1. Education serves as the most effective method of therapy for chronic lower back pain.
2. Yoga and physical therapy result in similar outcomes in treating chronic lower back pain.
Evidence rating level: 1 (Excellent)
Study Rundown: Chronic low back pain is a major cause of disability worldwide. In the United States alone, 10% of adults are affected by this condition. While many therapies exist for treatment of chronic low back pain, there is little evidence comparing more traditional treatments, like physical therapy, with novel ones, like yoga. As a result, the authors of this study aimed to determine whether yoga is non inferior for treatment of chronic low back pain compared to physical therapy. This study has several limitations. First, the study may have bias related to a disproportionate loss to follow up for the physical therapy group. Additionally, the participants were not blinded to their study group. However, to address this limitation, the study was presented as comparing three credible treatments. Overall, the results of the study indicate that yoga is non inferior to physical therapy and may serve as an effective alternate therapy for chronic lower back pain.
In-Depth [randomized control trial]: The authors conducted a 12 week, single-blind, three group randomized non-inferiority trial. This trial was followed up with a 40 week maintenance phase. The study groups included either 12 weeks of yoga, physical therapy, or educational materials. Outcomes consisted of back function, measured by Roland Morris Disability Questionnaire (RMDQ), and pain, as well as several secondary outcomes. In general, it was observed that education as treatment was superior to both physical therapy and yoga in terms of back function. For example, the mean RMDQ score for yoga at 12 weeks was 11.0 (SD 4.9) and 11.3 (SD 5.1) for physical therapy, compared to 12.3 (SD 5.0) for education. Additionally, one sided 95% confidence intervals were 0.83 (RMDQ) and 0.97 (pain) for yoga compared to physical therapy. These results suggest that yoga is non inferior to physical therapy as treatment for chronic low back pain.
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