Evaluation of a specialized yoga program for persons with a spinal cord injury: a pilot randomized controlled trial

Figures & data

Figure 1 Flow of participants through the study

Table 1 Demographics of the sample (n=22) by group

Demographic information	Yoga group (n=10), mean (SD)	Control (n=12), mean (SD)
Age (years)	47.9 (19.51)	54.75 (10.11)
Height (cm)	165.33 (6.83)	167.43 (15.13)
Weight (kg)	66.18 (10.42)	78.43 (16.89)
	n (%)	n (%)
Injury origin
Traumatic	7 (70)	8 (66.7)
Non-traumatic	3 (30)	4 (33.3)
Completeness
Complete	2 (20)	5 (41.7)
Incomplete/disease-related	8 (80)	7 (58.3)
Level of injury
Paraplegia	6 (60)	4 (33.3)
Tetraplegia	0	4 (33.3)
Ambulatory/unspecified	4 (40)	4 (33.3)
Mobility device
Wheelchair	7 (70)	7 (58.3)
Walker	1 (10)	2 (16.7)
Cane/poles	2 (20)	3 (25)
Race/ethnicity*
African-Canadian	1 (10)	0
South Asian	4 (40)	0
East Asian	1 (10)	1 (8.3)
Caucasian	3 (30)	10 (83.3)
Hispanic	1 (10)	0
Other	0	1 (8.3)
Annual income (CA$)
<25,000	6 (66.7)	4 (36.4)
25,000–39,000	1 (11.1)	2 (18.2)
40,000–59,000	1 (11.1)	1 (9.1)
60,000–100,000	1 (11.1)	2 (18.2)
>100,000	0	2 (18.2)
Level of education
High school	2 (20)	2 (16.7)
University/college	8 (80)	9 (75)
Postgraduate school	0	1 (8.3)

Note:

* P<0.05 (Fisher’s exact test).

Abbreviation: SD, standard deviation.

Figure 2 Temporal sequence of the yoga interventions and data collection for both groups Iyengar yoga group

Table 2 Yoga philosophy concepts by class

Class	Concept	Explanation
1	Witness consciousness and ahimsā (nonviolence); Sūtra 2.35	Practicing “being with” challenging experiences without pushing them away or clinging to personal narratives. Practicing in a way that is safe and supportive. Doing without over- or underdoing. Using the right amount of effort for growth.
2	Abhyāsa (repeated practice); Sūtra 1.12	The important of repeating practice to yield benefits in the mind and body.
3	Satya (truthfulness); Sūtra 2.36	Honestly examining one’s experience to better understand one’s “starting point” and using yoga practice as a springboard for positive change.
4	Concept review: ahimsā, abhyāsa, satya; Sūtras 1.12, 2.35, 2.36	Review and integration of preliminary concepts and emphasis of self as a friend and the use of compassion in practice.
5	Breath awareness to balance the nervous system and calm the mind; Sūtra 1.34	Pain management through relaxation, training the attention to see tension patterns in the body, using imagery and visualization.
6	Sthira sukham āsanam; Sūtra 2.46	Finding a balance between steadiness/stability/effort with ease/joy/relaxation. Link to teaching on ahimsā and dosing of effort in activity and rest.
7	Ekā gra (one pointed concentration); Sūtra 1.32	Training attention and concentration by returning to a point of focus repeatedly, with a calming effect on the mind.
8	Meditation for relaxation, contemplation on the heart; Sūtra 1.36	The heart as a resource, refuge, and source of inner luminosity.
9	Review of Ekā gra and breath as nourishment; Sūtras 1.32, 1.34	Tying together concepts from previous classes regarding one pointed focus and the breath as calming and revitalizing. Training attention to return to the breath repeatedly, as a way to regulate the body–mind.
10	Aparigraha and santoṣa; Sūtras 2.39, 2.42	Effort to make positive change in the body can be helpful to move toward health, but care is needed to prevent agitation in striving/grasping. Importance of cultivating contentment (santoṣa) with current abilities/body.
11	Śodhana, śoṣana, śobhāna, śamana; Iyengar’s teaching on the four elements of practice	Śodhana, purification through active āsana to lift heavy states of body–mind; śoṣana, integration of practice, doing one’s best, which changes over time; śobhāna, excellence and auspiciousness, good intention to do practice with care and good effort, śamana, practice as a vehicle for relaxation and calmness; one should feel better after practicing.
12	Śodhana, śoṣana, śobhāna, śamana; Iyengar’s teaching on the four elements of practice and taking the practice to life	Repetition of previous class content and explaining how to work with these elements of practice individually, should participants want to keep practicing after the program is completed.

