain may last for three months or more, at which point the condition is considered chronic. Yoga is sometimes used as a treatment for low back pain. Nurses need to understand the evidence supporting the use of yoga in treating chronic low back pain so they can advocate for the best pain management for their patients.

CHARACTERISTICS OF THE EVIDENCE

The review included 12 trials (for a total of 1,080 participants) conducted in the United States (seven trials), India (three trials), and the United Kingdom (two trials). Most trials used Iyengar, Hatha, or Viniyoga forms of yoga. The trials compared yoga with an exercise intervention such as aerobic exercise or muscle strengthening (three trials), no intervention or a nonexercise intervention such as education (seven trials), or both exercise and nonexercise interventions (two trials).

No participants or providers in any of the studies were blinded to treatment assignment, and all outcomes were self-reported. Therefore, all studies were at high risk for performance and detection bias, and the authors considered none of the evidence to be of high certainty.

There was low-certainty to moderate-certainty evidence that yoga compared with nonexercise results in small-to-moderate improvements in back-related function at three and six months. Yoga may also be slightly more effective than nonexercise in alleviating pain at three and six months, however the effects were not clinically important. It is uncertain whether there is any difference between yoga and other exercise in improving back-related function or pain, or whether yoga in addition to exercise is more effective than exercise alone. Yoga is associated with more adverse events than nonexercise, but may have the same risk of adverse events as other back-focused exercise. Yoga is not associated with serious adverse events.

BEST PRACTICE RECOMMENDATIONS

Yoga appears to be more effective than nonexercise interventions and either as effective as or slightly more effective than nonyoga exercise interventions. The findings of this review in terms of the safety of yoga were consistent with those of a previous systematic review in that yoga results in more adverse events than psychological or educational interventions but has the same number of adverse events as nonyoga exercise.

RESEARCH RECOMMENDATIONS

There is a need for additional high-quality research to improve confidence in estimates of effect, to evaluate long-term outcomes, and to provide additional information on comparisons between yoga and other exercise for chronic nonspecific low back pain. Also, most trials comparing yoga with nonexercise options have been carried out in well-educated, middle and upper socioeconomic populations in the United States or the United Kingdom. Therefore, there is a need for further trials in a range of populations, including those of low socioeconomic status, older adults, and populations with comorbidities. There is also a need for additional research into the potential influence of people's preferences and expectations on outcomes within randomized trials of yoga.

REFERENCE