Background: We aim to compare the effectiveness of 3 active interventions, i.e., yoga, eurythmy therapy, and physiotherapeutic exercise, on chronic lower back pain. Methods: In this randomized controlled trial over 16 weeks (8 weeks of intervention, 8 weeks of follow-up), data of individuals with chronic lower back pain will be analyzed. Interventions are implemented as group sessions (75 min) once per week. Participants receive a manual for home-based practice and are assessed before and at the end of the 8-week intervention period, and at the end of an 8-week follow-up period. Standardized questionnaires are: the Roland-Morris Disability Score, visual analog scales measuring intensity of pain, the Brief Multidimensional Life Satisfaction Scale, the Perceived Stress Scale, the Inner Correspondence with the Practices questionnaire, the Freiburg Mindfulness Questionnaire, the General Self-Efficacy Scale, a self-regulation questionnaire, the Internal Coherence Scale, a pain diary (registering the need of analgesic medication), and a questionnaire on the patients' expectation that the interventions will be effective in reducing pain and how strong this reduction might be (2 single items), etc. Discussion: This large multicenter study will provide evidence on the effectiveness of 3 contrasting movement-orientated treatments that share some similarities but differ in essential details: yoga, eurythmy therapy, and physiotherapeutic exercises. It will provide important data on non-pharmacological options to treat lower back pain in a large group of affected individuals.

Balagué F, Mannion AF, Pellisé F, Cedraschi C: Non-specific low back pain. Lancet 2012;379:482-491.
Meucci RD, Fassa AG, Faria NMX: Prevalence of chronic low back pain: systematic review. Rev Saúde Pública 2015;49:1-10.
Schmidt CO, Raspe H, Pfingsten M, Hasenbring M, Basler HD, Eich W, et al: Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine 2007;32:2005-2011.
Juniper M, Le TK, Mladsi D: The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review. Expert Opin Pharmacother 2009;10:2581-2592.
Saper RB, Sherman KJ, Delitto A, Herman PM, Stevans J, Paris R, et al: Yoga vs. physical therapy vs. education for chronic low back pain in predominantly minority populations: study protocol for a randomized controlled trial. Trials 2014;15:67.
Hayden J, van Tulder MW, Malmivaara A, Koes BW: Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev 2005;(3):CD000335.
van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, et al: A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 2011;20:19-39.
Smith C, Grimmer-Somers K: The treatment effect of exercise programmes for chronic low back pain. J Eval Clin Pract 2010;16:484-491.
Searle A, Spink M, Ho A, Chuter V: Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2015;29:1155-1167.
Feuerstein G, Wilber K: The Yoga Tradition: Its History, Literature, Philosophy and Practice, ed 3. Prescott, Hohm Press, 2001.
Broad WJ: The Science of Yoga: The Risks and the Rewards. New York, Simon & Schuster, 2012.
Iyengar BKS: Licht auf Yoga: Das grundlegende Lehrbuch des Hatha-Yoga. Hamburg, Nikol, 2013.
Field T: Yoga clinical research review. Complement Ther Clin Pract 2011;17:1-8.
Galantino ML, Bzdewka TM, Eissler-Russo JL, Holbrook ML, Mogck EP, Geigle P, Farrar JT: The impact of modified Hatha yoga on chronic low back pain: a pilot study. Altern Ther Health Med 2004;10:56-59.
Tekur P, Singphow C, Nagendra HR, Raghuram N: Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med 2008;14:637-644.
Tilbrook HE, Cox H, Hewitt CE, Kang'ombe AR, Chuang L-H, Jayakody S, et al: Yoga for chronic low back pain: a randomized trial. Ann Intern Med 2011;155:569-578.
Holtzman S, Beggs RT: Yoga for chronic low back pain: a meta-analysis of randomized controlled trials. Pain Res Manag 2013;18:267-272.
Williams K, Abildso C, Steinberg L, Doyle E, Eppstein B, Smith D, et al: Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine 2009;34:2066-2076.
Williams KA, Petronis J, Smith D, Goodrich D, Wu J, Ravi N, et al: Effect of Iyengar yoga therapy for chronic low back pain. Pain 2005;115:107-117.
Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA: Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med 2005;143:849-856.
Kelly Z: Is yoga an effective treatment for low back pain: a research review. Int J Yoga Ther 2009;19:103-112.
Posadzki P, Ernst E: Yoga for low back pain: a systematic review of randomized clinical trials. Clin Rheumatol 2011;30:1257-1262.
Cramer H, Lauche R, Haller H, Dobos G: A systematic review and meta-analysis of yoga for low back pain. Clin J Pain 2013;29:450-460.
Hill C: Is yoga an effective treatment in the management of patients with chronic low back pain compared with other care modalities - a systematic review. J Complement Integr Med 2013;10.
Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, et al: Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147:478-491.
Büssing A, Ostermann T, Edelhäuser F: Klinische Studien zur Heileurythmie - Aspekte für zukünftige Planungen. Merkurstab 2009;62:234-238.
Büssing A, Ostermann T, Majorek M, Matthiessen PF: Eurythmy therapy in clinical studies: a systematic literature review. BMC Complement Altern Med 2008;8:8.
Steiner R, Wegman I: Fundamentals of Therapy. An Extension of the Art of Healing through Spiritual Knowledge. Dornach, Rudolf Steiner Verlag, 1983.
