Date of Award

5-2009

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Nursing

Research Advisor

Michael Carter, DNSc, FAAN

Committee

Patricia Cowan, Ph.D Margaret Hartig, Ph.D Richard Panico, M.D. James Pruett, Ph.D.

Abstract

Chronic low back pain (cLBP) is a significant public health problem that is difficult and costly to treat. Determining whether a patient with cLBP will benefit from a particular treatment approach is challenging, since little is understood about the patient characteristics that predict improved treatment outcomes. Understanding these characteristics could reduce treatment failures and costs of care.

This study was designed to explore the demographic, clinical and treatment- related characteristics of individuals self-selecting yoga versus physical therapy (PT) for treatment of cLBP. A growing body of research demonstrates that yoga reduces pain and improves function in persons with cLBP. However, questions remain about how people selecting yoga as a treatment for cLBP differ from persons selecting standard therapies, like PT, and whether pre-treatment differences influence treatment outcomes.

A convenience sample of 53 adults ≥ age 18 with cLBP ≥ 3 months enrolling in either a 6 week modified Integral yoga program (n = 27) or a 6 week program of individualized PT (n = 26) participated in the study. Data were collected at baseline and at 6 and 12 weeks after completion of treatment. Study variables included disability (Roland Morris Disability Questionnaire), depression (Beck Depression Inventory-II), health status (RAND Short-Form 36-Item Health Survey 1.0 Questionnaire), fear of movement (Tampa Scale of Kinesiophobia), pain self-efficacy, pain bothersomeness, pain medication use, reasons for treatment choice and satisfaction with care. Group differences were compared using non-parametric statistics.

The findings revealed no significant differences between the groups in duration of cLBP (9.02 ± 9.29 years), worst pain in the past 6 months (8.05 ± 1.93 on a 0-10 pain bothersomeness scale), age (50.69 ± 15.56 years), gender (66% female) or education (16 ± 3.05 years). However, PT participants were more likely to be nonwhite, earning ≤ $30,000/yr and selecting PT based on healthcare provider referral or insurance coverage. Yoga participants were more likely to be gainfully employed, earning ≥ $70,000/yr and selecting yoga based on personal research. Neither group was depressed at baseline, but PT participants were significantly more disabled, had lower health status, greater pain and twice the pain medication use compared to yoga participants at baseline.

At the conclusion of 6 weeks of treatment, both groups had significant improvements in disability and health status with fewer days in pain. PT participants who showed significantly greater pain symptoms at baseline had greater reductions in pain at 6 and 12 weeks compared to yoga participants. At 12 weeks the groups had equivalent pain levels, demonstrating persistent treatment benefits with few adverse effects and high satisfaction with care. Cost was cited as a reason for early termination of treatment for PT participants but was not an issue for yoga participants. The improved outcomes and group differences support the effectiveness of both treatments in reducing pain and disability. The similarities between the groups at 12 weeks and differences in total cost of care suggest the need for further research to examine the long-term costs and benefits of yoga versus PT for treatment of cLBP.

DOI

10.21007/etd.cghs.2009.0087

Comments

Six month embargo expired October 2009