Objective

To determine and compare the effect of yoga, physical therapy (PT), and education on depressive and anxious symptoms in patients with chronic low back pain (CLBP).

Design

Secondary analysis of a randomized controlled trial.

Setting

Academic safety net hospital and 7 community health centers.

Participants

A total of 320 adults with CLBP.

Intervention

Yoga classes, PT sessions, or an educational book.

Outcome Measure

Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder 7-item Scale, respectively, at baseline, 12, and 52 weeks. We identified baseline and midtreatment (6-wk) factors associated with clinically meaningful improvements in depressive (≥3 points) or anxious (≥2 points) symptoms at 12 weeks.

Results

Participants (female=64%; mean age, 46.0±10.7 years) were predominantly non-White (82%), low-income (<$30,000/year, 59%), and had not received a college degree (71%). Most participants had mild or worse depressive (60%) and anxious (50%) symptoms. At 12 weeks, yoga and PT participants experienced modest within-group improvements in depressive symptoms (mean difference [MD]=−1.23 [95% CI, −2.18 to −0.28]; MD=−1.01 [95% CI, −2.05 to −0.03], respectively). Compared with the education group, 12-week differences were not statistically significant, although trends favored yoga (MD=−0.71 [95% CI, −2.22 to 0.81]) and PT (MD= −0.32 [95% CI, −1.82 to 1.18]). At 12 weeks, improvements in anxious symptoms were only found in participants who had mild or moderate anxiety at baseline. Independent of treatment arm, participants who had 30% or greater improvement in pain or function midtreatment were more likely to have a clinically meaningful improvement in depressive symptoms (odds ratio [OR], 1.82 [95% CI, 1.03-3.22]; OR, 1.79 [95% CI, 1.06-3.04], respectively).

Conclusions

In our secondary analysis we found that depression and anxiety, common in this sample of underserved adults with CLBP, may improve modestly with PT and yoga. However, effects were not superior to education. Improvements in pain and function are associated with a decrease in depressive symptoms. More research is needed to optimize the integration of physical and psychological well-being in PT and yoga.

中文翻译：

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治疗慢性腰痛的瑜伽或物理疗法能否改善来自种族多样化、低收入社区的成年人的抑郁和焦虑？随机对照试验的二次分析

客观的

确定和比较瑜伽、物理疗法 (PT) 和教育对慢性腰痛 (CLBP) 患者抑郁和焦虑症状的影响。

设计

随机对照试验的二次分析。

环境

学术安全网医院和 7 个社区卫生中心。

参与者

共有 320 名患有 CLBP 的成年人。

干涉

瑜伽课、PT 课程或教育书籍。

结果测量

分别在基线、12 周和 52 周时使用患者健康问卷和广泛性焦虑症 7 项量表测量抑郁和焦虑。我们确定了与 12 周时抑郁（≥3 分）或焦虑（≥2 分）症状的临床意义改善相关的基线和治疗中期（6 周）因素。

结果

参与者（女性=64%；平均年龄，46.0±10.7 岁）主要是非白人（82%）、低收入（<30,000 美元/年，59%），并且没有获得大学学位（71%）。大多数参与者有轻度或更严重的抑郁（60%）和焦虑（50%）症状。在 12 周时，瑜伽和 PT 参与者的抑郁症状在组内得到了适度的改善（平均差 [MD]=-1.23 [95% CI，-2.18 至 -0.28]；MD=-1.01 [95% CI，-2.05 至-0.03]，分别）。与教育组相比，12 周差异无统计学意义，尽管趋势有利于瑜伽（MD=-0.71 [95% CI，-2.22 至 0.81]）和 PT（MD= -0.32 [95% CI，-1.82 至1.18]）。在 12 周时，仅在基线时有轻度或中度焦虑的参与者中发现焦虑症状有所改善。独立于治疗臂，

结论

在我们的二次分析中，我们发现在这个服务不足的 CLBP 成年人样本中常见的抑郁和焦虑可能会通过 PT 和瑜伽得到适度改善。然而，效果并不优于教育。疼痛和功能的改善与抑郁症状的减少有关。需要更多的研究来优化身体和心理健康在 PT 和瑜伽中的整合。