Joyce C, Roseen EJ, Keysor JJ, et al. Can Yoga or Physical Therapy for Chronic Low Back Pain Improve Depression and Anxiety Among Adults From a Racially Diverse, Low-Income Community? A Secondary Analysis of a Randomized Controlled Trial. Arch Phys Med Rehabil. 2021 Feb 5. pii: S0003-9993(21)00140-4. doi: 10.1016/j.apmr.2021.01.072. (Original study)

OBJECTIVE: To determine and compare the effect of yoga, physical therapy (PT), and education on depressive and anxious symptoms in patients with chronic low back pain (CLBP).

DESIGN: Secondary analysis of a randomized controlled trial.

SETTING: Academic safety net hospital and 7 community health centers.

PARTICIPANTS: A total of 320 adults with CLBP.

INTERVENTION: Yoga classes, PT sessions, or an educational book.

OUTCOME MEASURE: Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder 7-item Scale, respectively, at baseline, 12, and 52 weeks. We identified baseline and midtreatment (6-wk) factors associated with clinically meaningful improvements in depressive (=3 points) or anxious (=2 points) symptoms at 12 weeks.

RESULTS: Participants (female=64%; mean age, 46.0±10.7 years) were predominantly non-White (82%), low-income (<$30,000/year, 59%), and had not received a college degree (71%). Most participants had mild or worse depressive (60%) and anxious (50%) symptoms. At 12 weeks, yoga and PT participants experienced modest within-group improvements in depressive symptoms (mean difference [MD]=-1.23 [95% CI, -2.18 to -0.28]; MD=-1.01 [95% CI, -2.05 to -0.03], respectively). Compared with the education group, 12-week differences were not statistically significant, although trends favored yoga (MD=-0.71 [95% CI, -2.22 to 0.81]) and PT (MD= -0.32 [95% CI, -1.82 to 1.18]). At 12 weeks, improvements in anxious symptoms were only found in participants who had mild or moderate anxiety at baseline. Independent of treatment arm, participants who had 30% or greater improvement in pain or function midtreatment were more likely to have a clinically meaningful improvement in depressive symptoms (odds ratio [OR], 1.82 [95% CI, 1.03-3.22]; OR, 1.79 [95% CI, 1.06-3.04], respectively).

CONCLUSIONS: In our secondary analysis we found that depression and anxiety, common in this sample of underserved adults with CLBP, may improve modestly with PT and yoga. However, effects were not superior to education. Improvements in pain and function are associated with a decrease in depressive symptoms. More research is needed to optimize the integration of physical and psychological well-being in PT and yoga.

Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 6 / 7
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Comments from MORE raters

Physician rater

This study potentially adds to a growing body of work that recognises that msk and mental health are common co-morbidities, and the presence of one will impact on the likelihood of effectiveness of tmt for another. For example, see the STartBack work in UK - stratifying tmt for back pain based on MH

Rehab Clinician (OT/PT) rater

The study is an excellent exploration of the issues of anxiety, depression, low socioeconomic status and low back pain. The study was well designed, used standardized outcome measures, and treatment was applied in a manner similar to that in general practice. It is well worth a read for clinicians working with people with persistent low back pain.
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