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Open Access Highly Accessed Study protocol

Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial

Karen J Sherman12*, Daniel C Cherkin13, Andrea J Cook14, Rene J Hawkes1, Richard A Deyo5, Robert Wellman1 and Partap S Khalsa6

Author Affiliations

1 Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, USA

2 Department of Epidemiology, University of Washington, Seattle, WA, USA

3 Departments of Family Medicine and Health Services, University of Washington, Seattle, WA, USA

4 Department of Biostatistics, University of Washington, Seattle, WA, USA

5 Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA

6 Division of Extramural Research and Training, National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, MD, USA

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Trials 2010, 11:36  doi:10.1186/1745-6215-11-36

Published: 31 March 2010

Abstract

Background

Back pain, one of the most prevalent conditions afflicting American adults, is the leading reason for using complementary and alternative medicine (CAM) therapies. Yoga is an increasingly popular "mind-body" CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition. This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits.

Methods/Design

A total of 210 participants with low back pain lasting at least 3 months will be recruited from primary care clinics of a large healthcare system based in Seattle. They will be randomized in a 2:2:1 ratio to receive 12 weekly yoga classes, 12 weekly conventional therapeutic exercise classes of comparable physical exertion, or a self-care book. Interviewers masked to participants' treatment group will assess outcomes at baseline and 6, 12 and 26 weeks after randomization. Primary outcomes will be back-related dysfunction and symptom bothersomeness. In addition, data will be collected on physical measurements (e.g., flexion) at baseline and 12 weeks and saliva samples will be obtained at baseline, 6 and 12 weeks. Information will be collected on specific physical, psychological, and physiological factors to allow exploration of possible mechanisms of action through which yoga could relieve back pain and dysfunction. The effectiveness of yoga will be assessed using analysis of covariance (using general estimating equations - GEE) within an intention-to-treat context. If yoga is found effective, further analyses will explore whether yoga's benefits are attributable to physical, psychological and/or physiological factors.

Conclusions

This study will provide the clearest evidence to date about the value of yoga as a therapeutic option for treating chronic back pain, and if the results are positive, will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.

Trial registration

This trial is registered in ClinicalTrials.gov, with the ID number of NCT00447668.