Yoga: a cost-effective treatment for back pain sufferers?

Led by the University of York, and funded by Arthritis Research UK, the study provides an evaluation of a specially-developed 12-week group yoga intervention programme compared to conventional general practitioner (GP) care alone.

The results published in Spine, show that the yoga intervention programme -- 'Yoga for Healthy Lower Backs' -- is likely to be cost effective for both the UK National Health Service (NHS) and wider society.

The cost assumed for yoga intervention is important in determining whether this is an efficient use of NHS resources. As yoga classes are not currently available through the NHS, the researchers examined a range of possible costs. They conclude that if the NHS was to offer specialist yoga and managed to maintain the cost below £300 per patient (for a cycle of 12 classes), there is a high probability (around 70 per cent) of the yoga intervention being cost effective.

Researchers also found that those taking part in the yoga programme had far fewer days off work than those in the control group. On average, a control group participant reported 12 days off due to back pain, whereas those in the yoga group had four days off. The cost associated with taking time off was £1,202 for a control group member, compared with £374 for a yoga group member.

The study was carried out by researchers from the University of York's Department of Health Sciences and the Centre for Health Economics, and the Hull York Medical School.

Chief Investigator Professor David Torgerson, Director of York Trials Unit, in the University of York's Department of Health Sciences, said: "Back pain represents a significant burden to the NHS in the UK and to society as a whole. As well as the associated health care costs, it is also a major cause of work absenteeism which leads to a productivity loss to society.

"While yoga has been shown as an effective intervention for treating chronic and low back pain, until now there has been little evidence on its cost effectiveness. In our study we evaluated a specially-designed yoga class package by using individual-level data from a multi-centred randomized controlled trial. On the basis of the 12-month trial, we conclude that 12 weekly group classes of specialised yoga are likely to provide a cost-effective intervention for the treatment of patients with chronic or recurrent low back pain."

Back pain is estimated to cost the NHS £1.37 billion and the health care sector £2.10 billion a year. It is also one of the most common conditions treated in primary care in the UK with about 2.6 million people seeking advice from their GP about back pain each year.

Professor Alan Silman, Medical Director of Arthritis Research UK, said: "We welcome the fact that not only has yoga been found to help people manage their back pain, but that it is also cost effective, and results in fewer sick days. It is another option for people who are struggling to manage their condition, and one that encourages the move to self-management. Yoga is an intervention that has been proven to make their everyday lives easier and their pain more manageable.

"We'd hope that on the back of this, more people with back pain are encouraged to take up the yoga programme."

The trial involved two groups of people who were identified as having chronic or recurrent back pain. A group of 156 people were offered group yoga classes specially designed to improve back function, while a second control group of 157 people received GP care alone.

Both groups received usual GP care, which could have involved, for example, referral to pain clinics and physiotherapists or prescription of painkillers.

The 12-week yoga programme was delivered by 12 experienced yoga teachers. It was designed by Alison Trewhela, an Iyengar Yoga teacher and Senior Practitioner in Yoga on the British Register of Complementary Practitioners, in collaboration with yoga teacher Anna Semlyen, a Back Care Advisor to the British Wheel of Yoga.

Alison Trewhela said: "GPs and commissioners are showing great interest in this yoga programme. Many consider it could be the primary treatment option because it offers long-term positive outcomes, as well as a multi-disciplinary combination of taught skills that suits the bio-psycho-social nature of the condition of chronic low back pain.

"Within its confidence-boosting, gradually-progressing environment, the gentle 'Yoga for Healthy Lower Backs' course addresses joint mobility, muscle-strengthening, emphasis on the breath, mental attitude to pain and perspective on life lessons, postural awareness and low back education, relaxation techniques, and advice about other potentially health-giving techniques and benefits."