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.

Keywords: back pain; chronic pain; education; physical therapy; sleep; yoga.

Conflict of interest statement

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

Figures

Change in PSQI global score over 52 weeks. In this complete case analysis, we used all PSQI data available at baseline (n= 320), 12 weeks (n= 287), and 52 weeks (n= 255).