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Benefits of the Restorative Exercise and Strength Training for Operational Resilience and Excellence Yoga Program for Chronic Low Back Pain in Service Members: A Pilot Randomized Controlled Trial

  • Krista Beth Highland
    Correspondence
    Corresponding author Krista Beth Highland, PhD, Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 709, Rockville, MD 20852.
    Affiliations
    Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
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  • Audrey Schoomaker
    Affiliations
    Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
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  • Winifred Rojas
    Affiliations
    Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
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  • Josh Suen
    Affiliations
    Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
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  • Ambareen Ahmed
    Affiliations
    Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
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  • Zhiwei Zhang
    Affiliations
    Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
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  • Sarah Fink Carlin
    Affiliations
    YogaMedics, Huntington Woods, MI
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  • Christian E. Calilung
    Affiliations
    Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
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  • Michael Kent
    Affiliations
    Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD

    Walter Reed National Military Medical Center, Bethesda, MD
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  • Christin McDonough
    Affiliations
    Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD

    The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
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  • Chester C. Buckenmaier III
    Affiliations
    Defense & Veterans Center for Integrative Pain Management, Uniformed Services University of the Health Sciences, Rockville, MD

    Walter Reed National Military Medical Center, Bethesda, MD
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Published:September 15, 2017DOI:https://doi.org/10.1016/j.apmr.2017.08.473

      Abstract

      Objective

      To examine the feasibility and preliminary effectiveness of an individualized yoga program.

      Design

      Pilot randomized controlled trial.

      Setting

      Military medical center.

      Participants

      Patients (N=68) with chronic low back pain.

      Interventions

      Restorative Exercise and Strength Training for Operational Resilience and Excellence (RESTORE) program (9–12 individual yoga sessions) or treatment as usual (control) for an 8-week period.

      Main Outcome Measures

      The primary outcome was past 24-hour pain (Defense & Veterans Pain Rating Scale 2.0). Secondary outcomes included disability (Roland-Morris Disability Questionnaire) and physical functioning and symptom burden (Patient-Reported Outcomes Measurement Information System-29 subscales). Assessment occurred at baseline, week 4, week 8, 3-month follow-up, and 6-month follow-up. Exploratory outcomes included the proportion of participants in each group reporting clinically meaningful changes at 3- and 6-month follow-ups.

      Results

      Generalized linear mixed models with sequential Bonferroni-adjusted pairwise significance tests and chi-square analyses examined longitudinal outcomes. Secondary outcome significance tests were Bonferroni adjusted for multiple outcomes. The RESTORE group reported improved pain compared with the control group. Secondary outcomes did not retain significance after Bonferroni adjustments for multiple outcomes, although a higher proportion of RESTORE participants reported clinically meaningfully changes in all outcomes at 3-month follow-up and in symptom burden at 6-month follow-up.

      Conclusions

      RESTORE may be a viable nonpharmacological treatment for low back pain with minimal side effects, and research efforts are needed to compare the effectiveness of RESTORE delivery formats (eg, group vs individual) with that of other treatment modalities.

      Keywords

      List of abbreviations:

      GLMM (generalized linear mixed model), LBP (low back pain), MHS (Military Health System), PROMIS (Patient-Reported Outcomes Measurement Information System), RESTORE (Restorative Exercise and Strength Training for Operational Resilience and Excellence)
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      References

