The Effects of Mind–Body Exercises on Chronic Spinal Pain Outcomes: A Synthesis Based on 72 Meta-Analyses
Abstract
:1. Introduction
2. Materials and Methods
2.1. Deviations from the Protocol
2.2. Data Sources and Search Strategy
2.3. Eligibility Criteria
2.4. Study Selection
2.5. Methodological Quality
2.6. Data Extraction and Synthesis
2.7. Overlapping between Reviews
2.8. Co-Occurrence Analysis
3. Results
3.1. Co-Occurrence Analysis
3.2. Overlapping
3.3. AMSTAR 2 Rating
3.4. Qigong for Chronic Spinal Pain
3.4.1. Qigong and Chronic Low Back Pain
3.4.2. Qigong and Chronic Neck Pain
3.5. Tai Chi for Chronic Spinal Pain
Tai Chi and Chronic Low Back Pain
3.6. Yoga for Chronic Spinal Pain
3.6.1. Yoga and Chronic Low Back Pain
3.6.2. Yoga and Chronic Neck Pain
4. Discussion
4.1. Clinical Implications
4.2. Methodological Considerations
4.3. Future Agenda
4.4. Limitations
5. Conclusions
- The effect of qigong on chronic back and neck pain was often inconsistent.
- Qigong seemed to be effective in improving the physical component of quality of life only 12 weeks after the intervention.
- Tai chi could be an interesting approach to reduce chronic low back pain.
- No meta-analyses satisfied our criteria regarding tai chi and outcomes of interest in chronic neck pain.
- Yoga could improve chronic low back pain.
- A lack of relevant effects was found for yoga in reducing depression and improving overall quality of life in chronic low back pain.
- The effects of yoga on both components of quality of life (mental and physical) were inconsistent in chronic low back pain.
- Yoga could be an effective approach to decreasing anxiety, depression, and overall mood states and improving overall quality of life in chronic neck pain.
- Inconsistencies were found that were associated with the effects of yoga on chronic neck pain.
- More well-designed research is required on our covered topic to solve the clinical and methodological concerns that were discussed in this umbrella review.
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Author(s) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | Overall Score |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Anheyer et al., 2021 [34] | CLQR | ||||||||||||||||
Bai et al., 2015 [29] | CLQR | ||||||||||||||||
Cramer et al., 2013 [51] | CLQR | ||||||||||||||||
Cramer et al., 2017 [52] | CLQR | ||||||||||||||||
Gross et al., 2015 [30] | LQR | ||||||||||||||||
Hall et al., 2017 [50] | CLOR | ||||||||||||||||
Holtzman et al., 2013 [45] | CLQR | ||||||||||||||||
Kim 2020 [35] | CLQR | ||||||||||||||||
Kong et al., 2016 [44] | LQR | ||||||||||||||||
Li et al., 2019 [46] | CLQR | ||||||||||||||||
Nduwimana et al., 2020 [31] | CLQR | ||||||||||||||||
Qin et al., 2019 [33] | LQR | ||||||||||||||||
Skelly et al., 2020 [28] | LQR | ||||||||||||||||
Slade et al., 2007 [36] | CLQR | ||||||||||||||||
Ward et al., 2013 [47] | CLQR | ||||||||||||||||
Wieland et al., 2017 [48] | LQR | ||||||||||||||||
Yuan et al., 2015 [49] | CLQR | ||||||||||||||||
Zhang et al., 2019 [32] | CLQR | ||||||||||||||||
Zhu et al., 2020 [37] | LQR | ||||||||||||||||
Zou et al., 2019 [13] | CLQR |
Study and Year | Quality Assessment | RCTs Included in This Umbrella | Participants | Interventions | Outcome Measurements | Effect Sizes |
