[Rehabilitation / Postoperative Spine Surgery Publications] Characteristics and Predictors of Short-Term Outcomes in Individuals Self-selecting Yoga or Physical Therapy for Treatment of Chronic Low Back Pain

[Justin]

PM&R. Volume 2, Issue 11 , Pages 1006-1015, November 2010

Characteristics and Predictors of Short-Term Outcomes in Individuals Self-selecting Yoga or Physical Therapy for Treatment of Chronic Low Back Pain

Dian Dowling Evans, PhD, Michael Carter, DNSc, DNP, Richard Panico, MD, Laura Kimble, PhD, RN, Jennifer T. Morlock, MPT, Manjula Judith Spears, RYT, CYT. © 2010 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Objective
To compare clinical and demographic characteristics of individuals self-selecting yoga or physical therapy (PT) for treatment of chronic low back pain (cLBP) and to examine predictors of short-term pain and functional outcomes.

Design
Descriptive, longitudinal study.

Settings
A hospital-based clinic that offers modified integral yoga classes for cLBP and 2 outpatient PT clinics that offer exercise-based PT.

Participants
Adults (n = 53) with cLBP ≥12 weeks: yoga (n = 27), PT (n = 26).

Methods
Yoga participants attended a 6-week, once weekly, 2-hour yoga class. PT participants underwent twice weekly, 1-hour individualized PT. Data were collected at baseline and at 6 weeks. Groups were compared by using χ2 and independent samples t-tests. Hierarchical linear regression was used to predict treatment outcomes.

Main Outcome Measures
Disability (Roland Morris Disability Questionnaire), health status (Rand Short Form 36 Health Survey 1.0), pain bothersomeness (numerical rating scale), back pain self-efficacy (Back Pain Self-Efficacy Scale), and treatment satisfaction.

Results
At baseline, yoga participants were significantly less disabled (P = .013), had higher health status (P = .023), greater pain self-efficacy (P = .012), and less average pain bothersomeness (P = .001) compared with PT participants. At 6 weeks, when controlling for baseline group differences, greater pain self-efficacy was the strongest predictor for reduced pain and higher function for the entire sample. A significant group interaction by baseline pain self-efficacy predicted disability at 6 weeks. PT participants with low pain self-efficacy reported significantly greater disability than those with high pain self-efficacy. Yoga participants with low and high pain self-efficacy had similar disability outcomes.

Conclusion
These findings strengthen evidence that self-efficacy is associated with cLBP outcomes, especially in individuals self-selecting PT. Further research to evaluate outcomes after yoga and PT in participants with low pain self-efficacy is needed.

[Hooch]

This study presents such a constrained viewpoint, that the logical conclusion is to relieve chronic pain you need to improve your 'self-efficacy' (belief that you can overcome and manage pain).

We all know from personal experience that this is true to a large degree, but that pain management entails what may be politlely called 'goal alteration', or more accurately reduction and acceptance of disability.

In this study, barring any individuals who are simply too negative to have a go (and speaking as someone who has done a lot of yoga and physio, I simply haven't met any), the explanation is the obvious one: the people with low self-efficacy scores are simply more chronically injured and their perceptions of their ability are accurate... really this psychobabble crap gives me the shits...