Evidence map›Paper›PMID 28631003›Full record

Trial reportAnnals of internal medicine2017

Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial.

Robert B Saper, Chelsey Lemaster, Anthony Delitto, Karen J Sherman, Patricia M Herman, Ekaterina Sadikova, Joel Stevans, Julia E Keosaian, Christian J Cerrada, Alexandra L Femia and 5 more

7 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of internal medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 7 registered trials, which are not on this map. Cited by 100 papers, 19 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
100citing papers in PubMed, 19 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01343927 nacompletednot on this map

Yoga vs. Physical Therapy vs. Education for Chronic Low Back Pain in Minority Populations (Back to Health)

TypeinterventionalSponsorBoston Medical CenterRan2012 to 2014Enrolled320ConditionsBack Pain Lower Back ChronicArmsWeekly yoga classes, Individual physical therapy treatment, Education
NCT04600843 nacompletednot on this mapstarted 2019, after this paper: background citation

Effects of Patient Education Manual on Pain, Range of Motion and Function in Patient With Chronic Low Back Pain Neck Pain

TypeinterventionalSponsorRiphah International UniversityRan2019 to 2020Enrolled24ConditionsBack DisorderArmsPhysical therapy with Patient education, Physical Therapy without patient Education
NCT04721639 nacompletednot on this mapstarted 2021, after this paper: background citation

Effect of Sphinx Pose (Salamba Bhujangasana) Among Health Care Providers With Chronic Low Back Pain: A Randomized Controlled Trial.

TypeinterventionalSponsorUniversity of KarachiRan2021 to 2023Enrolled100ConditionsChronic Low-back PainArmsSphinx Yoga Therapy
NCT04824547 nacompletednot on this mapstarted 2021, after this paper: background citation

Bel Ağrılı Bireylerde Egzersizlerin Uzun Dönem Devamlılığının Değerlendirilmesi

TypeinterventionalSponsorHacettepe UniversityRan2021 to 2024Enrolled104ConditionsChronic Low-back PainArmsexercise
NCT05319691 nacompletednot on this mapstarted 2022, after this paper: background citation

Yoga for Chronic Low Back Pain: A Type 1 Hybrid Implementation-Effectiveness Pragmatic Randomized Control Trial in the Cleveland Clinic Employee Health Plan

TypeinterventionalSponsorRobert SaperRan2022 to 2023Enrolled140ConditionsChronic Pain, Back PainArmsYoga
NCT05690178 nacompletednot on this mapstarted 2021, after this paper: background citation

Effect of Deep Tissue Massage on Subjective and Objective Parameters in Office Workers With Chronic Low Back Pain

TypeinterventionalSponsorPoznan University of Physical EducationRan2021 to 2021Enrolled40ConditionsChronic Low-back PainArmsDeep Tissue Massage
NCT06949007 narecruitingnot on this mapstarted 2026, after this paper: background citation

Yoga for Persistent Post-Surgical Pain (PPSP)

TypeinterventionalSponsorBrigham and Women's HospitalRan2026 to 2029Enrolled50ConditionsPersistent Post-surgical PainArmsYoga, Chronic Pain Health Education
3 · Its place in the literature

Who cites it

100 citing papers in PubMed, 19 syntheses or guidelines pooled it.

  1. Pooled it
  2. Effectiveness of booster strategies to promote physical activity maintenance: a systematic review and meta-analysis.The international journal of behavioral nutrition and physical activity · 2025
    Pooled it
  3. Pooled it
  4. Impact of education in patients undergoing physiotherapy for lower back pain: a level I systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025
    Pooled it
  5. Pooled it
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  10. Yoga for chronic non-specific low back pain.The Cochrane database of systematic reviews · 2022
    Pooled it
  11. Pooled it
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  15. Pooled it
  16. Exercise therapy for chronic low back pain.The Cochrane database of systematic reviews · 2021
    Pooled it
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  20. Trial

40 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors.

Robert B SaperFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Chelsey LemasterFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Anthony DelittoFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Karen J ShermanFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Patricia M HermanFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Ekaterina SadikovaFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Joel StevansFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Julia E KeosaianFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Christian J CerradaFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Alexandra L FemiaFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Eric J RoseenFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Paula GardinerFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Katherine Gergen BarnettFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Carol FaulknerFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.
Janice WeinbergFrom Boston University School of Medicine, Boston Medical Center, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts; University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania; Group Health Research Institute and University of Washington, Seattle, Washington; and RAND Corporation, Santa Monica, California.

Funding

Yoga vs. Physical Therapy for Chronic Low Back Pain in Minority PopulationsR01AT005956 · NCCIH · BOSTON MEDICAL CENTER · PI SAPER, ROBERT BRUCE · 2010 to 2015
$3.9M
NCCIH NIH HHS R01 AT005956
6 · The paper itself

Abstract

backgroundYoga is effective for mild to moderate chronic low back pain (cLBP), but its comparative effectiveness with physical therapy (PT) is unknown. Moreover, little is known about yoga's effectiveness in underserved patients with more severe functional disability and pain.

objectiveTo determine whether yoga is noninferior to PT for cLBP.

design12-week, single-blind, 3-group randomized noninferiority trial and subsequent 40-week maintenance phase. (ClinicalTrials.gov: NCT01343927).

settingAcademic safety-net hospital and 7 affiliated community health centers.

participants320 predominantly low-income, racially diverse adults with nonspecific cLBP.

interventionParticipants received 12 weekly yoga classes, 15 PT visits, or an educational book and newsletters. The maintenance phase compared yoga drop-in classes versus home practice and PT booster sessions versus home practice. MEASUREMENTS: Primary outcomes were back-related function, measured by the Roland Morris Disability Questionnaire (RMDQ), and pain, measured by an 11-point scale, at 12 weeks. Prespecified noninferiority margins were 1.5 (RMDQ) and 1.0 (pain). Secondary outcomes included pain medication use, global improvement, satisfaction with intervention, and health-related quality of life.

resultsOne-sided 95% lower confidence limits were 0.83 (RMDQ) and 0.97 (pain), demonstrating noninferiority of yoga to PT. However, yoga was not superior to education for either outcome. Yoga and PT were similar for most secondary outcomes. Yoga and PT participants were 21 and 22 percentage points less likely, respectively, than education participants to use pain medication at 12 weeks. Improvements in yoga and PT groups were maintained at 1 year with no differences between maintenance strategies. Frequency of adverse events, mostly mild self-limited joint and back pain, did not differ between the yoga and PT groups. LIMITATIONS: Participants were not blinded to treatment assignment. The PT group had disproportionate loss to follow-up.

conclusionA manualized yoga program for nonspecific cLBP was noninferior to PT for function and pain. PRIMARY FUNDING SOURCE: National Center for Complementary and Integrative Health of the National Institutes of Health.

Indexed as

Patient Education as TopicPhysical Therapy ModalitiesYogaAdultChronic PainComparative Effectiveness ResearchFemaleFollow-Up StudiesHumansLow Back PainMaleMiddle AgedPatient CompliancePovertySingle-Blind MethodTreatment Outcome

Identifiers

PMID28631003
PMCPMC6392183

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.