Effect of Yoga Versus Stretching on Chronic Back Pain

项目概述：背部疼痛是困扰美国成年人的最普遍的疾病之一，也是使用补充和替代医学（CAM）疗法的主要原因。瑜伽是一种越来越受欢迎的“身心”CAM疗法，经常用于缓解背痛，几项小型研究发现瑜伽对这种情况有效。拟议中的随机试验将确定与常规护理和锻炼相比，瑜伽是否是一种有效的治疗慢性腰痛的方法，如果是的话，将探索其益处的机制。研究人员将从西雅图一家大型医疗保健系统的初级保健诊所招募210名腰痛持续至少3个月的参与者。他们将以2:2:1的比例随机分配，接受12周的瑜伽课程，12周的常规治疗性运动课程，或常规护理。在随机分组后的基线、6周、12周和26周，对治疗组参与者进行评估。主要结果将是背部相关功能障碍和症状困扰。此外，将收集基线和12周时的物理测量数据（例如，屈曲），并在基线、6和12周时获得唾液样本。将收集具体的身体、心理和生理因素的信息，以探索瑜伽缓解背部疼痛和功能障碍的可能机制。瑜伽的有效性将在意向治疗背景下使用协方差分析（GEE）进行评估。如果发现瑜伽有效，进一步的分析将探讨瑜伽的好处是否归因于身体、心理和/或生理因素。这项研究将提供迄今为止最明确的证据，证明瑜伽作为治疗慢性背痛的治疗选择的价值，如果结果是积极的，将有助于未来更深入地研究本研究确定的最有希望的潜在作用机制。相关性：慢性腰痛是影响数百万美国人的主要公共卫生问题，导致巨大的医疗保健和残疾成本以及生产力损失。这项研究将确定瑜伽是否比通常的医疗护理或传统运动对慢性背痛更有效，如果是这样，瑜伽的任何优势是否可以归因于它对精神和身体的影响。

DESCRIPTION (provided by applicant): PROJECT SUMMARY: Back pain is one of the most prevalent conditions afflicting American adults and is the leading reason for using complementary and alternative medical (CAM) therapies. Yoga is an increasingly popular "mind-body" CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition. The proposed randomized trial will determine if yoga is an effective treatment for chronic low back pain compared with usual care and exercise and if so, will explore the mechanisms responsible for its benefits. A total of 210 participants with low back pain lasting at least 3 months will be recruited from primary care clinics of a large healthcare system based in Seattle. They will be randomized in a 2:2:1 ratio to receive 12 weekly yoga classes, 12 weekly conventional therapeutic exercise classes of comparable physical exertion, or usual care. Interviewers masked to participants' treatment group will assess outcomes at baseline and 6, 12 and 26 weeks after randomization. Primary outcomes will be back-related dysfunction and symptom bothersomeness. In addition, data will be collected on physical measurements (e.g., flexion) at baseline and 12 weeks and salivary samples will be obtained at baseline, 6 and 12 weeks. Information will be collected on specific physical, psychological, and physiological factors to allow exploration of possible mechanisms of action through which yoga could relieve back pain and dysfunction. The effectiveness of yoga will be assessed using analysis of covariance (GEE) within an intention-to-treat context. If yoga is found effective, further analyses will explore whether yoga's benefits are attributable to physical, psychological and/or physiological factors. This study will provide the clearest evidence to date about the value of yoga as a therapeutic option for treating chronic back pain, and if the results are positive, will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study. RELEVANCE: Chronic low back pain is a major public health problem affecting millions of Americans and resulting in huge medical care and disability costs and lost productivity. This study will determine if yoga is more effective for chronic back pain than usual medical care or conventional exercise, and if so, if any of yoga's advantages may be attributed to its effects on the mind as well as on the body.