        • Hardt J.
        • Jacobsen C.
        • Goldberg J.
        • Nickel R.
        • Buchwald D.
        Prevalence of chronic pain in a representative sample in the United States.
        Pain Med. 2008; 9: 803-812
        • Freburger J.K.
        • Holmes G.M.
        • Agans R.P.
        • et al.
        The rising prevalence of chronic low back pain.
        Arch Intern Med. 2009; 169: 251-258
        • Armed Forces Health Surveillance Center (AFHSC)
        Ambulatory visits among members of the active component, U.S. Armed Forces, 2014.
        MSMR. 2015; 22: 18-24
        • Gore M.
        • Sadosky A.
        • Stacey B.R.
        • Tai K.S.
        • Leslie D.
        The burden of chronic low back pain: clinical comorbidities, treatment patterns, and health care costs in usual care settings.
        Spine (Phila Pa 1976). 2012; 37: E668-E677
        • Armed Forces Health Surveillance Center (AFHSC)
        Ambulatory visits among members of the active component, U.S. Armed Forces, 2012.
        MSMR. 2013; 20: 18-23
        • Armed Forces Health Surveillance Center (AFHSC)
        Ambulatory visits among members of the active component, U.S. Armed Forces, 2010.
        MSMR. 2011; 18: 16-21
        • Mafi J.N.
        • McCarthy E.P.
        • Davis R.B.
        • Landon B.E.
        Worsening trends in the management and treatment of back pain.
        JAMA Intern Med. 2013; 173: 1573-1581
        • Office of the Army Surgeon General
        Pain Management Task Force: final report.
        May 2010 (Available at: http://armymedicine.mil/Documents/Pain-Management-Task-Force.pdf. Accessed January 25, 2017.)
        • Vallerand A.H.
        • Cosler P.
        • Henningfield J.E.
        • Galassini P.
        Pain management strategies and lessons from the military: a narrative review.
        Pain Res Manag. 2015; 20: 261-268
        • Coots N.V.
        • Galloway K.T.
        Statement on overmedication: problems and solution.
        Senate committee on veteran's affairs. 113th congress, ed. US Government: Washington, DC, 2014
        • Cramer H.
        • Lauche R.
        • Haller H.
        • Dobos G.
        A systematic review and meta-analysis of yoga for low back pain.
        Clin J Pain. 2013; 29: 450-460
        • Chou R.
        Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline.
        Ann Intern Med. 2007; 147: 492
        • Holtzman S.
        • Beggs R.T.
        Yoga for chronic low back pain: a meta-analysis of randomized controlled trials.
        Pain Res Manag. 2013; 18: 267-272
        • Sharma M.
        • Haider T.
        Yoga as an alternative and complementary treatment for patients with low back pain: a systematic review.
        J Evid Based Complementary Altern Med. 2013; 18: 23-28
        • Wren A.A.
        • Wright M.A.
        • Carson J.W.
        • Keefe F.J.
        Yoga for persistent pain: new findings and directions for an ancient practice.
        Pain. 2011; 152: 477-480
        • Flor H.
        • Turk D.C.
        • Berndt Scholz O.
        Impact of chronic pain on the spouse: marital, emotional and physical consequences.
        J Psychosom Res. 1987; 31: 63-71
        • Gatchel R.J.
        • Peng Y.B.
        • Peters M.L.
        • Fuchs P.N.
        • Turk D.C.
        The biopsychosocial approach to chronic pain: scientific advances and future directions.
        Psychol Bull. 2007; 133: 581-624
        • Solberg Nes L.
        • Roach A.R.
        • Segerstrom S.C.
        Executive functions, self-regulation, and chronic pain: a review.
        Ann Behav Med. 2009; 37: 173-183
        • Büssing A.
        • Michalsen A.
        • Khalsa S.B.
        • Telles S.
        • Sherman K.J.
        Effects of yoga on mental and physical health: a short summary of reviews.
        Evid Based Complement Alternat Med. 2012; 2012: 165410
        • Stoller C.C.
        • Greuel J.H.
        • Cimini L.S.
        • Fowler M.S.
        • Koomar J.A.
        Effects of sensory-enhanced yoga on symptoms of combat stress in deployed military personnel.
        Am J Occup Ther. 2012; 66: 59-68
        • Nassif T.H.
        • Chapman J.C.
        • Sandbrink F.
        • et al.
        Mindfulness meditation and chronic pain management in Iraq and Afghanistan veterans with traumatic brain injury: a pilot study.
        Mil Behav Health. 2016; 4: 82-89
        • Groessl E.J.
        • Weingart K.R.
        • Aschbacher K.
        • Pada L.
        • Baxi S.
        Yoga for veterans with chronic low-back pain.
        J Altern Complement Med. 2008; 14: 1123-1129
        • Deyo R.A.
        • Dworkin S.F.
        • Amtmann D.
        • et al.
        Report of the NIH Task Force on Research Standards for Chronic Low Back Pain.
        Pain Med. 2014; 15: 1249-1267
        • Buckenmaier III, C.C.
        • Galloway K.T.
        • Polomano R.C.
        • McDuffie M.
        • Kwon N.
        • Gallagher R.M.
        Preliminary validation of the Defense and Veterans Pain Rating Scale (DVPRS) in a military population.
        Pain Med. 2013; 14: 110-123
        • Nassif T.H.
        • Amanda H.
        • Holliday S.B.
        • Patrick S.
        • Friedhelm S.
        Concurrent validity of the Defense and Veterans Pain Rating Scale in VA outpatients.
        Pain Med. 2015; 16: 2152-2161
        • Schulz K.F.
        • Altman D.G.
        • Moher D.
        • CONSORT Group
        CONSORT 2010 Statement: updated guidelines for reporting parallel group randomized trials.
        Ann Intern Med. 2010; 152: 726-732
        • Page P.
        • Frank C.
        • Lardner R.
        Assessment and treatment of muscle imbalance: the Janda approach.
        BenchMark Physical Therapy Inc., Champaign, IL2010
        • Riddle D.L.
        • Stratford P.W.
        Roland-Morris scale reliability.
        Phys Ther. 2002; 82 (author reply 515-7): 512-515
        • Sahrmann S.
        Diagnosis and treatment of movement impairment syndromes.
        1st ed. St. Louis, MO: Mosby, Inc, 2001