---|---|---|---|---|---|---|
CHRONIC LOW BACK PAIN | ||||||
Nduwimana et al., 2020 [31] | GRADE Unavailable Tool for quality assessment The PEDro scale | 3 | 375 with chronic low back pain | EXPERIMENTAL Qigong CONTROL Exercise, or no intervention, or waitlist | Short-term (ST) effects: 0–3 months after the intervention Intermediate-term (IT) effects: 3–6 months postintervention | SMD (95% CI): subgroup analysis according to the type of intervention and the outcome measurement time points 1. Pain—qigong vs. exercise, no intervention, and waitlist: a. ST effect: −1.34 (−3.19 to 0.51), p = 0.16; I2 = 98% b. IT effect: 0.12 (−2.67 to 2.91), p = 0.93; I2 = 99% |
Zhang et al., 2019 [32] | GRADE Unavailable Tool for quality assessment The PEDro scale | 3 | 375 with chronic low back pain | EXPERIMENTAL Qigong CONTROL Exercise or waitlist | Unspecified | Hedge’s g (95% CI): subgroup analysis for the type of experimental group 1. Pain—qigong vs. exercise and waitlist: −0.54 (−0.86 to −0.23), p < 0.001; I2 = 75.9% |
Zou et al., 2019 [13] | GRADE Unavailable Tool for quality assessment The PEDro scale | 2 | 303 with chronic low back pain | EXPERIMENTAL Qigong CONTROL Exercise or waitlist | Authors declared that none of included studies used follow-up assessments | SMD (95% CI): subgroup analysis according to the type of experimental group 1. Pain—qigong vs. exercise and waitlist: −0.21 (−0.48 to 0.06), p = 0.12; I2 = 10.0% |
CHRONIC NECK PAIN | ||||||
Bai et al., 2015 [29] | GRADE Unavailable Tool for quality assessment The Cochrane risk of bias tool | 2 | 240 with chronic neck pain | EXPERIMENTAL Internal qigong CONTROL Waitlist | 3-month follow-up 6-month follow-up | SMD (95% CI): subgroup analysis according to clinical condition and the outcome measurement time points 1. Pain—internal qigong vs. waitlist: a. At 3 months: −1.17 (−2.44 to 0.10), p = 0.07; I2 = 93% b. At 6 months: −1.00 (−1.94 to −0.06), p = 0.04; I2 = 87% |
Gross et al., 2015 [30] | GRADE Available Tool for quality assessment The Cochrane risk of bias tool | 2 | 240 with chronic neck pain | EXPERIMENTAL Internal qigong CONTROL Waitlist | 12 weeks of treatment 24 weeks of treatment | MD (95% CI): subgroup analysis according to the type of intervention and the outcome measurement time points 1. Pain—internal qigong vs. waitlist: a. 12 weeks of treatment: −13.28 (−20.98 to −5.58), p = 0.00073; I2 = 0% b. 24 weeks of treatment: −7.82 (−14.57 to −1.07), p = 0.023; I2 = 0% 2. Quality of life (physical component)—internal qigong vs. waitlist: a. 12 weeks of treatment: −2.72 (−5.42 to −0.01), p = 0.049; I2 = 0% b. 24 weeks of treatment: −1.88 (−5.80 to 2.04), p = 0.35; I2 = 45% |
Yuan et al., 2015 [49] | GRADE Available Tool for quality assessment The Cochrane risk of bias tool | 2 | 240 with chronic neck pain | EXPERIMENTAL Internal qigong CONTROL Exercise or waitlist | ST: <3 months IT: ~3–12 months | WMD (95% CI): subgroup analysis according to the type of control group and the outcome measurement time points: 1. Pain—internal qigong vs. waitlist; p-value vas not reported: a. ST effect: −15.27 (−22.49 to −8.05); I2 = 47.5% b. IT effect: −10.18 (−16.63 to −3.73); I2 = 0% 2. Pain—internal qigong vs. exercise: a. ST effect: 1.88 (−5.77 to 9.54), p = 0.63; I2 = 0% b. IT effect: 1.00 (−6.21 to 8.21), p = 0.79; I2 = 0% |
