Can Yoga or Physical Therapy for Chronic Low Back Pain Improve Depression and Anxiety Among Adults From a Racially Diverse, Low-Income Community? A Secondary Analysis of a Randomized Controlled Trial.
Christopher Joyce, Eric J Roseen, Julie J Keysor and 3 others
PMID 33556352WHAT IT FOUND
Yoga and physical therapy did not significantly reduce depression or anxiety compared to education in the full group.
However, participants with moderate symptoms at baseline saw meaningful improvements in both conditions after 12 weeks of either treatment.
Key findings
01In the full sample, there were no statistically significant differences between yoga or PT and education for depression or anxiety at 12 weeks.
02Participants with moderate or worse depressive symptoms experienced clinically meaningful improvements at 12 weeks in both the yoga and PT groups.
03A 30% improvement in pain or function at 6 weeks was associated with a clinically meaningful improvement in depressive symptoms at 12 weeks.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This was a secondary analysis, so the original trial did not require participants to have significant depression or anxiety at baseline. Many participants had low scores to begin with, which makes it hard to detect improvement (flooring effect). The subgroup analyses reduced the sample size and disrupted the randomization, making these findings less reliable than the main trial results. The study did not track psychotropic medication use or social isolation, which are factors that can strongly influence depression and anxiety outcomes. Loss to follow-up was higher in the PT group at 52 weeks, though sensitivity analyses suggested this did not significantly change the results.
Declared interests
The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that yoga or physical therapy will treat depression or anxiety in all patients with low back pain. The overall trial showed no significant benefit over education for the whole group; benefits were only seen in patients who already had moderate to severe symptoms at the start.