Changes in Perceived Stress After Yoga, Physical Therapy, and Education Interventions for Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial
Author: Jonathan Berlowitz, Daniel L Hall, Christopher Joyce, Lisa Fredman, Karen J Sherman, Robert B Saper, Eric J Roseen
Affiliation:
1 Department of Family Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.
2 Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
3 Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts.
4 Department of Rehabilitation Science, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts.
5 School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts.
6 Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
7 Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
8 Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Conference/Journal: Pain medicine (Malden, Mass.)
Date published: 2020 Jun 4
Other:
Special Notes: doi: 10.1093/pm/pnaa150. , Word Count: 278
PMID: 32500130 DOI: 10.1093/pm/pnaa150
Abstract
Objective: Perceived stress and musculoskeletal pain are common, especially in low-income populations. Studies evaluating treatments to reduce stress in patients with chronic pain are lacking. We aimed to quantify the effect of two evidence-based interventions for chronic low back pain (cLBP), yoga and physical therapy (PT), on perceived stress in adults with cLBP.
Methods: We used data from an assessor-blinded, parallel-group randomized controlled trial, which recruited predominantly low-income and racially diverse adults with cLBP. Participants (N = 320) were randomly assigned to 12 weeks of yoga, PT, or back pain education. We compared changes in the 10-item Perceived Stress Scale (PSS-10) from baseline to 12- and 52-week follow-up among yoga and PT participants with those receiving education. Subanalyses were conducted for participants with elevated pre-intervention perceived stress (PSS-10 score ≥17). We conducted sensitivity analyses using various imputation methods to account for potential biases in our estimates due to missing data.
Results: Among 248 participants (mean age = 46.4 years, 80% nonwhite) completing all three surveys, yoga and PT showed greater reductions in PSS-10 scores compared with education at 12 weeks (mean between-group difference = -2.6, 95% confidence interval [CI] = -4.5 to -0.66, and mean between-group difference = -2.4, 95% CI = -4.4 to -0.48, respectively). This effect was stronger among participants with elevated pre-intervention perceived stress. Between-group effects had attenuated by 52 weeks. Results were similar in sensitivity analyses.
Conclusions: Yoga and PT were more effective than back pain education for reducing perceived stress among low-income adults with cLBP.
Keywords: Chronic Low Back Pain; Physical Therapy; Stress; Underserved Populations; Yoga.
© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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