Study and Year | Quality Assessment | RCTs Included in This Umbrella | Participants | Interventions | Outcome Measurements | Effect Sizes |
---|---|---|---|---|---|---|
CHRONIC LOW BACK PAIN | ||||||
Hall et al., 2017 [50] | GRADE Available Tool for quality assessment The Cochrane risk of bias tool | 2 | 349 with chronic low back pain | EXPERIMENTAL Tai chi CONTROL Attention control, no, usual care, or waitlist | Unspecified | SMD (95%): subgroup analysis according to clinical condition 1. Pain—tai chi vs. attention control, usual care, or waitlist: −0.84 (−1.27 to −0.42), p < 0.0001; I2 = 69% |
Kong et al., 2016 [44] | GRADE Unavailable Tool for quality assessment The PEDro scale | 3 | 385 with chronic low back pain | EXPERIMENTAL Tai chi CONTROL Physical therapy or waitlist plus health care | Immediately after the treatments—up to 1 day | SMD (95%): subgroup analysis according to clinical condition 1. Pain—tai chi vs. physical therapy or waitlist plus health care: −0.81 (−1.11 to −0.52), p < 0.00001; I2 = 46% |
Nduwimana et al., 2020 [31] | GRADE Unavailable Tool for quality assessment The PEDro scale | 2 | 480 with chronic low back pain | EXPERIMENTAL Tai chi CONTROL Exercise (swimming, jogging), no exercise, usual care, or waitlist | Short-term (ST) effects: 0–3 months after the intervention | SMD (95%CI): subgroup analysis according to the type of experimental group and outcome measurement time points: 1. ST pain—tai chi vs. exercise, no exercise, usual care, and waitlist: −1.19 (−2.97 to 0.58), p = 0.19; I2 = 99% |
Qin et al., 2019 [33] | GRADE Unavailable Tool for quality assessment The PEDro scale | 3 | 252 with chronic low back pain | EXPERIMENTAL Tai chi CONTROL No intervention or waitlist | Unspecified | MD (95%): subgroup analysis according to the type of control group 1. Pain—tai chi vs. no intervention, usual care, or waitlist −1.71 (−2.31 to −1.11), p < 0.00001; I2 = 82% |
Zou et al., 2019 [13] | GRADE Unavailable Tool for quality assessment The PEDro scale | 2 | 203 with chronic low back pain | EXPERIMENTAL Tai chi CONTROL Exercise, no intervention, or waitlist | Authors declared that none of included studies used follow-up assessments | SMD (95%): subgroup analysis according to the type of experimental group 1. Pain—tai chi vs. exercise, no intervention, or waitlist: −0.75 (−1.05 to −0.46), p < 0.001; I2 = 0% |
Study and Year | Quality Assessment | RCTs Included in This Umbrella | Participants | Interventions | Outcome Measurements | Effect Sizes |
---|---|---|---|---|---|---|
CHRONIC LOW BACK PAIN | ||||||
Anheyer et al., 2021 [34] | GRADE Unavailable Tool for quality assessment The Cochrane risk of bias tool | 19 | 2250 with chronic low back pain | EXPERIMENTAL Yoga (Kundalini, Iyengar, Hatha, Vinyasa, therapeutic approach, or integrated approach) with or without usual care CONTROL Exercise, lifestyle advice, multicomponent intervention, usual care, or waitlist | Short-term (ST) effects: postintervention and closest to 12 weeks after randomization Long-term (LT) effects: closest to 6 months after randomization | SMD (95% CI): subgroup analysis according to outcome measurement time points—p value was not reported. 