Deb Zahnow

Deb Zahnow
December 2003

Yoga based treatment approach in Occupational Therapy

Introduction (purpose of review):
In recent years, Western culture has seen a dramatic increase in the practice of yoga. This popularity has become evident in the media and health clubs. However, this trend has moved beyond these areas and is now being embraced by mainstream medicine as a tool for improved health. Thus, an increased amount of research is being done to analyze the benefits and effectiveness of yoga in the health care field.
This review looks at the available evidence and attempts to provide some insight into how practitioners may utilize this information in order to achieve the best practice for their clients.

Evidence-Based Practice Question:
Is the use of a yoga based treatment approach effective in promoting and maintaining health and wellness for adults with debilitating physical impairments/conditions?

Criteria for Evidence Selection:
*Adults
*Yoga and its potential benefits with treating various physical conditions/impairments.
*Impairments/conditions addressed or seen in various occupational therapy settings.

Table Summarizing the Evidence:

Reference	Study Design/Data Collection	Level of Evidence	Sample Size	Outcome/ Intervention	Summary of Results (Conclusion and Implications)
Damordaran, Malathi, Patil, Shah, Suryavanshi and Marathe (2002)	Single case design	Level III	20 subjects (16 males, 4 females; age range 35 to 55 years) with mild to moderate hypertension.	Subjects underwent daily yoga practice for 3 months. Biomechanical, physiological and psychological parameters were studied prior to and after 3 months of yoga practice.	After intervention, subjects demonstrated a decrease in heart rate, respiration, blood pressure, blood glucose and cholesterol. Subjects also demonstrated improvements in concentration and memory. Indicates that yoga may play an important role in risk modification.

Garfinkel, Schumacher, Husain, Levy and Reshetar (1994)

Randomized, control study

Level I

25 subjects with OA of the DIP and/or PIP joints of the fingers. Age range and gender were not specified.

Subjects were randomly assigned to either receive yoga training or no treatment.

Hand variables such as ROM, strength, tenderness, joint circumference, pain and function were assessed before and after 10 weeks of intervention.

In all cases the yoga group improved more than the control group. From the yoga group, the most significant improvement was in pain level during activity, tenderness and finger range of motion. Findings provide evidence of a potentially valuable option in the management of OA in the hands and finger joints.

Garfinkel, Singhal, Katz, Allan, Reshetar and Schumacher (1998)

Randomized, single-blind, controlled trial.

Level I

42 (age range 24-77 years) employed or retired individuals with carpal tunnel syndrome.

Subjects were randomly placed into either a control group (wore a standard wrist cock-up splint) or a yoga group. Changes in various biomechanical and sensory components were measured at beginning of the study and 8 weeks after intervention

Patients in the yoga group had statistically significant improvement in grip strength and pain reduction. Indicates that the use of yoga may be effective in improving awareness of proper postures and preventing recurrence and onset of symptoms.

Khanam, Sachdeva, Guleria and Deepak (1996)

Single case design

Level III

9 subjects (6 males and 3 females; age range 12 to 60 years) with the diagnosis of bronchial asthma.

Subjects were trained in yoga for seven days at a yoga training camp. Performance in parasympathetic reactivity, sympathetic reactivity and pulmonary function tests were recorded before and after yoga training.

After training, subjects demonstrated significant decrease in resting heart rate, sympathetic reactivity and portions of the pulmonary function tests. Indicates that yoga may promote relaxation of voluntary inspiratory and expiratory muscles during practice. Reveals significant benefits of yoga training even within a short period of time.

Luskin, et al (2000)

Systematic review (review of the literature)

Level I

Computerized searches and interviews with practitioners and the elderly were conducted.

Various mind/body practices were evaluated (including yoga). Studies published before 1990 were preferred and utilized first. However, other controlled studies were included when literature was scarce.

Results suggest that yoga and other mind/body practices may be efficient treatments for musculoskeletal diseases and other related disorders. Indicates that yoga may provide a more cost-effective and noninvasive treatment option for patients. The most apparent finding was the need for further research.

Summary of the Evidence:

Beneficial in alleviating some symptoms of various musculoskeletal and cardiopulmonary conditions (i.e., carpal tunnel syndrome, arthritis, asthma).
Limited research available.
Yoga may reduce the need for more extensive treatment approaches (i.e., surgery, splinting).

Implications for the Consumers:

More cost-effective and less invasive than other treatment approaches (surgery, medication).
Has a variety of techniques and approaches; Allows individuals to find a method/approach that best meet their needs.

Obtain a diagnosis and weigh all benefits and side effects of the proposed treatment.

Implications for Practitioners:

Provides evidence of how yoga may be used as an alternative treatment approach in a therapeutic setting.
OT’s need to be knowledgeable in benefits and specific techniques that best meets their client’s needs.
OT’s need to know how to access and analyze research to ensure appropriate use and understanding.

Implications for Researchers:

Need for further exploration of yoga and its therapeutic/ health benefits for those with debilitating conditions.
Follow-up studies to analyze benefits/applicability over an extended period of time.

Recommendations for Best Practice:

It is recommended that therapists consider the specific needs of their clients through evaluations, assessments and interviews. Therapy sessions should focus on educating the client in how yoga techniques and principles can be utilized to decrease symptoms and improve physical/mental health. The therapist needs to consider the individual’s lifestyle, daily environments, social situations and possible side effects/precautions when implementing a treatment program. In conclusion, OT’s can use their knowledge of physiological, psychological and biomechanical factors to utilize yoga as a therapeutic approach to best meet their clients needs and maximize their overall health and wellness.

References

Damordaran, A., Malathi, A., Patil, N., Shah, N., Suryavanshi, & Marathe, S. (2002). Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. Journal of the Association of Physicians of India, 50, 633-640.

Garfinkel, M.S., Schumacher, H.R., Husain, A., Levy, M., & Reshetar, R.A. (1994). Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. The Journal of Rheumatology, 21, 2341-2343.

Garfinkel, M.S., Singhal, A., Katz, W.A., Allan, D.A., Reshetar, R., & Schumacher, H.R. (1998). Yoga-Based intervention for carpal tunnel syndrome. Journal of the American Medical Association, 280(18), 1601-1603.

Khanam, A.A., Sachdeva, U., Guleria, R., & Deepak, K.K. (1996). Study of pulmonary and autonomic functions of asthma patients after yoga training. Indian Journal of Physiology Pharmacology, 40(4), 318-324.

Luskin, F.M., & et al. (2000). A review of mind/body therapies in the treatment of musculoskeletal disorders with implications for the elderly. Alternative Therapies Health Medicine, 6(2), 46-56.