Paul Posadzki

Yoga for low back pain: a systematic review of randomized clinical trials

It has been suggested that yoga has a positive effect on low back pain and function. The objective of this systematic review was to assess the effectiveness of yoga as a treatment option for low back pain. Seven databases were searched from their inception to March 2011. Randomized clinical trials were considered if they investigated yoga in patients with low back pain and if they assessed pain as an outcome measure. The selection of studies, data extraction and validation were performed independently by two reviewers. Seven randomized controlled clinical trials (RCTs) met the inclusion criteria. Their methodological quality ranged between 2 and 4 on the Jadad scale. Five RCTs suggested that yoga leads to a significantly greater reduction in low back pain than usual care, education or conventional therapeutic exercises. Two RCTs showed no between-group differences. It is concluded that yoga has the potential to alleviate low back pain. However, any definitive claims should be treated with caution.

A mixed‐method approach to sense of coherence, health behaviors, self‐efficacy and optimism: Towards the operationalization of positive health attitudes

This study discusses the results of a cross-sectional survey of healthy college students in Poland. More specifically, it describes, explores, and explains the relationships between psychological variables/models such as health behaviors (HB), sense of coherence (SOC), level of optimism (LOO), and self-efficacy (SE) among college students. These separate constructs have also been used to operationalize a positive health attitude (PHA) as a novel construct. The social survey was carried out at three higher education institutions in Poland in January 2006. The random sample of 455 undergraduate students was taken from five different faculties: Physiotherapy, Physical Education, Tourism and Recreation, English Philology and Polish Philology. Four reliable and validated research tools were used to collect the data: Juczynskys Health Behaviour Inventory (HBI); Antonovskys Sense of Coherence Questionnaire (SOC-29); Schwarzer & Jerusalems Generalized Self-Efficacy Scale (GSES); and Seligmans Scale (SS). The results indicate statistically significant differences (p < 0.001) between these four variables: for example, the healthier health behaviors the stronger the sense of coherence, level of optimism and self-efficacy. It was also demonstrated that LOO, SOC, SE, and HB correlate with one another. Finally, these variables create an explicit empirical-theoretical pattern. All the research results from REGWQ tests, Pearsons correlation coefficient and cluster analysis suggest the existence of conceptual similarities between these four variables and/or the existence of some broader scientific construct such as PHA. However, this needs to be examined further. These results could be a good indicator for future research among different faculties or age groups.

Osteopathy for musculoskeletal pain patients: a systematic review of randomized controlled trials.

The objective of this systematic review was to assess the effectiveness of osteopathy as a treatment option for musculoskeletal pain. Six databases were searched from their inception to August 2010. Only randomized clinical trials (RCTs) were considered if they tested osteopathic manipulation/mobilization against any control intervention or no therapy in human with any musculoskeletal pain in any anatomical location, and if they assessed pain as an outcome measure. The selection of studies, data extraction, and validation were performed independently by two reviewers. Studies of chiropractic manipulations were excluded. Sixteen RCTs met the inclusion criteria. Their methodological quality ranged between 1 and 4 on the Jadad scale (maxu2009=u20095). Five RCTs suggested that osteopathy compared to various control interventions leads to a significantly stronger reduction of musculoskeletal pain. Eleven RCTs indicated that osteopathy compared to controls generates no change in musculoskeletal pain. Collectively, these data fail to produce compelling evidence for the effectiveness of osteopathy as a treatment of musculoskeletal pain.

Yoga for hypertension: A systematic review of randomized clinical trials

OBJECTIVESnTo critically evaluate the effectiveness of yoga as a treatment of hypertension.nnnMETHODSnSeventeen databases were searched from their inceptions to January 2014. Randomized clinical trials (RCTs) were included, if they evaluated yoga against any type of control in patients with any form of arterial hypertension. Risk of bias was estimated using the Cochrane criteria. Three independent reviewers performed the selection of studies, data extraction, and quality assessments.nnnRESULTSnSeventeen trials met the inclusion criteria. Only two RCTs were of acceptable methodological quality. Eleven RCTs suggested that yoga leads to a significantly greater reduction in systolic blood pressure (SBP) compared to various forms of pharmacotherapy, breath awareness or reading, health education, no treatment (NT), or usual care (UC). Eight RCTs suggested that yoga leads to a significantly greater reduction in diastolic blood pressure (DBP) or night-time DBP compared to pharmacotherapy, NT, or UC. Five RCTs indicated that yoga had no effect on SBP compared to dietary modification (DIM), enhanced UC, passive relaxation (PR), or physical exercises (PE). Eight RCTs indicated that yoga had no effect on DBP compared to DIM, enhanced UC, pharmacotherapy, NT, PE, PR, or breath awareness or reading. One RCT did not report between-group comparisons.nnnCONCLUSIONnThe evidence for the effectiveness of yoga as a treatment of hypertension is encouraging but inconclusive. Further, more rigorous trials seem warranted.

T'ai chi for the treatment of osteoarthritis: a systematic review and meta-analysis.

