Unsupervised online yoga transiently improves symptoms in patients with knee osteoarthritis

1. Compared to a control group, patients with knee osteoarthritis who engaged in online yoga had improvements in pain and function at 12 weeks of follow-up.

2. Improvements in pain and function in the online yoga group were not maintained at 24 weeks.

Evidence Rating Level: 2 (Good)

Study Rundown: Knee osteoarthritis is a significant source of disability as a result of pain, reduced function, and disruption of mood. There is a gap in the literature as to the impact of low-impact exercise on disease burden in knee osteoarthritis patients. Accordingly, the present study examined the effectiveness of an unsupervised online yoga program as compared to a control group in improving outcomes for patients with symptomatic knee osteoarthritis. The majority of patients in the treatment group adhered to the program to an acceptable level. Compared to the control population, the yoga group had greater improvements in function at 12 weeks. Minimal differences were observed in knee pain between groups at 12 weeks. The benefits of the yoga intervention were not maintained at the 24-week mark. Improvements in secondary outcomes such as stiffness, quality of life, arthritis self-efficacy for pain, and self-efficacy in other symptoms were improved at 12 weeks but not at 24 weeks. Factors such as age, gender, body mass index, the expectation of treatment effects, pain self-efficacy, and fear of movement did not significantly affect the relationship between yoga and primary outcomes at 12 weeks. No serious adverse events were reported throughout the study duration. However, due to reported difficulties with adherence and self-report measures, it is difficult to gauge the efficacy of the intervention in the general osteoarthritis population.

Click to read the study in the Annals of Internal Medicine

Relevant Reading: Stepped exercise program for patients with knee osteoarthritis

In-Depth [randomized controlled trial]: This randomized control trial evaluated the effectiveness of an unsupervised 12-week online yoga program in patients with knee osteoarthritis compared to a control of only online education. The treatment group was provided access to an online website with 12 different prerecorded 30-minute videos, to be performed three times a week. The primary outcomes were 12-week changes in validated pain and physical function scales for knee osteoarthritis. A total of 212 participants were enrolled, with baseline characteristics that were acceptably similar between groups. Both primary outcomes were provided by 92% of participants at 12 weeks and 89% at 24 weeks, with minor differences between those who did and did not provide outcomes. Yoga group participants accessed the website a mean of 20.5 times (Standard deviation [SD], 19.5) for a mean of 25.4 minutes (SD, 12.8) per session over 12 weeks. Control participants accessed their online information for a mean of 1.6 times (SD, 1.5) for a mean of 9.8 minutes (SD, 14.3) during the first 12 weeks. The treatment group had greater improvements in function at 12 weeks (between-group mean difference in change, -4.0; 95% Confidence Interval [CI], -6.8 to -1.3). Only small differences were seen for knee pain during walking at 12 weeks (mean difference in change, -0.6; 95% CI, 1.09 to 1.91). Benefits seen in the primary outcomes did not persist at 24 weeks. At 12 weeks, yoga led to improvements in knee stiffness (mean difference in change, -0.4; 95% CI, -0.8 to 0.0), quality of life (mean difference in change, 0.04; 95% CI, 0.0 to 0.07), arthritis self-efficacy for pain (mean difference in change, 0.6; 95% CI, 0.1 to 1.1), and self-efficacy for other symptoms (mean difference in change, 0.6; 95% CI, 0.2 to 1.0). In summary, this study found that online yoga was not associated with long-term symptom improvement in knee osteoarthritis patients.

Image: PD

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