Yoga improves occupational performance, depression, and daily activities for people with chronic pain

Issue title: Special Section: Complementary and Integrative Medicine in Healthcare

Guest editors: Valerie J. Rice

Article type: Research Article

Authors: Schmid, Arlene A.^{a; *} | Van Puymbroeck, Marieke^b | Fruhauf, Christine A.^c | Bair, Matthew J.^d | Portz, Jennifer Dickman^e

Affiliations: [a] Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA | [b] Department of Parks, Clemson University, Recreation and Tourism Management, Clemson, SC, USA | [c] Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA | [d] Department of Medicine, VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indiana University School of Medicine, Regenstrief Institute, Inc., Indianapolis, IN, USA | [e] University of Colorado, School of Medicine, Aurora, CO, USA

Correspondence: [*] Address for correspondence: Arlene A. Schmid, PhD, OTR FAOTA, Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80523, USA. Tel.: +1 970 491 7562; E-mail: [email protected].

Abstract: BACKGROUND:Chronic pain is a complex accumulation of physical, psychological, and social conditions, thus interventions that address pain and promote occupational performance are needed. A holistic intervention, with mind and body components, is likely necessary to best treat the complexities of chronic pain. Thus, we developed and tested a yoga intervention for people with chronic pain. OBJECTIVES:In a randomized control trial (RCT), participants with chronic pain were randomized to a yoga intervention or usual care group. Between and within group differences for pre-and post-outcome measure scores were assessed for: occupational performance, completion of activities, and depression. METHODS:Pilot RCT with participant allocation to 8 weeks of yoga or usual care. Both groups received ongoing monthly self-management programming. Data were collected before and after the 8-week intervention. Participants were randomized to yoga or usual care after baseline assessments. Demographics were collected and measures included: Canadian Occupational Performance Measure (COPM) to assess occupational performance; the 15-item Frenchay Activities Index (FAI)(activities); and the 9-item Patient Health Questionnaire (PHQ-9) for depression. Independent t-tests were used to assess differences between groups. Paired t-tests were used to assess differences between pre- and post 8-week intervention for both the yoga and the usual care groups. Percent change scores and effect sizes were calculated. RESULTS:83 people were recruited for the study and completed baseline assessments; 44 individuals were randomized to yoga and 39 to the control group. The average age of all participants was 51.4±10.5 years, 68% were female; and 60% had at least some college education. There were no significant differences in demographics or outcome measures between groups at baseline or 8 weeks; however, the study was not powered to see such differences. Individuals randomized to the control group did not significantly improve in any outcome measure over the 8 weeks. There were significant improvements in COPM performance and COPM satisfaction scores for individuals randomized to the yoga group; both scores significantly improved. COPM performance improved by 27% with a moderate to large effect size (3.66±1.85 vs 4.66±1.93, p < 0.001, d = 0.76). COPM satisfaction significantly improved by 78% (2.14±2.31 vs. 3.80±2.50, p < 0.001) and had a large effects size (d = 1.02). FAI scores improved, indicating increased activity or engagement in daily occupation during the 8-week intervention. Scores increased by 5% (38.13±8.48 vs. 39.90±8.57, p = 0.024) with a small effect size (d = 0.37). Depression significantly decreased from 13.21±5.60 to 11.41±5.82, p = 0.041, with a small effect size. CONCLUSION:Data from this pilot RCT indicate yoga may be an effective therapeutic intervention with people in chronic pain to improve occupational performance, increase engagement in activities, and decrease depression. Occupational therapy practitioners may consider adding yoga as a treatment intervention to address the needs of people with pain.

Keywords: Occupational therapy, chronic pain, occupation, mind body interventions, function

DOI: 10.3233/WOR-192919

Journal: Work, vol. 63, no. 2, pp. 181-189, 2019