Table 3 Variance across intercepts and change in −2LL for the combined groups

Measure	Var(U0j)	Δ–2LL, χ^2
AAQ-II	72.16*	10.67*
HADS-A	24.76*	28.26*
HADS-D	6.7*	7.72*
GSES	10.25*	12.1*
PTGI-SF	127.98*	26.78*
CD-RISC-10	28.21*	8.12*
SCS-SF	0.36*	10.26*
FFMQ-SF – total	84.68*	9.57*
FFMQ-SF – describing	16.93*	14.59*
FFMQ-SF – observing	1.9	0.93
FFMQ-SF – acting with awareness	4.4	1.95
FFMQ-SF – nonreactivity	9.87*	10.25*
FFMQ-SF – nonjudging	14.65*	12.57*
BPI-SF – worst pain	4.79*	8.15*
BPI-SF – least pain	4.52*	23.32*
BPI-SF – average pain	3.67*	16.48*
BPI-SF – pain right now	6.42*	17.15*
BPI-SF – pain interference	316.4*	12.42*
PCS – total	146.02*	9.88*
PCS – magnification	6.32	3.58
PCS – helplessness	33.88*	12.79*
PCS – rumination	17.62*	13.32*

Note:

* P<0.05.

Abbreviations: AAQ-II, Acceptance and Action Questionnaire; HADS-A, Hospital Anxiety and Depression Scale – anxiety; HADS-D, HADS – depression; GSES, General Self-Efficacy Scale; PTGI-SF, Posttraumatic Growth Inventory – short form; CD-RISC-10, ten-item Connor–Davidson Resilience Scale; SCS-SF, Self Compassion Scale – short form; FFMQ-SF, Five Facet Mindfulness Questionnaire – short form; BPI-SF, Brief Pain Inventory – short form; PCS, Pain Catastrophizing Scale.

Table 4 Results from the mixed-model analysis (n=22)

Measure	F	t	df	b
HADS-D	6.62*	−2.57*	1, 14.83	−1.37
SCS-SF	4.49*	2.12*	1, 16.6	0.27
FFMQ-SF – total	5.42*	2.33*	1, 16.79	4.87
FFMQ-SF – observing	5.06*	2.25*	1, 19.82	1.88
FFMQ-SF – nonreactivity	4.92*	2.22*	1, 16.53	1.5

Note:

* P<0.05

Abbreviations: HADS-D, Hospital Anxiety and Depression Scale – depression; SCS-SF, Self-Compassion Scale – short form; FFMQ-SF, Five Facet Mindfulness Questionnaire – short form.

Table 5 Mean (SD) values for psychological, mindfulness, and pain variables pre- (n=22) and postintervention (n=17) for all participants

Measure	Preintervention	Postintervention	P-value
AAQ-II	17.59 (10)	14.24 (6.09)	0.226
HADS-A	6.64 (5.35)	5.53 (3.37)	0.795
HADS-D	4.95 (3.18)	3.06 (2.36)	0.021*
GSES	34.09 (3.64)	34.88 (3.48)	0.551
PTGI-SF	31.45 (12.62)	33.76 (12.15)	0.462
CD-RISC-10	30.73 (6.74)	32.59 (5.59)	0.568
SCS-SF	3.36 (0.73)	3.71 (0.66)	0.049*
FFMQ-SF – total	82.27 (11.43)	88.41 (10.43)	0.033*
FFMQ-SF – describing	17.82 (4.81)	19.24 (3.95)	0.551
FFMQ-SF – observing	14.68 (3.29)	16.47 (2.29)	0.036*
FFMQ-SF – acting with awareness	17.82 (3.79)	18.65 (3.6)	0.497
FFMQ-SF – nonreactivity	15.5 (3.91)	17.35 (3.33)	0.041*
FFMQ-SF – nonjudging	16.45 (4.66)	16.71 (3.53)	0.784
BPI-SF – worst pain	5.79 (2.37)	6.14 (2.77)	0.845
BPI-SF – least pain	2.79 (2.37)	3.07 (2.13)	0.528
BPI-SF – average pain	5.11 (2.13)	5.14 (2.03)	0.196
BPI-SF – pain right now	3.89 (2.85)	3.79 (2.39)	0.107
BPI-SF – pain interference	30.42 (20.54)	28.86 (17.06)	0.275
PCS – total	18.95 (14.97)	14.64 (8.89)	0.328
PCS – magnification	3.36 (3.62)	2.79 (2.61)	0.522
PCS – helplessness	9 (6.85)	6.57 (4.47)	0.191
PCS – rumination	6.32 (5.04)	5.29 (3.36)	0.461

Notes:

* P<0.05. For pain variables (BPI-SF and PCS), only participants with pain were included in the analysis (preintervention, n=19; postintervention, n=14).

Abbreviations: AAQ-II, Acceptance and Action Questionnaire; HADS-A: Hospital Anxiety and Depression Scale – anxiety; HADS-D, HADS – depression; GSES, General Self-Efficacy Scale; PTGI-SF, Posttraumatic Growth Inventory – short form; CD-RISC-10, ten-item Connor–Davidson Resilience Scale; SCS-SF, Self Compassion Scale – short form; FFMQ-SF, Five Facet Mindfulness Questionnaire – short form; BPI-SF, Brief Pain Inventory – short form; PCS, Pain Catastrophizing Scale.