Yoga Therapy to Improve Function among Veterans with Chronic Low Back Pain

描述(由申请人提供)： 对退伍军人的影响：慢性下腰痛(CLBP)是退伍军人的一种非常普遍的疾病，特别是那些在军事冲突中积极部署的退伍军人。除了慢性疼痛，CLBP还会导致大量残疾，降低与健康相关的生活质量(HRQOL)，并增加医疗保健利用率。现有的CLBP治疗方法通常有轻微到中度的效果，患者经常寻求其他治疗方案。随着越来越多的证据支持其疗效，瑜伽是一种廉价的治疗选择。然而，它还没有在患有CLBP的退伍军人中进行研究。项目背景：慢性下腰痛非常普遍，特别是在积极部署的退伍军人中。CLBP已被证明会导致更多的残疾、更高的卫生保健利用率、更低的生产力和更低的HRQOL。现有的治疗CLBP的方法，如药物、物理治疗、运动和脊柱推拿，已被证明具有轻微到中度的效果。由于患者患有慢性疾病多年，而且通常是在他们的余生中生活，他们很高兴能够选择最符合他们当前价值观和偏好的治疗方法。此外, 其中一些现有的治疗方法比其他治疗方法成本更低，通常是因为它们是以小组形式提供的。一项临床瑜伽项目的试点数据显示，患有CLBP的退伍军人的疼痛和抑郁有所减少，而精力和HRQOL有所提高。主要目标：我们的主要目标是进行一项随机试验，将参加瑜伽的退伍军人的健康结果与被分配延迟瑜伽治疗的退伍军人的健康结果进行比较。我们的主要假设是，被分配到瑜伽中的CLBP退伍军人在功能能力方面的改善将显著高于没有立即接受瑜伽的对照组。次要结果包括疼痛、心理症状、精力和HRQOL。项目方法：我们将通过VA初级保健、疼痛服务、物理治疗和行为医学诊所招募144名VA CLBP患者。将对患者进行筛查，以确保他们能够安全参与。符合条件的患者将是 随机接受瑜伽治疗或延迟治疗对照组，12周后允许开始瑜伽。瑜伽疗法包括每周两次瑜伽课程，由一名认证的瑜伽练习者指导，为期12周。鼓励患者在家练习瑜伽姿势，除非他们的疼痛加剧。对照组同意在12周内不参加瑜伽或类似的干预。否则，两组人都会像往常一样接受治疗。问卷数据、病历数据和一些生理数据将在基线、12周和6个月的随访时收集。主要结果数据将使用ANCOVA和线性随机效应模型进行分析。

DESCRIPTION (provided by applicant): Impact for Veterans: Chronic low back pain (CLBP) is a highly prevalent condition for veterans, especially those who were actively deployed in military conflicts. In addition to chronic pain, CLBP leads to significant amounts of disability, reduced health-related quality of life (HRQOL), and increased health care utilization. Existing treatments for CLBP typically have small to moderate effects, and patients often seek additional treatment options. Yoga is an inexpensive treatment option with increasing evidence supporting its efficacy. However, it has not been studied among veterans with CLBP. Project Background: Chronic low back pain is highly prevalent, especially among veterans who were actively deployed. CLBP has been shown to result in more disability, higher health care utilization, reduced productivity, and lower HRQOL. Existing treatments for CLBP such as medication, physical therapy, exercise, and spinal manipulation have been shown to have small to moderate effects. Since patients live with chronic conditions for many years, and often for the rest of their lives, they appreciate being able to choose the treatments that best fit with their current values and preferences. In addition, some of these existing treatments are less expensive to provide than others, often because they are delivered in group format. Pilot data from a clinical yoga program show decreases in pain and depression, and increases in energy and HRQOL among veterans with CLBP. Primary Objectives: Our primary objective is to conduct a randomized trial, in which the health outcomes of veterans assigned to yoga is compared to the health outcomes of veterans assigned to delayed treatment with yoga. Our primary hypothesis is that veterans with CLBP assigned to the yoga will have improvements in functional ability that are significantly greater than the comparison group that does not receive yoga right away. Secondary outcomes include pain, psychological symptoms, energy, and HRQOL. Project Methods: We will recruit 144 VA patients with CLBP through VA primary care, pain service, physical therapy, and behavioral medicine clinics. Patients will be screened to ensure they can participate safely. Eligible patients will be randomized to yoga therapy or to the delayed treatment comparison group, which will be allowed to start yoga 12 weeks later. Yoga therapy consists of twice weekly yoga sessions led by a certified yoga practitioner for 12 weeks. Patients are encouraged to practice yoga postures at home unless their pain increases. The comparison group agrees to not participate in yoga or similar interventions for 12 weeks. Otherwise, both groups receive care as usual. Questionnaire data, medical record data, and some physiological data will be collected at baseline, 12 weeks, and at a 6-month follow-up. The main outcome data will be analyzed using ANCOVA and linear random effects models.