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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 1/2020

01-01-2020 | Physical Therapy | Original Research

Yoga, Physical Therapy, and Back Pain Education for Sleep Quality in Low-Income Racially Diverse Adults with Chronic Low Back Pain: a Secondary Analysis of a Randomized Controlled Trial

Authors: Eric J. Roseen, DC, MSc, Hanna Gerlovin, PhD, Alexandra Femia, MS, Jae Cho, Suzanne Bertisch, MD, MPH, Susan Redline, MD, MPH, Karen J. Sherman, PhD, MPH, Robert Saper, MD, MPH

Published in: Journal of General Internal Medicine | Issue 1/2020

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Abstract

Background

Poor sleep is common among adults with chronic low back pain (cLBP), but the influence of cLBP treatments, such as yoga and physical therapy (PT), on sleep quality is under studied.

Objective

Evaluate the effectiveness of yoga and PT for improving sleep quality in adults with cLBP.

Design

Secondary analysis of a randomized controlled trial.

Setting

Academic safety-net hospital and 7 affiliated community health centers.

Participants

A total of 320 adults with cLBP.

Intervention

Twelve weekly yoga classes, 1-on-1 PT sessions, or an educational book.

Main Measures

Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) global score (0–21) at baseline, 12 weeks, and 52 weeks. Additionally, we also evaluated how the proportion of participants who achieved a clinically meaningful improvement in sleep quality (> 3-point reduction in PSQI) at 12 weeks varied by changes in pain and physical function at 6 weeks.

Key Results

Among participants (mean age = 46.0, 64% female, 82% non-white), nearly all (92%) reported poor sleep quality (PSQI > 5) at baseline. At 12 weeks, modest improvements in sleep quality were observed among the yoga (PSQI mean difference [MD] = − 1.19, 95% confidence interval [CI] − 1.82, − 0.55) and PT (PSQI MD = − 0.91, 95% CI − 1.61, − 0.20) groups. Participants who reported a ≥ 30% improvement in pain or physical function at 6 weeks, compared with those who improved < 10%, were more likely to be a sleep quality responder at 12 weeks (odds ratio [OR] = 3.51, 95% CI 1.73, 7.11 and OR = 2.16, 95% CI 1.18, 3.95, respectively). Results were similar at 52 weeks.

Conclusion

In a sample of adults with cLBP, virtually all with poor sleep quality prior to intervention, modest but statistically significant improvements in sleep quality were observed with both yoga and PT. Irrespective of treatment, clinically important sleep improvements at the end of the intervention were associated with mid-intervention pain and physical function improvements.

Trial Registration

ClinicalTrials.​gov Identifier: NCT01343927
Appendix
Available only for authorised users
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Metadata
Title
Yoga, Physical Therapy, and Back Pain Education for Sleep Quality in Low-Income Racially Diverse Adults with Chronic Low Back Pain: a Secondary Analysis of a Randomized Controlled Trial
Authors
Eric J. Roseen, DC, MSc
Hanna Gerlovin, PhD
Alexandra Femia, MS
Jae Cho
Suzanne Bertisch, MD, MPH
Susan Redline, MD, MPH
Karen J. Sherman, PhD, MPH
Robert Saper, MD, MPH
Publication date
01-01-2020
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 1/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-019-05329-4

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