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Yoga as a therapeutic intervention for adults with arthritis: A Systematic Review

Yoga as a therapeutic intervention for adults with arthritis: A Systematic Review. Gerilynn Gobuyan OCCT 643. Yoga. A form of mind-body practice that originated in ancient Indian philosophy Goal is to achieve a state of unified consciousness. Yoga.

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Yoga as a therapeutic intervention for adults with arthritis: A Systematic Review

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  1. Yoga as a therapeutic intervention for adults with arthritis: A Systematic Review Gerilynn Gobuyan OCCT 643

  2. Yoga • A form of mind-body practicethat originated in ancient Indian philosophy • Goal is to achieve a state of unified consciousness (Büssing, et al., 2012a; Büssinget al., 2012b; Garfinkel & Schumacher, 200; Haaz & Bartlett, 2011; NCCAM, 2013)

  3. Yoga • Numerous modern schools or styles of yoga that are based off traditional Hatha yoga, which focuses on the mind and body • Iyengar yoga (IY) – focuses on structural alignment of the physical body through the development of asanas; uses props to help individuals perform asanas correctly • Raj (or rāja) yoga – meditation for spiritual self-realization; mind is the instrument of perception • Typically lasts between 1-2 hours (Büssing, et al., 2012a; Büssinget al., 2012b; Garfinkel & Schumacher, 200; Haaz & Bartlett, 2011; NCCAM, 2013)

  4. Yoga & Arthritis • Regular engagement in physical activity helps preserve physical function, increase strength and improve endurance in individuals with arthritis • Benefits of yoga for individuals with arthritis • Engagement of muscles in isometric contraction • Strengthen stabilizing muscles to help promote balance and improve proprioception • Increase flexibility throughout the body • One of the most commonly used CAM therapies in the U. S. • Alternative to traditional exercises • Opportunity to remain active and engaged in health-promoting behaviors (American College of Rheumatology, 2002; Barnes, Bloom, & Nahin, 2008; Haaz & Bartlett, 2011)

  5. Methods

  6. Results

  7. Level of Evidence

  8. Results • Study Design • 1 RCT • Waitlist control • 7 NRCTs • 1 waitlist control • 1 convenience control • 4 before and after design • Sample Size • Ranged from 7 to 64 intervention participants • Similar comparable group numbers • 2 studies used single groups with no controls • Intervention Protocol • Frequency & Duration • Ranging from 60 minutes to 5 hours for 1 week to 10 weeks • All studies were developed and/or taught by a licensed or certified yoga professional • Style of yoga • Hatha yoga (3 studies) • IY (3 studies) • Raj yoga (1 study)

  9. Results • Functional Ability • Health Assessment Questionnaire (HAQ) was used in 4 of the 5 RA studies (Badsha et al., 2009; Bosch et al., 2009; Evans et al., 2010; Telles et al., 2011) • Significant improvements (decrease in HAQ scores) found in all 4 studies • Improvements found in 2 OA studies using the Visual Analog Scale (VAS) of pain, part of the HAQ (Garfinkel et al., 1994; Kolasinski et al., 2005) • Clinical Outcomes • Badsha et al. (2009) – adults with RA • Disability Activity Score using 28 joint count (DAS-28) – improvements in disease activity for the intervention group compared to control group • JAMR hydraulic hand dynamometer • No significant differences between the treatment and control groups improvements on hand grip strength (Garfinkel et al., 1994) • Improved grip strength for male participants (Telles et al., 2011) • Improved hand grip strength for adult patients with RA post-yoga (Dash & Telles, 2001) • Kolasinski et al. (2005) – knee OA • No significant improvement in stiffness using the Western Ontario and McMaster Universities Arthritis Index (WOMAC)

  10. Results • Psychosocial Outcomes • Kolasinski et al. (2005) – knee OA • WOMAC pain and physical function subscales declined • Arthritis Impact Measurement Scale 2 (AIMS 2) – improvement in AIMS2 psychological subscale, specifically affect • Beck Depression Inventory (BDI) – fewer symptoms of depression post-yoga (Bosch et al., 2005; Evans et al., 2010) • Badsha et al. (2009) – adults with RA • Medical Outcomes Study Short Form-36 (SF-36) – no changes in psychological health • Medication Use • Badsha et al. (2009) – adults with RA • Reduction in medications for 3 persons with RA in the yoga group • Dash and Telles (2001) – adults with RA • Reduction in NSAID use for the intervention group of person with RA

  11. Significance for Occupational Therapy • Yoga practices improve all the body systems simultaneously • Decreases depression, pain, and anxiety • Reduces stress and increases cardiopulmonary capacity and endurance • Increases muscle strength and flexibility, endurance, balance, and overall coordination • Strengthens bones • Increases attention, concentration, and memory • Yoga-based interventions can be practiced one-on-one or in a group setting • Can be used as a preparatory method or as a purposeful activity • Can be integrated into everyday life to enhance health and wellness

