title: Establishing key components of yoga interventions for musculoskeletal conditions: a Delphi survey.
abstract: BACKGROUND
  Evidence suggests yoga is a safe and effective intervention for the management of physical and psychosocial symptoms associated with musculoskeletal conditions. However, heterogeneity in the components and reporting of clinical yoga trials impedes both the generalization of study results and the replication of study protocols. The aim of this Delphi survey was to address these issues of heterogeneity, by developing a list of recommendations of key components for the design and reporting of yoga interventions for musculoskeletal conditions.
  
  
  METHODS
  Recognised experts involved in the design, conduct, and teaching of yoga for musculoskeletal conditions were identified from a systematic review, and invited to contribute to the Delphi survey. Forty-one of the 58 experts contacted, representing six countries, agreed to participate. A three-round Delphi was conducted via electronic surveys. Round 1 presented an open-ended question, allowing panellists to individually identify components they considered key to the design and reporting of yoga interventions for musculoskeletal conditions. Thematic analysis of Round 1 identified items for quantitative rating in Round 2; items not reaching consensus were forwarded to Round 3 for re-rating.
  
  
  RESULTS
  Thirty-six panellists (36/41; 88%) completed the three rounds of the Delphi survey. Panellists provided 348 comments to the Round 1 question. These comments were reduced to 49 items, grouped under five themes, for rating in subsequent rounds. A priori group consensus of ≥80% was reached on 28 items related to five themes concerning defining the yoga intervention, types of yoga practices to include in an intervention, delivery of the yoga protocol, domains of outcome measures, and reporting of yoga interventions for musculoskeletal conditions. Additionally, a priori consensus of ≥50% was reached on five items relating to minimum values for intervention parameters.
  
  
  CONCLUSIONS
  Expert consensus has provided a non-prescriptive reference list for the design and reporting of yoga interventions for musculoskeletal conditions. It is anticipated future research incorporating the Delphi guidelines will facilitate high quality international research in this field, increase homogeneity of intervention components and parameters, and enhance the comparison and reproducibility of research into the use of yoga for the management of musculoskeletal conditions.
authors.affiliation: Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand. lesley.ward@otago.ac.nz.
authors.forename: Lesley
authors.initials: L
authors.lastname: Ward
authors.forename: Simon
authors.initials: S
authors.lastname: Stebbings
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Sherman
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherkin
authors.forename: G David
authors.initials: GD
authors.lastname: Baxter
mesh_terms: D032921:Consensus; D003697:Delphi Technique; D005260:Female; D006801:Humans; D009140:Musculoskeletal Diseases / Q000628:therapy*; D015203:Reproducibility of Results; D015013:Yoga