Objectives To summarise and critically evaluate the evidence from randomised clinical trials (RCTs) of tai chi as a treatment for patients with osteoarthritis (OA). Design Eleven databases were searched from their inception to July 2010. RCTs testing tai chi against any type of controls in human patients with OA localised in any joints that assessed any type of clinical outcome measures were considered. Two reviewers independently performed the selection of the studies, data abstraction and validations. The risk of bias was assessed using Cochrane criteria. Results Nine RCTs met the inclusion criteria, and most of them had significant methodological weaknesses. Six RCTs tested the effects of tai chi compared with that of an attention-control programme, a waiting list and routine care or self-help programmes in patients with OA in the knee. The meta-analysis suggested that tai chi has favourable effects on pain (n=256; standard mean difference (SMD), −0.79; 95% CI −1.19 to −0.39; p=0.0001; I2=55%), physical function (n=256; SMD, −0.86; 95% CI −1.20 to −0.52; p<0.00001; I2=38%) and joint stiffness (n=256; SMD, −0.53; 95% CI −0.99 to −0.08; p=0.02; I2=67%). Conclusion The results are encouraging and suggest that tai chi may be effective in controlling pain and improving physical function in patients with OA in the knee. However, owing to the small number of RCTs with a low risk of bias, the evidence that tai chi is effective in patients with OA is limited.

Yoga for asthma: a systematic review and meta-analysis

BACKGROUNDnAlthough yoga is frequently used by patients with asthma, its efficacy in alleviating asthma remains unclear.nnnOBJECTIVEnTo systematically assess and meta-analyze the available data on efficacy and safety of yoga in alleviating asthma.nnnMETHODSnMEDLINE/PubMed, Scopus, the Cochrane Central Register of Controlled Trials, PsycINFO, CAM-Quest, CAMbase, and IndMED were searched through January 2014. Randomized controlled trials of yoga for patients with asthma were included if they assessed asthma control, symptoms, quality of life, and/or pulmonary function. For each outcome, standardized mean differences (SMDs) or risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. Risk of bias was assessed using the Cochrane tool.nnnRESULTSnFourteen randomized controlled trials with 824 patients were included. Evidence for effects of yoga compared with usual care was found for asthma control (RR, 10.64; 95% CI, 1.98 to 57.19; Pxa0= .006), asthma symptoms (SMD,xa0-0.37; 95% CI,xa0-0.55 toxa0-0.19; P < .001), quality of life (SMD, 0.86; 95% CI, 0.39 to 1.33; P < .001), peak expiratory flow rate (SMD, 0.49; 95% CI, 0.32 to 0.67; P < .001), and ratio of forced expiratory volume in 1 second to forced vital capacity (SMD, 0.50; 95% CI, 0.24 to 0.75; P < .001); evidence for effects of yoga compared with psychological interventions was found for quality of life (SMD, 0.61; 95% CI, 0.22 to 0.99; Pxa0= .002) and peak expiratory flow rate (SMD, 2.87; 95% CI, 0.14 to 5.60; Pxa0= .04). No evidence for effects of yoga compared with sham yoga or breathing exercises was revealed. No effect was robust against all potential sources of bias. Yoga was not associated with serious adverse events.nnnCONCLUSIONnYoga cannot be considered a routine intervention for asthmatic patients at this point. It can be considered an ancillary intervention or an alternative to breathing exercises for asthma patients interested in complementary interventions.

Guided imagery for musculoskeletal pain: a systematic review.

AimsThe objective of this systematic review was to assess the effectiveness of guided imagery (GI) as a treatment option for musculoskeletal pain (MSP). MethodSix databases were searched from their inception to May 2010. All controlled clinical trials were considered, if they investigated GI in patients with any MSP in any anatomic location and if they assessed pain as an outcome measure. Trials of motor imagery were excluded. The selection of studies, data extraction, and validation were performed independently by 2 reviewers. ResultsNine randomized clinical trials (RCTs) met the inclusion criteria. Their methodologic quality ranged between 1 and 3 on the Jadad scale. Eight RCTs suggested that GI leads to a significant reduction of MSP. One RCT indicated no change in MSP in comparison with usual care. ConclusionsIt is concluded that there are too few rigorous RCTs testing the effectiveness of GI in the management of MSP. Therefore, the evidence that GI alleviates MSP is encouraging but inconclusive.

Adverse effects of aromatherapy: A systematic review of case reports and case series

AIMnThis systematic review was aimed at critically evaluating the evidence regarding the adverse effects associated with aromatherapy.nnnMETHODnFive electronic databases were searched to identify all relevant case reports and case series.nnnRESULTSnForty two primary reports met our inclusion criteria. In total, 71 patients experienced adverse effects of aromatherapy. Adverse effects ranged from mild to severe and included one fatality. The most common adverse effect was dermatitis. Lavender, peppermint, tea tree oil and ylang-ylang were the most common essential oils responsible for adverse effects.nnnCONCLUSIONnAromatherapy has the potential to cause adverse effects some of which are serious. Their frequency remains unknown. Lack of sufficiently convincing evidence regarding the effectiveness of aromatherapy combined with its potential to cause adverse effects questions the usefulness of this modality in any condition.

Spinal manipulations for cervicogenic headaches: a systematic review of randomized clinical trials.

(Headache 2011;51:1132‐1139)

Acupuncture for Chronic Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome: A Systematic Review

The objective of this systematic review was to assess the effectiveness of acupuncture as a treatment option for chronic prostatitis/chronic pelvic pain syndrome. Eight databases were searched from their inception to October 2010. Randomized clinical trials (RCT) were considered if they tested acupuncture against any control intervention or no therapy in humans with chronic prostatitis/chronic pelvic pain syndrome. The selection of studies, data extraction, and validation were performed independently by 2 reviewers. The methodologic quality of all included RCTs was assessed using the Jadad scale. Studies of stimulation of acupoints other than by needles were excluded. Nine RCTs met the inclusion criteria. They all suggested that acupuncture is effective as a range of control interventions. Their methodologic quality was variable; most were associated with major flaws. Only one RCT had a Jadad score of more than 3. The evidence that acupuncture is effective for chronic prostatitis/chronic pelvic pain syndrome is encouraging but, because of several caveats, not conclusive. Therefore, more rigorous studies seem warranted.