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Meta-Analysis
. 2015 Oct 21;2015(10):CD010554.
doi: 10.1002/14651858.CD010554.pub2.

Yoga versus standard care for schizophrenia

Julie Broderick  1 , Abigail Knowles, Jonathan Chadwick, Davy Vancampfort
Affiliations
Meta-Analysis

Yoga versus standard care for schizophrenia

Julie Broderick et al. Cochrane Database Syst Rev. .

Abstract

Background: Yoga is an ancient spiritual practice that originated in India and is currently accepted in the Western world as a form of relaxation and exercise. It has been of interest for people with schizophrenia to determine its efficacy as an adjunct to standard-care treatment.

Objectives: To examine the effects of yoga versus standard care for people with schizophrenia.

Search methods: We searched the Cochrane Schizophrenia Group Trials Register (November 2012 and January 29, 2015), which is based on regular searches of MEDLINE, PubMed, EMBASE, CINAHL, BIOSIS, AMED, PsycINFO, and registries of clinical trials. We searched the references of all included studies. There were no language, date, document type, or publication status limitations for inclusion of records in the register.

Selection criteria: All randomised controlled trials (RCTs) including people with schizophrenia comparing yoga to standard-care control.

Data collection and analysis: The review team independently selected studies, quality rated these, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed mixed-effect and fixed-effect models for analyses. We examined data for heterogeneity (I(2) technique), assessed risk of bias for included studies, and created 'Summary of findings' tables using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

Main results: We included eight studies in the review. All outcomes were short term (less than six months). There were clear differences in a number of outcomes in favour of the yoga group, although these were based on one study each, with the exception of leaving the study early. These included mental state (improvement in Positive and Negative Syndrome Scale, 1 RCT, n = 83, RR 0.70 CI 0.55 to 0.88, medium-quality evidence), social functioning (improvement in Social Occupational Functioning Scale, 1 RCT, n = 83, RR 0.88 CI 0.77 to 1, medium-quality evidence), quality of life (average change 36-Item Short Form Survey (SF-36) quality-of-life subscale, 1 RCT, n = 60, MD 15.50, 95% CI 4.27 to 26.73, low-quality evidence), and leaving the study early (8 RCTs, n = 457, RR 0.91 CI 0.6 to 1.37, medium-quality evidence). For the outcome of physical health, there was not a clear difference between groups (average change SF-36 physical-health subscale, 1 RCT, n = 60, MD 6.60, 95% CI -2.44 to 15.64, low-quality evidence). Only one study reported adverse effects, finding no incidence of adverse events in either treatment group. This review was subject to a considerable number of missing outcomes, which included global state, change in cognition, costs of care, effect on standard care, service intervention, disability, and activities of daily living.

Authors' conclusions: Even though we found some positive evidence in favour of yoga over standard-care control, this should be interpreted cautiously in view of outcomes largely based each on one study with limited sample sizes and short-term follow-up. Overall, many outcomes were not reported and evidence presented in this review is of low to moderate quality - -too weak to indicate that yoga is superior to standard-care control for the management of schizophrenia.

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Conflict of interest statement

Julie Broderick: No conflicts of interest are known at the time of writing the review. Abigail Knowles: No conflicts of interest are known at the time of writing the review. Jonathan Chadwick: No conflicts of interest are known at the time of writing the review. Davy Vancampfort: No conflicts of interest are known at the time of writing the review.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 1 Mental state: 1. Overall a. Not improved (total PANSS).
1.2
1.2. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 2 Mental state: 1. Overall b. Average change score (PANSS, low=good).
1.3
1.3. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 3 Mental state: 1. Overall c. Average endpoint score (PANSS, low=good).
1.4
1.4. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 4 Mental state: 2. Negative symptoms a. Not improved (PANSS).
1.5
1.5. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 5 Mental state: 2. Negative symptoms b. Average score at endpoint (PANSS, low=good).
1.6
1.6. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 6 Mental state: 2. Negative symptoms c. Average score at endpoint (SANS, low=good).
1.7
1.7. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 7 Mental state: 2. Negative symptoms d. Average change score (PANSS, greater decrease=good).
1.8
1.8. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 8 Mental state: 3. Positive symptoms a. Not improved (PANSS).
1.9
1.9. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 9 Mental state: 3. Positive symptoms b. Average score at endpoint (PANSS, low=good).
1.10
1.10. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 10 Mental state: 3. Positive symptoms c. Average score at endpoint (SAPS, low=good).
1.11
1.11. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 11 Mental state: 3. Positive symptoms d. Average change score (PANSS, greater decrease=good).
1.12
1.12. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 12 Mental state: 4. Depresssive symptoms: a. Average score (CDS, greater decrease=good).
1.13
1.13. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 13 Mental state: 5. Resilience a. Average score at end‐point (Resilience scale, high=good).
1.14
1.14. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 14 Social functioning: 1. Overall a. Not improved (total SOFS).
1.15
1.15. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 15 Social functioning: 1. Overall b. Average score at endpoint (SOFS, high score=good).
1.16
1.16. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 16 Social functioning 1. Overall c. Average score at endpoint (FACT‐Sz, high score=good).
1.17
1.17. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 17 Social functioning: 2. Emotional recognition ‐ average score (TRACS, high score=good).
1.18
1.18. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 18 Adverse events.
1.19
1.19. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 19 Quality of life: 1. Average change (WHOQOL‐BREF, greater increase=good).
1.20
1.20. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 20 Quality of life: 2. Average change (SF‐36, greater increase=good).
1.21
1.21. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 21 Quality of life: 3. Average end‐point index scale (EQ‐5D, high score=good).
1.22
1.22. Analysis
Comparison 1 YOGA versus STANDARD‐CARE CONTROL, Outcome 22 Leaving the study early: people lost to follow up ‐ short term (low=good).
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Update of

  • doi: 10.1002/14651858.CD010554

References

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