        • Polomano R.C.
        • Galloway K.T.
        • Kent M.L.
        • et al.
        Psychometric testing of the Defense and Veterans Pain Rating Scale (DVPRS): a new pain scale for military populations.
        Pain Med. 2016; 17: 1505-1519
        • Ostelo R.W.
        • Deyo R.A.
        • Stratford P.
        • et al.
        Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change.
        Spine (Phila Pa 1976). 2008; 33: 90-94
        • Roland M.
        • Fairbank J.
        The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire.
        Spine (Phila Pa 1976). 2000; 25: 3115-3124
        • Ostelo R.W.
        • de Vet H.C.
        • Knol D.L.
        • van den Brandt P.A.
        24-item Roland-Morris Disability Questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery.
        J Clin Epidemiol. 2004; 57: 268-276
        • Chakravarty E.F.
        • Bjorner J.B.
        • Fries J.F.
        Improving patient reported outcomes using item response theory and computerized adaptive testing.
        J Rheumatol. 2007; 34: 1426-1431
        • Rose M.
        • Bjorner J.B.
        • Becker J.
        • Fries J.F.
        • Ware J.E.
        Evaluation of a preliminary physical function item bank supported the expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS).
        J Clin Epidemiol. 2008; 61: 17-33
        • Deyo R.A.
        • Ramsey K.
        • Buckley D.I.
        • et al.
        Performance of a Patient Reported Outcomes Measurement Information System (PROMIS) short form in older adults with chronic musculoskeletal pain.
        Pain Med. 2016; 17: 314-324
        • Karayannis N.V.
        • Sturgeon J.A.
        • Chih-Kao M.
        • Cooley C.
        • Mackey S.C.
        Pain interference and physical function demonstrate poor longitudinal association in people living with pain: a PROMIS investigation.
        Pain. 2017; 158: 1063-1068
        • Davis L.L.
        • Kroenke K.
        • Monahan P.
        • Kean J.
        • Stump T.E.
        The SPADE Symptom Cluster in primary care patients with chronic pain.
        Clin J Pain. 2016; 32: 388-393
        • Salaffi F.
        • Stancati A.
        • Silvestri C.A.
        • Ciapetti A.
        • Grassi W.
        Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale.
        Eur J Pain. 2004; 8: 283-291
        • Molenberghs G.
        • Thijs H.
        • Jansen I.
        • et al.
        Analyzing incomplete longitudinal clinical trial data.
        Biostatistics. 2004; 5: 445-464
        • Mallinckrodt C.H.
        • Sanger T.M.
        • Dube S.
        • et al.
        Assessing and interpreting treatment effects in longitudinal clinical trials with missing data.
        Biol Psychiatry. 2003; 53: 754-760
        • McCulloch C.E.
        • Neuhaus J.M.
        Generalized linear mixed models.
        in: Encyclopedia of biostatistics. Wiley, Chichester, West Sussex, England2005
        • Satterthwaite F.E.
        An approximate distribution of estimates of variance components.
        Biometrics. 1946; 2: 110-114
        • R Foundation for Statistical Computing
        R Development Core Team: a language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna2005
        • Military Health System
        Final Report to the Secretary of Defense: Military Health System Review.
        2014 (Available at: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/MHS-Review. Accessed February 12, 2017)
        • Saper R.B.
        • Boah A.R.
        • Keosaian J.
        • Cerrada C.
        • Weinberg J.
        • Sherman K.J.
        Comparing once- versus twice-weekly yoga classes for chronic low back pain in predominantly low income minorities: a randomized dosing trial.
        Evid Based Complement Alternat Med. 2013; 2013: 658030
        • Tran H.H.
        • Weinberg J.
        • Sherman K.J.
        • Saper R.B.
        Preference and expectation for treatment assignment in a randomized controlled trial of once- vs twice-weekly yoga for chronic low back pain.
        Glob Adv Health Med. 2015; 4: 34-39
        • Sturgeon J.A.
        • Zautra A.J.
        Resilience: a new paradigm for adaptation to chronic pain.
        Curr Pain Headache Rep. 2010; 14: 105-112
        • Elwy A.R.
        • Johnston J.M.
        • Bormann J.E.
        • Hull A.
        • Taylor S.L.
        A systematic scoping review of complementary and alternative medicine mind and body practices to improve the health of veterans and military personnel.
        Med Care. 2014; 52: S70-S82
        • Eaves E.R.
        • Sherman K.J.
        • Ritenbaugh C.
        • et al.
        A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies.
        BMC Complement Altern Med. 2015; 15: 12
        • George S.Z.
        • Calley D.
        • Valencia C.
        • Beneciuk J.M.
        Clinical investigation of pain-related fear and pain catastrophizing for patients with low back pain.
        Clin J Pain. 2011; 27: 108-115
        • Taylor R.S.
        • Taylor R.J.
        The economic impact of failed back surgery syndrome.
        Br J Pain. 2012; 6: 174-181
        • North R.B.
        • Shipley J.
        • Wang H.
        • Mekhail N.
        A review of economic factors related to the delivery of health care for chronic low back pain.
        Neuromodulation. 2014; 17: 69-76

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        Archives of Physical Medicine and RehabilitationVol. 99Issue 4
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          The article Highland et al, Benefits of the Restorative Exercise and Strength Training for Operational Resilience and Excellence Yoga Program for Chronic Low Back Pain in Service Members: A Pilot Randomized Controlled Trial, published in Archives of Physical Medicine and Rehabilitation 2018;99:91-98 ( https://doi.org/10.1016/j.apmr.2017.08.473 ) should have been published with the following disclaimer: “The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S.
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