報告者 : 張昭容 日期 :101 年 12 月 19 日 指導者 : 郭素真副護理長

Background LOW BACK PAIN PREVALENCE: 1.Lower back pain is the foremost cause of activity limitationin people below age 45 years 2.the 2 nd most frequent reason for physician visits 3. the 3 rd most common cause of surgical procedures and the 5 th ranked cause of admission to hospitals (Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 354(9178):581-5, 1999). 15% to 20% of adults have back pain during a single year and50% to 80% experience at least one episode of back pain during a lifetime.

Background In the United States, estimates of the costs of low back pain range between $38 and $50 billion a year. In the United States it is the most common cause of job-related disability, a leading contributor to missed work`. Treatments for back pain, including medications, exercise, education, self-care, injections, life-style aids, manual therapies, complementary and alternative medicine (CAM) therapies, minimally invasive treatments and surgery

Background Eisenberg [12] found that most people with back Back pain, is the leading reason for using complementary and alternative medicine (CAM) therapies. 6.9% of U.S. adults, or 15.8 million people, practice yoga 6.1%, or nearly 14 million Americans, say that a doctor or therapist has recommended yoga to them. In addition, nearly half (45%) of all adults agree that yoga would be a beneficial if they were undergoing treatment for a medical condition

Background The benefits of yoga may be greater than those of exercise alone because yoga offers a combination of physical exercise with mental focus, and patients are taught good posture, self-awareness, and self-care along with relaxation. Yoga is an increasingly popular "mind-body" CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition. However, the previous studies had limitations, including small sample sizes, a single yoga teacher delivering the program, and short-term follow-up. Yoga would be an attractive therapeutic option for lower back pain if proved effective.

Review Question To assess the efficacy of yoga in the treatment of people with low back pain

Objective The objective of this review is to identify the effectiveness of yoga on low back pain people

Method Inclusion criteria Types of participants This review will consider studies that include yoga for the low back pain people Types of interventions This review will consider studies that include yoga for the low back pain people Types of studies This review will consider any experimental study design including randomized controlled trials and non- randomized controlled trials, quasi-experimental, before and after studies for inclusion Types of outcome measures This review will consider studies that include the following outcome measure yoga for low back pain people

Method Exclusion criteria Trials with participants suffering from LBP with a specific cause (e.g. infection, neoplasm, metastasis, osteoporosis, rheumatoid arthritis, fractures or lumbosacral radicular syndrome) and low back pain people age under 18 years old were excluded.

Search strategy The databases to be searched include: CINAHL, MEDLINE, PubMed, Cochrane, ProQuest and CEPS. The search for unpublished studies will include Google scholar, Googel, CDRCD. The databases for written Chinese will include: Electronic theses dissertations systemChinese electronic periodical services Airits Library( 華藝線上圖書館；原 CEPS 中文電子期刊 )Taiwan academic online(TAO 台灣學術線上 )

Search strategy Initial keywords search terms include : English search term Type of participants : Back pain*, low back pain, backache, Backache Low Type of interventions : yoga, relaxation, meditation, pranayama, saunas Type of studies: randomized controlled trials non- randomized controlled trials quasi-experimental, Chinese search terms: Type of participants : 背痛、下背痛 Type of interventions : 瑜珈、放鬆、冥想、調息、體式 Type of studies: 隨機研究、非隨機研究、類實驗性研究

Methodological quality Paper selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Bridge Institute Meta Analysis of statistics assessment and review instrument (JBI-MAStARI). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

Data collection Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI, The data extracted will be include specific details about the interventions, populations, study methods and outcome of significance to the review question and specific objectives.

Data synthesis Quantitative data will, where possible, be pooled in statistical meta-analysis using JBI-MAStARI.all results will be subjective to double data entry. Effect sizes expressed as a risk ratio(for categorical data)and their 95% confidence intervals will be calculated for analysis the incidence of low back pain. Heterogeneity will be assessed statistically using the standard Chi-square. Where statistical pooling is not possible the finding will be presented in narrative form including tables and figures to aid in data presentation where appropriate.

文獻篩選流程圖 Potentially relevant paper n=472 Abstracts retrieved for examination n=76 Paper retrieved for detailed examination n=13 Paper included in the systematic review n=11 Paper excluded after appraisal n=2

Reference Groessl EJ, Weingart KR, Johnson N, Baxi S, (2012) ·The Benefits of Yoga for Women Veterans with Chronic Low Back Pain·. The Journal of Alternative and Complementary Medicine,18(9), 832–838. Saper RB, Sherman KJ, Cullum-Dugan D, Davis RB, Phillips RS,Culpepper L,(2009) ·Yoga for chronic low back pain in a predominantlypopulation: a pilot randomized controlled trail· Altern Ther Health Med, 15(6),18–27. Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA.(2005)·Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain·Ann Intern Med. 143, Tekur P, Singphow C, Nagendra HR,Raghuram N,(2008)·Effect of Short-Term Intensive Yoga Program on Pain,Functional Disability, and Spinal Flexibility in Chronic LowBack Pain: A Randomized Control Study·The Journal of Alternative and Complementary Medicine,14(6), 637–644. Tekur P, Nagarathn R, Chametch S, Hankey A, Nagendra HR. (2012)·A comprehensive yoga programs improves pain,anxiety and depression in chronic low back painpatients more than exercise: An RCT·Complementary Therapies in Medicine,20, Tilbrook HE, Cox H, Hewitt CE, Kang’ombe AR, Chuang L-S, Jayakody S, et al., (2011)·Yoga for Chronic Low Back Pain American College of Physicians·Annals of Internal Medicine,155,