Following an online yoga program improves physical function in knee patients in the spineAccording to the results of a new randomized controlled trial.
Although pain did not significantly improve in the yoga group, participants only completed about two-thirds of the recommended sessions, suggesting that more benefits may be possible with increased adherence, writes lead author Kim L. Melbourne, and colleagues in Annals of Internal Medicine.
“To date, an online yoga program intended for people with osteoarthritis of the knee has not been investigated,” the investigators said. “The need for such online and evidence-based training programs is highlighted in the 2020 US National Public Health Agenda for Osteoporosis.”
METHODOLOGY AND RESULTS
The trial included 212 adults aged 45 or older with symptomatic knee osteoarthritis. All patients had access to online educational materials on arthritis management.
Half of the participants were randomly assigned to an online yoga program for 12 weeks. This self-guided, unsupervised course consisted of 12 pre-recorded 30-minute tutorial yoga sessions, each with a unique sequence of asanas to be completed three times in one week before moving on to the next class the following week. After 12 weeks, these participants can choose to continue practicing yoga via the online program for an additional 12 weeks, if desired.
The primary outcomes were knee pain and physical function, as measured by a 10-point numerical rating scale and the Western Ontario and McMaster Universities (WOMAC) Arthritis Index, respectively. Commitment was defined as completing at least two yoga sessions during the previous week.
At the 12-week mark, the yoga group showed no significant improvement in knee pain (-0.6; 95% confidence interval, -1.2 to 0.1), but had a mean reduction of 4 points in WOMAC, indicating significant improvement in knee function (– 4.0; 95% CI, -6.8 to -1.3). It is noteworthy, however, that this improvement was not sufficient to meet the minimum clinically significant difference. At week 24, the yoga group no longer showed significant improvement in knee function versus baseline.
“I don’t think a longer program will necessarily reduce knee pain, because the benefits from a whole range of different types of exercise for knee osteoarthritis can generally show benefits within 8 weeks,” Bennell said in an interview.
However, she noted, the average result in the trial may not represent what would be possible if the patient adhered to a regular yoga routine.
“I think it’s more about commitment [than duration]I think the benefits of knee pain would have been seen if more people had fully adhered to the program three times a week.”
At 12 weeks, 68.8% of participants in the yoga group were adherent, while only 28.4% remained committed at week 24 after the optional extension period.
“Because this was a self-directed program, commitment would be expected to be lower than that of a supervised program,” Bennell noted.
Referring to unpublished data, Pennell said a sensitivity analysis showed that participants in the yoga group who completed yoga at least twice a week showed greater improvement in function and pain than those who did yoga less than twice a week.
“So it indicates that commitment is important, as we might expect,” she said.
Another tool in the OA Toolbox
Nick Trasolini, MD, of Wake Forest University School of Medicine, Winston-Salem, N.C., described the benefits in the trial as “modest” and noted that the improvement in function did not meet a minimal clinically significant difference.
“However,” he said in a written comment. [yoga] The program was safe and associated with a high degree of participant satisfaction [mean satisfaction, 8 out of 10]. While this may not be the ‘silver solution’, it is another tool we can offer to motivated enough patients looking for non-surgical solutions to osteoarthritis of the knee.”
Unfortunately, Trasolini added, these tools remain “challenging”.
“While multiple injection options are available (including corticosteroid, hyaluronic acid, and biological injections), the benefits of these injections can be short-lived,” he said. “This is frustrating for patients and clinicians alike. Physical therapy is beneficial for osteoarthritis of the knee when lack of conditioning has resulted in lower knee, hip and core stability. However, physical therapy can be time consuming, painful and prohibitively expensive.”
In this study, participants in the yoga group were more or less willing (average willingness, 5 out of 10) to pay for a 12-week yoga program. They reported that they would pay close to $80 for a chance to do it again.
The study was supported by grants from the National Health and Medical Research Council Program and Centers of Research Excellence. Investigators have disclosed additional relationships with Pfizer, Lilly, TLCBio, and others. Trasolini revealed no relevant conflict of interest.
This story originally appeared MDedge.compart of the Medscape Professional Network.