  12. Limitations of Systematic Review • Small sample sizes, especially in the pilot studies • Not generalizable to the entire population • A majority of the studies used non-randomized controls • Lack of control groups • Studies did not always explain how they reduced or avoided bias • No studies focused on occupational therapy nor were any of the certified yoga instructors also occupational therapists

  13. Recommendations for Future Research • Create standardized protocols that enhance safety, enjoyment, and long-term adherence • Specific poses and modifications • Thoroughly describe the practice of yoga utilized in the study • Sample sizes larger than 20 persons • Interdisciplinary collaboration in the design of yoga interventions

  14. References Badsha, H., Chhabra, V., Leibman, C., Mofti, A., Kong, K. O. (2009). The benefits of yoga for rheumatoid arthritis: results of a preliminary, structured 8-week program. Rheumatology International,29(12), 1417-1421. doi: 10.1007/s00296-009-0871-1 Barnes, P. M., Bloom, B., & Nahin, R. L. (2008). Complementary and alternative medicine use among adults and children: United States, 2007. National Health Statistics Reports. Retrieved from http://www.cdc.gov/nchs/data/nhsr/nhsr012.pdf. Bosch, P. R., Traustadottir, T., Howard, P., & Matt, K. S. (2009). Functional and physiological effects of yoga in women with rheumatoid arthritis: a pilot study. Alternative therapies in health and medicine, 15(4), 24. Retrieved from http://search.proquest.com/docview/204839615?accountid=28843 Büssing, A., Khalsa, S. B. S., Michalsen, A., Sherman, K. J., & Telles, S. (2012). Yoga as a therapeutic intervention. Evidence-Based Complementary and Alternative Medicine. 2012, 1. doi:10.1155/2012/174291 Büssing, A., Ostermann, T., Lüdtke, R., & Michalsen, A. (2012). Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. The Journal of Pain, 13(1), 1-9. doi: 10.1016/j.jpain.2011.10.001

  15. References Dash, M., & Telles, S. (2001). Improvement in hand grip strength in normal volunteers and rheumatoid arthritis patients following yoga training. Indian journal of physiology and pharmacology, 45(3), 355-360. Retrieved from http://www.ijpp.com/IJPP%20archives/2001_45_3/355-360.pdf Evans, S., Moieni, M., Taub, R., Subramanian, S. K., Tsao, J. C., Sternlieb, B., & Zeltzer, L. K. (2010). Iyengar yoga for young adults with rheumatoid arthritis: results from a mixed-methods pilot study. Journal of pain and symptom management, 39(5), 904-913. doi:10.1016/j.jpainsymman.2009.09.018 Haaz, S., & Bartlett, S. J. (2011). Yoga for arthritis: a scoping review. Rheumatic disease clinics of North America, 37(1), 33. doi: 10.1016/j.rdc.2010.11.001 Garfinkel, M., & Schumacher, H. R. (2000). Yoga. Rheumatic Disease Clinics of North America, 26(1), 125-132. doi: 10.1016/S0889-857X%2805%2970126-5 Garfinkel, M. S., Schumacher, H. R., Husain, A., Levy, M., & Reshetar, R. A. (1994). Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. The Journal of Rheumatology, 21(12), 2341-2343. Retrieved from http://europepmc.org/abstract/MED/7699639

  16. References Kolasinski, S., Garfinkel, M., Tsai, A., Matz, W., Van Dyke, A., Schumacher, H. (2005). Iyengar yoga for treating symptoms of osteoarthritis of the knees: A pilot study. The Journal of Alternative and Complementary Medicine, 11(4) 689-693. doi:10.1089/acm.2005.11.689 Middleton, K.R., Ward, M.M., Haaz, S., Velummylum,S., Fike, A.,Acevedo, A.T., Tataw-Ayuketah,G., Dietz,L., Mittleman, B.M., & Wallen, G.R., (2013). A pilot study of yoga as self-care for arthritis in minority communities. Health and Quality of Life Outcomes, 11(55), 1-14. Retrieved from http://www.hqlo.com/content/11/1/55 National Center for Complementary and Alternative Medicine [NCCAM]. (2013). Yoga. Retrieved from http://nccam.nih.gov/health/yoga Ramamani Iyengar Memorial Yoga Institute. (n.d.). What are the unique features of “Iyengar Yoga”? Retrieved from http://www.bksiyengar.com/modules/FAQ/faq.htm SahajMarg Spirituality Foundation. (2004). What is raj yoga? Retrieved from http://spiritualityfoundation.org/smrti/education/articles/general/art0026.html Telles, S., Naveen, K.V., Gaur, V., & Balkrishna, A. (2011). Effect of one week of yoga on function and severity in rheumatoid arthritis. BMC Research Notes, 4(118), 1-4. Retrieved from http://www.biomedcentral.com/1756-0500/4/118

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