Yoga for chronic non-specific low back pain.

BACKGROUND: Non-specific low back pain is a common, potentially disabling condition usually treated with self-care and non-prescription medication. For chronic low back pain, current guidelines recommend exercise therapy. Yoga is a mind-body exercise sometimes used for non-specific low back pain. OBJECTIVES: To evaluate the benefits and harms of yoga for treating chronic non-specific low back pain in adults compared to sham yoga, no specific treatment, a minimal intervention (e.g. education), or another active treatment, focusing on pain, function, quality of life, and adverse events. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was 31 August 2021 without language or publication status restrictions. SELECTION CRITERIA: We included randomized controlled trials of yoga compared to sham yoga, no intervention, any other intervention and yoga added to other therapies. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. Our major outcomes were 1. back-specific function, 2. pain, 3. clinical improvement, 4. mental and physical quality of life, 5. depression, and 6. ADVERSE EVENTS: Our minor outcome was 1. work disability. We used GRADE to assess certainty of evidence for the major outcomes. MAIN RESULTS: We included 21 trials (2223 participants) from the USA, India, the UK, Croatia, Germany, Sweden, and Turkey. Participants were recruited from both clinical and community settings. Most were women in their 40s or 50s. Most trials used iyengar, hatha, or viniyoga yoga. Trials compared yoga to a non-exercise control including waiting list, usual care, or education (10 trials); back-focused exercise such as physical therapy (five trials); both exercise and non-exercise controls (four trials); both non-exercise and another mind-body exercise (qigong) (one trial); and yoga plus exercise to exercise alone (one trial). One trial comparing yoga to exercise was an intensive residential one-week program, and we analyzed this trial separately. All trials were at high risk of performance and detection bias because participants and providers were not blinded to treatment, and outcomes were self-assessed. We found no trials comparing yoga to sham yoga. Low-certainty evidence from 11 trials showed that there may be a small clinically unimportant improvement in back-specific function with yoga (mean difference [MD] -1.69, 95% confidence interval [CI] -2.73 to -0.65 on the 0- to 24-point Roland-Morris Disability Questionnaire [RMDQ], lower = better, minimal clinically important difference [MCID] 5 points; 1155 participants) and moderate-certainty evidence from nine trials showed a clinically unimportant improvement in pain (MD -4.53, 95% CI -6.61 to -2.46 on a 0 to 100 scale, 0 no pain, MCID 15 points; 946 participants) compared to no exercise at three months. Low-certainty evidence from four trials showed that there may be a clinical improvement with yoga (risk ratio [RR] 2.33, 95% CI 1.46 to 3.71; assessed as participant rating that back pain was improved or resolved; 353 participants). Moderate-certainty evidence from six trials showed that there is probably a small improvement in physical and mental quality of life (physical: MD 1.80, 95% CI 0.27 to 3.33 on the 36-item Short Form [SF-36] physical health scale, higher = better; mental: MD 2.38, 95% CI 0.60 to 4.17 on the SF-36 mental health scale, higher = better; both 686 participants). Low-certainty evidence from three trials showed little to no improvement in depression (MD -1.25, 95% CI -2.90 to 0.46 on the Beck Depression Inventory, lower = better; 241 participants). There was low-certainty evidence from eight trials that yoga increased the risk of adverse events, primarily increased back pain, at six to 12 months (RR 4.76, 95% CI 2.08 to 10.89; 43/1000 with yoga and 9/1000 with no exercise; 1037 participants). For yoga compared to back-focused exercise controls (8 trials, 912 participants) at three months, we found moderate-certainty evidence from four trials for little or no difference in back-specific function (MD -0.38, 95% CI -1.33 to 0.62 on the RMDQ, lower = better; 575 participants) and very low-certainty evidence from two trials for little or no difference in pain (MD 2.68, 95% CI -2.01 to 7.36 on a 0 to 100 scale, lower = better; 326 participants). We found very low-certainty evidence from three trials for no difference in clinical improvement assessed as participant rating that back pain was improved or resolved (RR 0.97, 95% CI 0.72 to 1.31; 433 participants) and very low-certainty evidence from one trial for little or no difference in physical and mental quality of life (physical: MD 1.30, 95% CI -0.95 to 3.55 on the SF-36 physical health scale, higher = better; mental: MD 1.90, 95% CI -1.17 to 4.97 on the SF-36 mental health scale, higher = better; both 237 participants). No studies reported depression. Low-certainty evidence from five trials showed that there was little or no difference between yoga and exercise in the risk of adverse events at six to 12 months (RR 0.93, 95% CI 0.56 to 1.53; 84/1000 with yoga and 91/1000 with non-yoga exercise; 640 participants). AUTHORS' CONCLUSIONS: There is low- to moderate-certainty evidence that yoga compared to no exercise results in small and clinically unimportant improvements in back-related function and pain. There is probably little or no difference between yoga and other back-related exercise for back-related function at three months, although it remains uncertain whether there is any difference between yoga and other exercise for pain and quality of life. Yoga is associated with more adverse events than no exercise, but may have the same risk of adverse events as other exercise. In light of these results, decisions to use yoga instead of no exercise or another exercise may depend on availability, cost, and participant or provider preference. Since all studies were unblinded and at high risk of performance and detection bias, it is unlikely that blinded comparisons would find a clinically important benefit.

