INHE 4001 Week 5 Appraisal Summary Example

What the Three Strongest Sources Show: An Appraisal Summary on Yoga for Chronic Low Back Pain, With Effect Sizes, Certainty and Harms Stated Plainly

Student Name

Walden University

INHE 4001: Evidence-Based Practices in Integrative and Holistic Healthcare

Instructor Name

Month Day, Year

What the Three Strongest Sources Show: An Appraisal Summary on Yoga for Chronic Low Back Pain, With Effect Sizes, Certainty and Harms Stated Plainly

Which Sources Carry the Weight

Of the seven sources in the evidence table, three carry most of the weight for the wellness center's question: the Cochrane review that pools 12 trials (Wieland et al., 2017), the largest trial comparing yoga with physical therapy (Saper et al., 2017) and the largest trial comparing yoga with usual care (Tilbrook et al., 2011). The guideline relies largely on the same trials, and the smaller trials are included in the review. This summary condenses what the three show into one account.

Size of the Effect

Against non-exercise controls, the review found that yoga produced small to moderate improvements in back-related function at three to four months, a standardized mean difference of -0.40, which corresponds to about 2.2 points on the 24-point Roland-Morris Disability Questionnaire, with similar effects at six months and smaller ones at a year (Wieland et al., 2017). The United Kingdom trial found a similar difference, about 2.2 points at three months and about 1.5 points at six and twelve months (Tilbrook et al., 2011). For pain, the review found yoga slightly better than non-exercise controls on a 0 to 100 scale, by about 5 to 8 points, below the 15-point threshold the reviewers had set in advance as clinically significant.

Against other exercise, the review found little or no difference in function. The large trial with physical therapy as the comparison found yoga noninferior to physical therapy for function and pain, meaning not meaningfully worse, but also found that neither yoga nor physical therapy was superior to an education booklet on those primary outcomes (Saper et al., 2017).

Certainty of the Evidence

The review rated the evidence as low to moderate certainty for most comparisons with non-exercise controls and very low certainty for comparisons with other exercise. The main reason is that participants in yoga trials know which treatment they receive and rate their own pain and function, so expectations can shape results. The trials also varied in yoga style, duration and population.

Harms

The review found moderate-certainty evidence that yoga carries a small increase in the risk of adverse events compared with non-exercise controls, mostly temporary increases in back pain, a risk difference of about 5 percentage points. Compared with other exercise, there was no detectable difference. Serious harms were rare across the trials.

What Would Change This Summary

A trial that blinded outcome assessors and used a credible attention-control class could raise certainty. Trials in older adults or community settings would extend the findings to more of the center's clients. A large trial finding no benefit against usual care would lower the estimate. Any of these would change the summary, and it should be revised when they appear.

The Combined Account

Taken together, the strongest evidence says that group yoga modestly improves back-related function in adults with chronic nonspecific low back pain compared with doing nothing extra, that it helps about as much as other active treatments such as physical therapy or stretching, that its effect on pain is small, and that it occasionally causes temporary flares. The certainty is low to moderate. That supports offering yoga as one reasonable option, not as a superior one.

References

Saper, R. B., Lemaster, C., Delitto, A., Sherman, K. J., Herman, P. M., Sadikova, E., Stevans, J., Keosaian, J. E., Cerrada, C. J., Femia, A. L., Roseen, E. J., Gardiner, P., Gergen Barnett, K., Faulkner, C., & Weinberg, J. (2017). Yoga, physical therapy, or education for chronic low back pain: A randomized noninferiority trial. Annals of Internal Medicine, 167(2), 85-94. https://doi.org/10.7326/M16-2579

Tilbrook, H. E., Cox, H., Hewitt, C. E., Kang'ombe, A. R., Chuang, L.-H., Jayakody, S., Aplin, J. D., Semlyen, A., Trewhela, A., Watt, I., & Torgerson, D. J. (2011). Yoga for chronic low back pain: A randomized trial. Annals of Internal Medicine, 155(9), 569-578. https://doi.org/10.7326/0003-4819-155-9-201111010-00003

Wieland, L. S., Skoetz, N., Pilkington, K., Vempati, R., D'Adamo, C. R., & Berman, B. M. (2017). Yoga treatment for chronic non-specific low back pain. Cochrane Database of Systematic Reviews, 2017(1), Article CD010671. https://doi.org/10.1002/14651858.CD010671.pub2