Yoga for Managing Knee Osteoarthritis in Older Women: a Feasibility Study
Condition: Osteoarthritis, Knee; Quality of Life; Poor Quality Sleep; Physical Impairment
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      The study hypothesized that it is feasible and safe to use Hatha yoga in older women with
      knee osteoarthritis (OA), and practicing Hatha yoga regularly will help reduce pain and
      stiffness, enhance physical function, and improve quality of sleep and quality of life in
      older women with knee OA.
    

Detailed description: 
      1. Potential participants were initially screened via telephone by a trained research
           assistant for eligibility which was based on the following inclusion criteria:

             1. community-dwelling women aged 65 years or over;

             2. had a symptomatic OA of knee diagnosis for at least 6 months;

             3. had no previous training in any form of yoga; and

             4. were not currently participating in a supervised exercise program.

        2. Once initial screening eligibility was established, the individual was seen at home to
           confirm:

             1. the presence of knee OA symptoms using the Clinical Criteria for the Classification
                of Idiopathic OA of the Knee developed by the American College of Rheumatology.

             2. Cognitively intact using the Short Portable Mental Status Questionnaire (SPMSQ).

        3. Exclusion criteria included:

             -  symptoms of joint locking;

             -  instability indicated by chronic use of a knee brace, cane, walker, or wheelchair;

             -  a corticosteroid injection in the symptomatic joint within three months of study
                entry;

             -  a hyaluronic acid injection in the symptomatic joint within six months of study
                entry;

             -  a history of knee surgery within the last two years or a joint replacement at any
                point;

             -  individuals who had self-reported significant medical comorbidities that might
                preclude exercise participation such as: a) uncontrolled high blood pressure or
                existing heart condition; and b) other comorbid condition with overlapping symptoms
                (i.e. fibromyalgia, rheumatoid arthritis);

             -  individuals who had medication changes for arthritis symptoms were permitted to
                remain in the trial; however, these changes were monitored.

        4. Primary outcome measures included:

           - OA symptoms (e.g., pain, stiffness and physical function) were assessed using the
           Western Ontario and McMaster Universities OA Index scale (LK scale 3.1) (WOMAC) and a
           single question that asked about the number of pain medications used per day.

             -  WOMAC scale contains 24 items divided into 3 subscales: Pain (5 items), Stiffness
                (2 items), and Physical Function (17 items). The 5-point Likert Scale uses the
                following descriptors for all items: none, mild moderate, severe, and extreme.
                These correspond to an ordinal scale of 0-4. The scores are summed for items in
                each subscale, with possible ranges as follows: pain=0-20, stiffness=0-8, physical
                function=0-68. A total WOMAC score is created by summing the items for all three
                subscales. Higher values represent a worse OA symptom.

        5. Secondary outcome measures included:

             -  physical performance of the LE which was assessed using the Short Physical
                Performance Battery (SPPB) developed by the National Institute on Aging. The test
                consists of three components: repeated chair stands, balance, and timed 8" walk.
                Each subscale 0 (worst performance) to 12 (best performance).

             -  BMI in kg/m^2 was calculated using the participant's weight and height.

             -  Quality of sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI). A
                score of ≥ 5 on the PSQI total scale, which is computed as a sum of the seven
                subscales (e.g., sleep quality, sleep latency, sleep duration, sleep disturbance,
                sleep efficiency, and use sleep medication) is associated with clinically
                significant sleep disruptions, including insomnia and major mood disorders.

             -  The self-perceived quality of life was assessed using the Short Form Health Survey
                (SF-12) which measures a total of 8 health domains: 4 physical and 4 mental
                component summary scales. Physical Health (physical functioning, role-physical,
                bodily pain, and general health)and Mental Health (vitality, social functioning,
                role-emotional, and mental health) Composite Scores (PCS & MCS) are computed using
                the scores of twelve questions and range from 0 to 100, where a zero score
                indicates the lowest level of health measured by the scales and 100 indicates the
                highest level of health. The Cantril Self-Anchoring Ladder that measures both
                "current" and "in 5 years" using steps from 0 to 10, where "0" represents the worst
                possible life and "10" represents the best possible life.

        6. Feasibility measures: Feasibility was measured by eligibility, recruitment, and
           retention rates.

             -  The average number of yoga class attendance and minutes of home practice were used
                to measure the retention and adherence rates.

             -  Acceptability was evaluated by the participants' perceived difficulty of the yoga
                class and level of enjoyment.

             -  Perceived level of difficulty and enjoyment were rated by participants after
                completing the yoga program on two different scales of 1 - 10 where 10 represents
                "extremely difficult" and "most enjoyable", respectively.

             -  Safety was assessed by recording the frequency of injuries that occur during group
                and home-based exercise sessions.

        7. Demographic information (e.g., age, race/ethnic background, education level, annual
           household income, marital status, living arrangement, and type of insurance), and
           comorbidities were collected from all participants.
    

Intervention name(s): Hatha yoga; Hatha Yoga
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Hatha yoga poses that were specifically designed by a group of yoga experts for older adults with knee osteoarthritis. Program included physical poses and sequence that focus on strengthening the lower extremities, and relaxation techniques.; The same intervention was provided to the wait-list control group at the end of 8 weeks when the intervention completed their intervention classes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Other
Keywords: Yoga; Knee osteoarthritis; Symptom management; Older women; Pain; Stiffness; Physical function); Physical function of the lower extremities; Quality of sleep; Quality of life