Differences between men and women in their risk of work injury and disability: A systematic review.

BACKGROUND: Health responses associated with occupational exposures can vary between men and women. AIMS: This study reviewed the work injury and disability risks associated with similar types of occupational exposures for men and women within and across occupations. MATERIALS & METHODS: A systematic review was undertaken of observational studies published between 2009 and 2019. Studies were required to empirically compare men and women for associations between occupational exposures and work injury or disability outcomes. Included studies were appraised for methodological quality and medium to high rated studies were compared for risk differences between men and women. RESULTS: Of 14,006 records identified, 440 articles were assessed for methodological quality, and 33 medium to high rated studies were included and reviewed. Among all occupations, the association between physical exposures, job demands, noise, and repetitive tasks, and injury risk were stronger among men. The relationship between repetitive tasks and sickness absence was stronger among women. Most studies examining psychological exposures found no risk differences for men and women across occupations. Men were at higher injury risk in certain occupations in primary and secondary industry sectors involving physical exposures and some chemical/biological exposures. Women were at higher injury risk for the physical demands and repetitive tasks of health care and aluminum production occupations. CONCLUSION: This review found that men and women can have different work injury and disability risks, both across and within the same occupations, for some physical exposures and to a lesser extent for some chemical and biological exposures. These differences might be a result of occupation-specific task differences.

Primary Care Physicians' Learning Needs in Returning Ill or Injured Workers to Work. A Scoping Review.

Primary care physicians are uniquely positioned to assist ill and injured workers to stay-at-work or to return-to-work. Purpose The purpose of this scoping review is to identify primary care physicians' learning needs in returning ill or injured workers to work and to identify gaps to guide future research. Methods We used established methodologies developed by Arksey and O'Malley, Cochrane and adapted by the Systematic Review Program at the Institute for Work & Health. We used Distiller SR©, an online systematic review software to screen for relevance and perform data extraction. We followed the PRISMA for Scoping Reviews checklist for reporting. Results We screened 2106 titles and abstracts, 375 full-text papers for relevance and included 44 studies for qualitative synthesis. The first learning need was related to administrative tasks. These included (1) appropriate record-keeping, (2) time management to review occupational information, (3) communication skills to provide clear, sufficient and relevant factual information, (4) coordination of services between different stakeholders, and (5) collaboration within teams and between different professions. The second learning need was related to attitudes and beliefs and included intrinsic biases, self-confidence, role clarity and culture of blaming the patient. The third learning need was related to specific knowledge and included work capacity assessments and needs for sick leave, environmental exposures, disclosure of information, prognosis of certain conditions and care to certain groups such as adolescents and pregnant workers. The fourth learning need was related to awareness of services and tools. Conclusions There are many opportunities to improve medical education for physicians in training or in continuing medical education to improve care for workers with an illness or injury that affect their work.

The 22nd Anniversary of the Cochrane Back and Neck Group.

STUDY DESIGN: Retrospective review and literature review. OBJECTIVE: The aim of this study was to provide an update on The Cochrane Back and Neck (CBN) activities. SUMMARY OF BACKGROUND DATA: Low back pain (LBP) affects 80% of people at some time in their lives. CBN Group has been housed in Toronto at the Institute for Work & Health since 1996 and has published 85 reviews and 32 protocols in the Cochrane Library. METHODS: Narrative review of CBN publications, impact factor, usage data, and social media impact. RESULTS: In the past 3 years, CBN conducted priority setting with organizations that develop clinical practice guidelines for LBP. CBN editors and associate editors published key methodological articles in the field of back and neck pain research. The methodological quality of CBN reviews has been assessed by external groups in a variety of areas, which found that CBN reviews had higher methodological quality than non-Cochrane reviews. CBN reviews have been included in 35 clinical practice guidelines for back and neck conditions. The 2018 journal impact factor of CBN is 11.154, which is higher than the 2018 impact factor for CDSR (7.755). CBN reviews ranked 4th among 53 Cochrane review groups in terms of Cochrane Library usage data. The most accessed CBN review was "Yoga treatment for chronic non-specific low-back pain" which had 9689 full-text downloads. CBN is active on Twitter with 3958 followers. CONCLUSION: CBN has published highly utilized systematic reviews and made important methodological contributions to the field of spine research over the past 22 years within Cochrane. LEVEL OF EVIDENCE: 4.