DOES A SELF-DIRECTED ONLINE YOGA PROGRAM IMPROVE PAIN AND FUNCTION IN PEOPLE WITH KNEE OSTEOARTHRITIS?: A RANDOMIZED CONTROLLED TRIAL

Aim: Yoga is a mind‐body exercise option for knee osteoarthritis (OA). It is typically undertaken 'in‐person' in a group setting, but this delivery mode can be inaccessible, inconvenient and costly. Online self‐directed programs may increase access to exercise, a core recommended treatment for knee OA. Thus, this study aimed to evaluate the effectiveness of an unsupervised 12‐week online yoga program (https://www.jointyoga.com.au). Methods: We performed a two‐arm superiority randomized controlled trial in 212 community‐dwelling adults from around Australia with symptomatic knee OA. Both groups received online OA information (control). The yoga group also received access to an unsupervised online Hatha yoga program over 12‐weeks (pre‐recorded videos, one video/week, undertaken three times/week), with optional continuation thereafter. Primary outcomes were changes in: (i) knee pain during walking (0‐10 numeric rating scale) and (ii) physical function (0‐68 WOMAC) at 12‐ (primary timepoint) and 24‐weeks, analysed using mixed‐effects linear regression models. Secondary outcomes were self‐reported overall knee pain, knee stiffness, depression, anxiety, stress, global change, quality‐of‐life, self‐efficacy, fear of movement, and balance confidence. Results: 195 (92%) and 189 (89%) participants provided 12‐ and 24‐week primary outcomes, respectively. Yoga participants undertook a mean (SD) of 2.5 (0.7) yoga sessions per week during the 12‐weeks. Yoga improved function (between‐group mean difference in change; ‐4.0 [95% CI, ‐6.8 to ‐1.3]), but not knee pain during walking (‐0.6 [CI ‐1.2 to 0.1]), compared to control at 12‐weeks. More yoga than control participants achieved the minimal clinically important difference for both outcomes. At 12‐weeks, knee stiffness, quality‐of‐life and arthritis self‐efficacy improved more with yoga than control. Benefits were not maintained at 24‐weeks. Adverse events were minor. Conclusion: In people with knee OA, an unsupervised online yoga program improved physical function, but not knee pain, compared to online education. Benefits were not sustained 12‐weeks following program completion when adherence waned.