1. Pain—yoga vs. passive control (usual care and/or waitlist) a. LT (6 months and longer): −0.29 (−0.47 to −0.11); I2 = 33% 2. Pain—yoga vs. active control: a. LT (6 months and longer): −0.31 (−1.55 to 0.93); I2 = 91% 3. Quality of life (physical component)—yoga vs. passive control (usual care and/or waitlist): a. ST (2 to 4 months): 0.28 (0.10 to 0.47); I2 = 24% b. LT (6 months and longer): 0.22 (0.03 to 0.41); I2 = 0% 4. Quality of life (physical component)—yoga vs. active control: a. ST (2 to 4 months): 0.51 (−0.03 to 1.05); I2 = 88% b. LT (6 months and longer): 0.31 (−1.95 to 2.56); I2 = 93% 5. Quality of life (mental component)—yoga vs. passive control (usual care and/or waitlist): a. ST (2 to 4 months): 0.17 (0.02 to 0.32); I2 = 0% b. LT (6 months and longer): 0.13 (−0.23 to 0.48); I2 = 39% 6. Quality of life (mental component)—yoga vs. active control: a. ST (2 to 4 months): 0.57 (−0.25 to 1.40); I2 = 92% b. LT (6 months and longer): 0.64 (−7.81 to 9.10); I2 = 93% |
Cramer et al., 2013 [51] | GRADE Unavailable Tool for quality assessment The Cochrane risk of bias tool | 8 | 832 with chronic low back pain | EXPERIMENTAL Yoga (Iyengar, Hatha, Viniyoga), with or without education, usual care, or vegetarian diet CONTROL Education, exercise, multicomponent intervention, usual care, or waitlist | ST: after the end of the intervention and closest to 12 weeks after randomization LT: closest to 12 months after randomization | SMD (95% CI): subgroup analysis according to outcome measurement time points 1. Pain—yoga vs. active and passive controls: a. ST: −0.48 (−0.65 to −0.31), p < 0.00001; I2 = 0% b. LT: −0.33 (−0.59 to −0.07), p = 0.01; I2 = 48% 2. General quality of life—yoga vs. active and passive controls: a. ST: 0.41 (−0.11 to 0.93), p = 0.12; I2 = 72% b. LT: 0.18 (−0.05 to 0.41), p = 0.13; I2 = 0% |
Holtzman et al., 2013 [45] | GRADE Unavailable Tool for quality assessment CLEAR NPT | 6 | 522 with chronic low back pain | EXPERIMENTAL Yoga (Hatha, Viniyoga, Iyengar) CONTROL Exercise, education, or waitlist | Post-treatment analysis: the earliest assessment of the outcome variables after treatment Follow-up analysis: the assessment closest to three months postintervention | Cohen’s d (95%): subgroup analysis according to outcome measurement time points —p value was not reported 1. Pain—yoga vs. exercise, education, or waitlist: a. Post-treatment analysis: 0.623 (0.377 to 0.868); I2 = 22.4% b. Follow-up analysis: 0.397 (0.053 to 0.848); I2 = 74.8% |
Kim 2020 [35] | GRADE Unavailable Tool for quality assessment The Cochrane risk of bias tool | 6 | 523 with chronic low back pain | EXPERIMENTAL Yoga (Iyengar, Hatha, Viniyoga) CONTROL Education, usual care, or waitlist | After 12 weeks of treatment | SMD (95%): overall effect 1. Pain—yoga vs. education, usual care, or waitlist: −0.41 (−0.58 to −0.23), p < 0.0001; I2 = 0% |
Nduwimana et al., 2020 [31] | GRADE Unavailable Tool for quality assessment The PEDro scale | 4 | 241 with chronic low back pain | EXPERIMENTAL Yoga CONTROL Unspecified | Intermediate-term (IT) effects: 3–6 months postintervention | SMD (95%CI): subgroup analysis according to the type of experimental group and outcome measurement time points: 1. Pain—yoga vs. control group: a. IT: −1.70 (−3.52 to 0.12), p = 0.07; I2 = 97% |
