Attrition in Pediatric Yoga Research: 1 pose forward, 2 poses back?

1. Attrition in Pediatric Yoga Research: 1 pose forward, 2 poses back? Katherine S. Salamon, M.S.1, W. Hobart Davies, Ph.D.1, Steven J. Weisman, M.D.2 , & Keri R. Hainsworth, Ph.D.2 University of Wisconsin-Milwaukee1 and Children’s Hospital of Wisconsin/ Medical College of Wisconsin2 Introduction Measures Results • Complementary and Alternative Medicine (CAM) therapies have increased in popularity. An estimated 42% of the American population has utilized at least one form (Bazargan et al., 2008). • The benefits (e.g., decreased stress) of yoga for chronic pain in adult populations are well documented (Wren et al., 2011). • Research on the effectiveness of yoga in children and adolescents typically have small sample sizes or have other methodological limitations. Additionally, consent rates and attendance have been low. (Berger et al., 2009). • Although yoga has increased in popularity among many segments of the population, it remains unclear why participation in research on yoga continues to be problematic in pediatric populations. • Demographic information was collected at the time of consent, including age, gender, and ethnicity of the youth and education level of the parent/guardian. • Holistic Health Questionnaire(HHQ; Tsao et al., 2005): The HHQ asks respondents to indicate which (if any) CAM treatments they have sought out in the past and expectations regarding the pleasantness of yoga. Both the youth and the primary caregiver completed this measure. • Attrition data was collected throughout both interventions, including attendance and medical adherence for a subset (n=23). • Youth were categorized as completers (75%-100% attendance), partial completers (25%-74% attendance), and non-completers (less than 25% attendance). • The majority of youth that withdrew, did not attend any sessions (Figure 1). • Youth gender and ethnicity, parental education, and previous experience with yoga were not significantly associated with the attendance categories (Table 1). • Youth age, youth and parental expectations of yoga, and medical appointment adherence were not significantly related to the attendance categories (Table 2). • Distance to the yoga studio was related to attendance, such that completers tended to travel farther to the sessions. Table 1: Comparisons Among Attendance Categories (Chi-square) Conclusions • There has been a call to determine whether CAM interventions are efficacious for patients from diverse backgrounds (e.g., ethnicity, age, gender, and SES; Wren et al., 2011), • The results of this study suggest that attrition in pediatric yoga research may hinder these efforts. • Exploration of factors associated with attrition in pediatric research is critical to the advancement of this science. • The current study provides a foundation for future explorations of factors related to attrition and serves as a starting point to tailor recruitment methods and research designs in order to optimize participant attendance and retention. Hypothesis • Explore factors related to attrition in two different pediatric yoga research protocols. • Investigate variables associated with attrition in pediatric yoga. Methods • Data from two pediatric yoga protocols were combined. • Both protocols aimed to assess acceptability and feasibility of yoga for different pediatric populations (e.g., chronic headaches and pediatric obesity). • Youth were recruited from a neurology clinic and a weight management clinic at a large Midwestern children’s hospital. • Yoga: 8-weekly, 75 minute sessions (study 1) or 16-biweekly, 60 minute sessions over 8 weeks (study 2), involving the Iyengar style of yoga (focus on alignment of body and relaxation). • Instructor: Certified Yoga instructor with extensive teaching experience Iyengar yoga. Table 2: Comparisons Among Attendance Categories (ANOVA) Participant Demographics *p < . 10. **p < .05. ***p < .01. Figure 1: Attrition References • Bazargan, M., et al. (2008). Correlates of complementary and alternative medicine utilized in depressed, underserved African American and Hispanic patients in primary care settings. The Journal of Alternative and Complementary Medicine, 14, 537-544. • Berger, D. L., Silver, E. J., & Stein, R. E. K. (2009). Effects of yoga on inner-city • children's well-being: A pilot study. Alternative Therapies in Health and Medicine, 15, 36-42. • Wren, A.A., Wright, M.A., Carson, J.W., & Keefe, F.J. (2011). Yoga for persistent pain: New findings and directions for an ancient practice. Pain,152, 477–480.