Highlights
- •Depression and anxiety are common in low-income and minority groups with chronic low back pain.
- •Physical therapy and yoga for chronic low back pain may improve symptoms of comorbid depression and anxiety.
- •Improvement in back-related function is associated with an improvement in depressive symptoms.
Abstract
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.
Keywords
List of abbreviations:
CLBP (chronic low back pain), GAD-7 (Generalized Anxiety Disorder 7-item Scale), MCID (minimal clinically important difference), MD (mean difference), NRS (numeric rating scale), OR (odds ratio), PHQ-8 (Patient Health Questionnaire 8), PT (physical therapy), RMDQ (Roland Morris Disability Questionnaire)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 05, 2021
Footnotes
The Back to Health Study (5R01-AT005956) was funded by the National Center for Complementary and Integrative Health (NCCIH). Funding from NCCIH also supports the work of Dr Roseen (1F32AT009272, K23AT010487-01).
Clinical Trials Registration No.: NCT01343927.
Disclosures: none.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine
