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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

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

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Acknowledgments

We thank David Felson, MD, MPH, and the Boston University Clinical Epidemiology Research Unit for their constructive review of this paper.

Funding Information

The Back to Health Study (5R01-AT005956) was funded by the National Center for Complementary and Integrative Health (NCCIH). Dr. Roseen is supported by a Ruth L. Kirschstein National Research Service Award (1F32AT009272) from the NCCIH and by the Boston University Clinical and Translational Science Institute (CTSI) Clinical Research Training Program (1UL1TR001430). Drs. Bertisch and Redline are supported in part by NCCIH (R34 AT008923).

Author information

Drs. Roseen, Gerlovin, and Saper had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Roseen, Sherman, Saper.

Acquisition, analysis, or interpretation of data: Roseen, Gerlovin, Femia, Cho, Bertisch, Redline, Sherman, Saper.

Drafting of the manuscript: Roseen.

Critical revision of the manuscript for important intellectual content: Roseen, Gerlovin, Femia, Cho, Bertisch, Redline, Sherman, Saper.

Statistical analysis: Roseen, Gerlovin.

Obtained funding: n/a.

Administrative, technical, or material support: Roseen, Femia, Saper.

Study supervision: Roseen, Saper.

Correspondence to Eric J. Roseen DC, MSc.

Ethics declarations

The Boston University Medical Campus Institutional Review Board approved the study prior to data collection. All participants provided written informed consent.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of NCCIH.

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Prior Presentations This work was presented, in part, at the International Research Congress on Integrative Medicine & Health (May 2018) in Baltimore, MD, USA, and the International Back and Neck Pain Forum (July 2019) in Quebec City, Quebec, Canada.

Appendix

Appendix

Table 4 Pattern of Missing PSQI Values
Table 5 Unadjusted PSQI Global and Subscores for Participants Randomized to Yoga, PT, or Education Interventions at Baseline, 12 weeks, and 52 weeks
Table 6 PSQI Global Score Stratified by Sex and Race

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Roseen, E.J., Gerlovin, H., Femia, A. et al. 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. J GEN INTERN MED 35, 167–176 (2020). https://doi.org/10.1007/s11606-019-05329-4

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KEY WORDS

  • back pain
  • chronic pain
  • yoga
  • physical therapy
  • education
  • sleep