Certain aspects of yoga can be used as a non-pharmacological conservative therapeutic approach to the management of chronic low back pain (CLBP). This overview summarized and evaluated data from current systematic reviews (SRs) on the use of yoga for CLBP.

The researchers searched SRs on the use of yoga for CLBP in nine electronic databases from inception to September 2023. The methodological quality was evaluated using the Assessment of Multiple Systematic Review Scale-2 (AMSTAR-2). The reporting quality of the included SRs was evaluated using the Preferred Reporting Item for Systematic Review and Meta-Analysis-2020 (PRISMA-2020), and the quality of data was graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Two independent researchers performed the screening, data extraction, and quality assessment process of SRs.

A total of 13 SRs were included. The results of the AMSTAR-2 indicated that the methodological quality of the included studies was relatively low. The PRISMA-2020 checklist evaluation results indicated that methodological limitations in reporting, especially regarding data processing and presentation, were the main weaknesses. The GRADE assessment indicated that 30 outcomes were rated moderate, 42 were rated low level, and 20 were rated very low level. Downgrading factors were mainly due to the limitations of the included studies.

The authors concluded that yoga appears to be an effective and safe non-pharmacological therapeutic modality for the Management of CLBP. Currently, it may exhibit better efficacy in improving pain and functional disability associated with CLBP. However, the methodological quality and quality of evidence for SRs/MAs in the included studies were generally low, and these results should be interpreted cautiously.

Sorry, but I beg to differ!

  • The safety of a therapy cannot be ascertained on the basis of such small sample sizes.
  • The effectiveness of yoga has not been demonstrated by these data.
  • All that has been shown with this review is that the quality of the research in this area is too poor for drawing conclusions.

5 Responses to Yoga for back pain?

  • I beg you pardon but whether its right to call 13 srs ” a small sample sizes.” ?

    And the second question is why you think the effectiveness of yoga wasnt demonstrated. Is it because of the low quality of the researches?

    Not to argue just to understand.

    • 1) to demonstrate safety, you need much larger numbers.
      2) yes, the quality of the trials is poor

    • The number of systematic reviews (13 SRs) is not the issue; it is the small sample size of the individual trials — as mentioned many times in this review. E.g., [my emphasis]:

      [The tables have a note  ]
       Downgraded for imprecision: small-sample size, or wide confidence interval.

      4. Discussion
      Moreover, higher-quality, large-sample, multi-center RCTs should be conducted to improve the homogeneity of evidence sources.

      However, we think that this inference may also be related to publication bias because these results are pooled from small-sample studies, and large-sample RCTs have not been conducted yet.

      4.2. Implications
      Furthermore, the small-sample size and lack of appropriate methods reduced the quality of evidence, leading to unclarity regarding the benefits of yoga.

      5. Conclusion
      Nevertheless, the evidence presented herein is mostly obtained from small-sample studies without verification and validation from large-sample MAs.

      Further reading
      Insensitivity to sample size, Wikipedia/

      Insensitivity to sample size is a cognitive bias that occurs when people judge the probability of obtaining a sample statistic without respect to the sample size. For example, in one study, subjects assigned the same probability to the likelihood of obtaining a mean height of above six feet [183 cm] in samples of 10, 100, and 1,000 men. In other words, variation is more likely in smaller samples, but people may not expect this.

      In another example, Amos Tversky and Daniel Kahneman asked subjects

      A certain town is served by two hospitals. In the larger hospital about 45 babies are born each day, and in the smaller hospital about 15 babies are born each day. As you know, about 50% of all babies are boys. However, the exact percentage varies from day to day. Sometimes it may be higher than 50%, sometimes lower.

      For a period of 1 year, each hospital recorded the days on which more than 60% of the babies born were boys. Which hospital do you think recorded more such days?

      1. The larger hospital
      2. The smaller hospital
      3. About the same (that is, within 5% of each other)

      56% of subjects chose option 3, and 22% of subjects respectively chose options 1 or 2. However, according to sampling theory the larger hospital is much more likely to report a sex ratio close to 50% on a given day than the smaller hospital which requires that the correct answer to the question is the smaller hospital (see the law of large numbers).

      Relative neglect of sample size were obtained in a different study of statistically sophisticated psychologists.

  • In our corner of the world, the word “Yoga” has become a marketing buzzword for selling anything you fancy involving calisthenics sprinkled lightly with a decoration of meditative esoterics to the non-ascetic health-concerned population.
    It is already well known that movement, exercise and relaxation are beneficial for the all too common complications of sedentary habits. Anything works that gets people out of their office chair and TV-couch.

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