Skelly et al., 2020 [28] | GRADE Available Tool for quality assessment The Cochrane risk of bias tool | 9 | 1221 with chronic low back pain | EXPERIMENTAL Yoga (Hatha, Kundalini, Iyengar, Viniyoga) CONTROL Attention control, exercise, usual care, or waitlist | ST: 1 to <6 months following treatment completion IT: >6 to <12 months | MD (95%): subgroup analysis according to the type of control group and outcome measurement time points: 1. Pain—yoga vs. attention control or waitlist: a. ST: −0.87 (−1.49 vs. −0.24) p = 0.014; I2 = 64.1% b. IT: −1.16 (−2.16 to −0.27), p = 0.029; I2 = 0% 2. Pain—yoga vs. exercise: a. ST: −0.63 (−1.68 to 0.45), p = 0.196; I2 = 87.5% |
Slade et al., 2007 [36] | GRADE Unavailable Tool for quality assessment The PEDro scale | 2 | 145 with chronic low back pain | EXPERIMENTAL Yoga (Viniyoga, Iyengar) CONTROL No exercises plus education | IT: 26 to 32 weeks | SMD (95%): subgroup analysis outcome measurement time points—p value and heterogeneity (I2) were not reported 1. Pain—yoga vs. education or no exercise: a. IT: 0.92 (0.47 to 1.37) |
Ward et al., 2013 [47] | GRADE Unavailable Tool for quality assessment The Cochrane risk of bias tool and The PEDro scale | 4 | 449 with chronic low back pain | EXPERIMENTAL Yoga (Hatha, Viniyoga, Iyengar) CONTROL Exercise, usual care, or waitlist | Unspecified | SMD (95%): overall effect: 1. Pain—yoga vs. exercise, usual care, or waitlist: −0.61 (−0.97 to −0.26), p = 0.0007; I2 = 63% |
Wieland et al., 2017 [48] | GRADE Available Tool for quality assessment The Cochrane risk of bias tool and | 6 | 565 with chronic low back pain | EXPERIMENTAL Yoga (Iyengar, Hatha) CONTROL Education or usual care | ST: 4 to 6 weeks SIT: 3 to 4 months IT: 6 months LT: 12 months | MD (95%CI): subgroup analysis according to outcome measurement time points: 1. Pain—Yoga vs. education or usual care: a. ST: −10.83 (−20.85 to −0.81), p = 0.034: I2 = 0% b. SIT (3 to 4 months): −4.55 (−7.04 to −2.06), p = 0.00035; I2 = 0% c. IT: −7.81 (−13.37 to −2.25), p = 0.0059; I2 = 64% d. LT: −5.40 (−14.50 to 3.70), p = 0.24; I2 = 79% SMD (95%CI): subgroup analysis according to outcome measurement time points: 2. Quality of life (physical component)—yoga vs. education or usual care: a. SIT: 0.22 (0.00 to 0.44), p = 0.051; I2 = 0% 3. Quality of life (mental component)—yoga vs. education or usual care: a. SIT: 0.20 (−0.02 to 0.41), p = 0.081; I2 = 0% 4. Depression—yoga vs. education or usual care: a. SIT (3 months): −0.15 (−0.49 to 0.19), p = 0.39; I2 = 0% |
Zhu et al., 2020 [37] | GRADE Available Tool for quality assessment The Cochrane risk of bias tool and | 17 | 1921 with chronic low back pain | EXPERIMENTAL Yoga (Hatha, Iyengar, Viniyoga) CONTROL Education, exercise, no treatment, physical therapy, or usual care | ST, IT, and LT differed in different subgroup analyses | MD (95%CI): subgroup analysis according to the type of control group and outcome measurement time points: 1. Pain—yoga vs. non-exercise: a. ST (4 to 8 weeks): −0.83 (−1.19 to −0.48), p < 0.00001; I2 = 0% b. SIT (3 months): −0.43 (−0.64 to −0.23), p < 0.0001; I2 = 0% c. IT (6 to 7 months): −0.56 (−1.02 to −0.11), p = 0.02; I2 = 50% d. LT (12 months): −0.52 (−1.64 to 0.59), p = 0.36; I2 = 87% 2. Pain—yoga vs. physical therapy exercise: a. ST (7 days of intensive intervention): −2.36 (−3.15 to −1.56), p < 0.00001; I2 = 0% b. ST (4 to 10 weeks): −0.37 (−1.16 to 0.42), p = 0.36; I2 = 81% c. SIT (3 months): 0.19 (−0.63 to 1.01), p = 0.65; I2 = 64% d. IT (6 months): −0.73 (−2.13 to 0.67), p = 0.31; I2 = 85% 3. Quality of life (physical component)—yoga vs. physical therapy exercise: a. SIT (3 months): 0.18 (−1.97 to 2.32), p = 0.87; I2 = 0% 4. Quality of life (mental component)—yoga vs. physical therapy exercise: a. SIT (3 months): 0.07 (−2.74 to 2.89), p = 0.96; I2 = 0% Results were from a subgroup analysis according to the type of control group and outcome measurement time points: SMD (95%CI) 5. Quality of life (physical component)—yoga vs. non-exercise: a. SIT (3 months): 0.06 (−0.10 to 0.22), p = 0.48; I2 = 0% b. IT (6 months): 0.08 (−0.13 to 0.28), p = 0.45; I2 = 0% 6. Quality of life (mental component)—yoga vs. non-exercise: a. SIT (3 months): 0.15 (−0.01 to 0.31), p = 0.06; I2 = 0% b. IT (6 months): 0.18 (−0.03 to 0.39), p = 0.09; I2 = 0% |
Zou et al., 2019 [13] | GRADE Unavailable Tool for quality assessment The PEDro scale | 8 | 1237 with chronic low back pain | EXPERIMENTAL Yoga (group and home practice) CONTROL Education, exercise, self-care, or waitlist | Authors declared that none of studies used follow-up assessments | SMD (95%): subgroup analysis according to the type of experimental group: 1. Pain—yoga vs. education, exercise, self-care, or waitlist: −0.33 (−0.47 to −0.19), p = 0.001; I2 = 33.7% |
CHRONIC NECK PAIN | ||||||
Cramer et al., 2017 [52] | GRADE Unavailable Tool for quality assessment The Cochrane risk of bias tool | 188 with chronic neck pain | EXPERIMENTAL Yoga (Iyengar) with physiotherapy CONTROL Usual care | ST was not defined | SMD (95%): overall effects 1. Pain—yoga vs. usual care: −1.28 (−1.81 to −0.75), p < 0.00001; I2 = 62% 2. General quality of life—yoga vs. usual care: 0.57 (0.17 to 0.97), p = 0.006; I2 = 20% 3. Mood—yoga vs. usual care: −1.02 (−1.38 to −0.65), p < 0.00001; I2 = 0% |
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Martinez-Calderon, J.; de-la-Casa-Almeida, M.; Matias-Soto, J. The Effects of Mind–Body Exercises on Chronic Spinal Pain Outcomes: A Synthesis Based on 72 Meta-Analyses. Int. J. Environ. Res. Public Health 2022, 19, 12062. https://doi.org/10.3390/ijerph191912062
Martinez-Calderon J, de-la-Casa-Almeida M, Matias-Soto J. The Effects of Mind–Body Exercises on Chronic Spinal Pain Outcomes: A Synthesis Based on 72 Meta-Analyses. International Journal of Environmental Research and Public Health. 2022; 19(19):12062. https://doi.org/10.3390/ijerph191912062
Chicago/Turabian StyleMartinez-Calderon, Javier, Maria de-la-Casa-Almeida, and Javier Matias-Soto. 2022. "The Effects of Mind–Body Exercises on Chronic Spinal Pain Outcomes: A Synthesis Based on 72 Meta-Analyses" International Journal of Environmental Research and Public Health 19, no. 19: 12062. https://doi.org/10.3390/ijerph191912062