A new study published in JAMA Network Open indicates that virtual yoga classes can significantly alleviate chronic low back pain (CLBP) among health system employees. The randomized clinical trial, conducted by researchers at the Cleveland Clinic, compared a 12-week virtual yoga program to a wait-list control group, revealing substantial improvements in pain intensity and back-related function for participants in the yoga group.
The study enrolled 140 adults aged 18 to 64 with CLBP, recruited from the Cleveland Clinic Employee Health Plan. Participants had a mean low back pain intensity score of at least 4 on an 11-point numerical rating scale and experienced daily back pain interference for at least half of the days in the past six months. The yoga intervention consisted of 12 weekly, 60-minute, live-streamed hatha yoga group classes delivered via a HIPAA-secure virtual platform.
Significant Pain Reduction and Improved Function
Results showed that at 12 weeks, the yoga group experienced a significantly greater reduction in mean pain intensity compared to the control group (-1.5 points; 95% CI, -2.2 to -0.7; P < .001). Back-related function, measured by the modified Roland Morris Disability Questionnaire (RMDQ), also improved significantly in the yoga group (-2.8 points; 95% CI, -4.3 to -1.3; P < .001).
Sustained Benefits and Reduced Medication Use
The benefits of virtual yoga were sustained at 24 weeks, with the yoga group showing continued reductions in pain intensity (mean change, -2.3 points; 95% CI, -3.1 to -1.6; P < .001) and RMDQ scores (mean change, -4.6 points; 95% CI, -6.1 to -3.1; P < .001). Additionally, participants in the yoga group reported 21.4% less use of any analgesic medication at 12 weeks and 21.2% less at 24 weeks compared to the control group.
Enhanced Sleep Quality
Beyond pain and function, the study also assessed sleep quality using the PROMIS Sleep Disturbance Short Form. Participants in the yoga group experienced significantly greater improvements in sleep quality compared to the control group at both 12 weeks (mean change, 0.4 points; 95% CI, 0.1-0.7; P = .008) and 24 weeks (mean change, 0.4 points; 95% CI, 0.1-0.7; P = .005).
Implications for CLBP Treatment
"Findings of this study indicate that a 12-week therapeutic virtual yoga program for chronic low back pain is feasible, safe, and effective," the authors concluded. The study highlights the potential of virtual yoga to overcome barriers to accessing non-pharmacological treatments for CLBP, such as scheduling conflicts and mobility challenges. Given the demonstrated noninferiority of yoga to physical therapy, structured virtual yoga programs and physical therapy are reasonable choices for patients with CLBP depending on accessibility, cost, and patient preference.
Safety and Adherence
Adverse events were uncommon, with only three participants in the yoga group reporting transient exacerbation of back pain possibly related to the intervention. The adherence rate to yoga classes was 36.6%, with participants attending a median of 4 classes. However, participants also engaged in regular home yoga practice, averaging 4 days per week and 28.1 minutes per day.
Future Directions
The researchers suggest future studies should focus on scaling virtual therapeutic yoga within healthcare systems, assessing longer-term follow-up and cost-effectiveness, comparing different durations of classes, and testing recruitment strategies to increase the diversity of participants.