Kirchner-Bockholt M: Grundelemente der Heil-Eurythmie, ed 3. Dornach, Philosophisch-Anthroposophischer Verlag, Goetheanum, 1981.
Internationales Forum Heileurythmie Medizinische Sektion der Freien Hochschule für Geisteswissenschaft Goetheanum, Dornach, Schweiz: Rahmen-Curriculum der Heileurythmieausbildung., 2008 (last accessed May 14, 2014).
von Laue H-B, Elke E: The Physiology of Eurythmy Therapy, ed 1. Edinburgh, Floris Books, 2010.
Berger B, Bertram M, Kanitz J, Pretzer K, Seifert G: ‘Like walking into an empty room': Effects of eurythmy therapy on stress perception in comparison with a sports intervention from the subjects' perspective - a qualitative study. Evid Based Complement Alternat Med 2015;2015:e856107.
Hamre HJ, Witt CM, Kienle GS, Glockmann A, Ziegler R, Willich SN, et al: Long-term outcomes of anthroposophic therapy for chronic low back pain: a two-year follow-up analysis. J Pain Res 2009;2:75-85.
Hamre HJ, Witt CM, Glockmann A, Wegscheider K, Ziegler R, Willich SN, et al: Anthroposophic vs. conventional therapy for chronic low back pain: a prospective comparative study. Eur J Med Res 2007;12:302-310.
Sherman KJ, Cherkin DC, Cook AJ, Hawkes RJ, Deyo RA, Wellman R, et al: Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial. Trials 2010;11:36.
Deutscher Verband für Physiotherapie (ZVK): Patienten & Interessierte // Physiotherapie // Definition. (last accessed August 12, 2015).
Roland M, Morris R: A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine 1983;8:141-144.
Roland M, Fairbank J: The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine 2000;25:3115-3124.
Wiesinger GF, Nuhr M, Quittan M, Ebenbichler G, Wölfl G, Fialka-Moser V: Cross-cultural adaptation of the Roland-Morris questionnaire for German-speaking patients with low back pain. Spine 1999;24:1099-1103.
Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al: Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA project. J Clin Epidemiol 1998;51:1171-1178.
Luo X, George ML, Kakouras I, Edwards CL, Pietrobon R, Richardson W, et al: Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine 2003;28:1739-1745.
Muller-Nordhorn J: Comparison of the short form (SF)-12 health status instrument with the SF-36 in patients with coronary heart disease. Heart 2004;90:523-527.
Ware J, Kosinski M, Keller SD: A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220-233.
Büssing A, Fischer J, Haller A, Heusser P, Ostermann T, Matthiessen PF: Validation of the Brief Multidimensional Life Satisfaction Scale in patients with chronic diseases. Eur J Med Res 2009;14:171.
Dalbert C: Subjektives Wohlbefinden junger Erwachsener: theoretische und empirische Analysen der Struktur und Stabilität. Z Differ Diagn Psychol 1992;13:207-220.
Dalbert C: Momentanes Befinden/aktuelle Stimmungsskala. sdasts.pdf, 2009 (last accessed April 5, 2016).
Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav 1983;24:385-396.
Büssing A, Edelhäuser F, Weisskircher A, Fouladbakhsh JM, Heusser P: Inner correspondence and peacefulness with practices among participants in eurythmy therapy and yoga: a validation study. Evid Based Complement Alternat Med 2010;2011:e329023.
Walach H, Buchheld N, Buttenmüller V, Kleinknecht N, Schmidt S: Measuring mindfulness - the Freiburg Mindfulness Inventory (FMI). Pers Individ Dif 2006;40:1543-1555.
Buchheld N, Grossman P, Walach H: Measuring mindfulness in insight meditation (Vipassana) and meditation-based psychotherapy: the development of the Freiburg Mindfulness Inventory (FMI). J Medit Medit Res 2001;1:11-34.
Schwarzer R, Jerusalem M: Skalen zur Erfassung von Lehrer- und Schülermerkmalen. Dokumentation der psychometrischen Verfahren im Rahmen der wissenschaftlichen Begleitung des Modellversuchs Selbstwirksame Schulen. Berlin, Freie Universität Berlin, 1999.
Hinz A, Schumacher J, Albani C, Schmid G, Brähler E: Bevölkerungsrepräsentative Normierung der Skala zur Allgemeinen Selbstwirksamkeitserwartung. Diagnostica 2006;52:26-32.
Büssing A, Girke M, Heckmann C, Schad F, Ostermann T, Kröz M: Validation of the self regulation questionnaire as a measure of health in quality of life research. Eur J Med Res 2009;14:223.
Grossarth-Maticek R: Autonomietraining: Gesundheit und Problemlösung durch Anregung der Selbstregulation. Berlin, Walter de Gruyter, 2000.
Grossarth-Maticek R, Kiene H, Baumgartner SM, Ziegler R: Use of Iscador, an extract of European mistletoe (Viscum album), in cancer treatment: prospective nonrandomized and randomized matched-pair studies nested within a cohort study. Altern Ther Health Med 2001;7:57.
Kröz M, Büssing A, von Laue H, Reif M, Feder G, Schad F, et al: Reliability and validity of a new scale on internal coherence (ICS) of cancer patients. Health Qual Life Outcomes 2009;7:59.
National Research Council: The prevention and treatment of missing data in clinical trials. data-in-clinical-trials (last accessed April 30, 2015).
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