Effect of Integrated Yoga as an Adjuvant Therapy to Standard Care in Pulmonary Tuberculosis- A Randomized Control Trial

Abstract

Background: Pulmonary tuberculosis (PTB) is highly infectious, predominantly affects the lungs and its functions, and is often associated with psychological comorbidities, including depression and poor quality of life. Yoga therapy emerged as a holistic mind-body practice and has positively impacted physical and mental health outcomes. Objectives: The objective of the present study was to evaluate the impact of integrated Yoga on Pulmonary Function tests, Depression, and Health-Related Quality of Life (QOL) in patients with PTB. Methodology: It was a Randomized control trial study design. The study has screened 826 PTB patients. Seventy-two newly diagnosed PTB patients were selected based on inclusion and exclusion criteria from a tertiary care hospital. They were randomly assigned to the Yoga group (n = 36) and Control group (n = 36) using a sequentially, numbered, opaque, sealed, envelope (SNOSE) technique. The control group patients were treated with standard care (Anti-tuberculosis treatment (ATT)). The Yoga group patients were intervened with a validated Yoga module as an adjuvant to standard care. The Yoga module consisted of Yogic postures, Yogic breathing, and relaxation techniques, which lasted 45 minutes. Pulmonary Function tests were assessed using Spirometry, Health-Related Quality of Life was evaluated using the World Health Organisation Quality of Life BREF questionnaire (WHOQOL-BREF) and Depression was assessed using the Hamilton Depression Rating Scale (HDRS) for all the patients at baseline and post-intervention (after 8 weeks). Results: Data followed the normality, so data were analyzed using parametric tests between and within groups. Within-group analysis showed a significant improvement in pulmonary functions xvii scores FEV1, FVC, and % FEV1/FVC scores compared to baseline to 8th week, which were statistically significant with p < 0.0013, p < 0.001 and p < 0.001 effect size 0.29, 0.45 and 0.91. Reduction in depressive symptoms in both the Control (p < 0.001; ES = 1.59) and Yoga (p < 0.001; ES = 3.61) groups were observed. Similarly, within-group comparison of Health-Related QOL scores showed significant improvement i.e., physical (p is less than 0.001), psychological (p is less than 0.001), and social (p is less than 0.001) except environmental domain is not significant with p = 0.893. However, the effect size (ES) was higher in the Yoga group compared to the control. Between-group comparison at the baseline there is insignificant values of Pulmonary Function Tests (FEV1 < 0.9551, FVC < 0.9641 and %FEV1/FVC < 0.8969), Health-Related Quality of Life scores (Physical Domain<0.633, Psychological Domain<0.699, Social Domain<0.653 and Environmental Domain <0.656) and Depression scores (<0.34) and after 8 weeks of intervention there is a significant improvement. Yoga group exhibited a significant reduction in depressive symptoms (<0.001), enhanced Health-Related Quality of Life scores (Physical Domain<0.001, Psychological Domain<0.002, Social Domain<0.001 and except Environmental Domain <0.283) and Depression scores (<0.34) and improvement in Pulmonary Function Tests (FEV1 < 0.001, FVC < 0.001 and %FEV1/FVC < 0.01) values compared to the Control group for between-group analysis. Conclusion: The research evidence endorses the use of Yoga as an adjuvant treatment for patients undergoing the National Tuberculosis Elimination Program (NTEP) in patients with pulmonary tuberculosis (PTB) to enhance their Pulmonary Function values, quality of life (QoL) scores, and reduced depression symptoms. Yoga may be incorporated into NTEP to improve physical and mental health. The present study is single-centred with short-term intervention hence multi-centric studies with long-term, robust design interventions are warranted.