Yoga, Physical Therapy, and Back Pain Education for Sleep Quality in Low-Income Racially Diverse Adults with Chronic Low Back Pain: a Secondary Analysis of a Randomized Controlled Trial

BackgroundPoor sleep is common among adults with chronic low back pain (cLBP), but the influence of cLBP treatments, such as yoga and physical therapy (PT), on sleep quality is under studied.ObjectiveEvaluate the effectiveness of yoga and PT for improving sleep quality in adults with cLBP.DesignSecondary analysis of a randomized controlled trial.SettingAcademic safety-net hospital and 7 affiliated community health centers.ParticipantsA total of 320 adults with cLBP.InterventionTwelve weekly yoga classes, 1-on-1 PT sessions, or an educational book.Main MeasuresSleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) global score (0-21) at baseline, 12 weeks, and 52 weeks. Additionally, we also evaluated how the proportion of participants who achieved a clinically meaningful improvement in sleep quality (>3-point reduction in PSQI) at 12 weeks varied by changes in pain and physical function at 6 weeks.Key ResultsAmong participants (mean age=46.0, 64% female, 82% non-white), nearly all (92%) reported poor sleep quality (PSQI >5) at baseline. At 12 weeks, modest improvements in sleep quality were observed among the yoga (PSQI mean difference [MD]=-1.19, 95% confidence interval [CI] -1.82, -0.55) and PT (PSQI MD=-0.91, 95% CI -1.61, -0.20) groups. Participants who reported a >= 30% improvement in pain or physical function at 6 weeks, compared with those who improved <10%, were more likely to be a sleep quality responder at 12 weeks (odds ratio [OR]=3.51, 95% CI 1.73, 7.11 and OR=2.16, 95% CI 1.18, 3.95, respectively). Results were similar at 52 weeks.ConclusionIn a sample of adults with cLBP, virtually all with poor sleep quality prior to intervention, modest but statistically significant improvements in sleep quality were observed with both yoga and PT. Irrespective of treatment, clinically important sleep improvements at the end of the intervention were associated with mid-intervention pain and physical function improvements.Trial RegistrationClinicalTrials.gov Identifier: NCT01343927