RESULTS
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The age, stages of disease, grade and node status were similar in the yoga and supportive therapy (control) groups. The Chi square test on all sociodemographic and medical characteristics of study sample did not show any significant differences in the proportions across groups [Table 1]. The mean years of education of the study sample was 12.49 ± 2.67 years with a minimum of seven years and a maximum of 17 years of education. The mean overall age of the subjects was 49.2 – 9.6 years in both groups.
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Effects of group on postoperative outcomes
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Independent samples t test was done to assess the effects of groups on postoperative outcomes. There was a decrease in the number of days of drain retention (95% confidence interval, CI (0.74 to 2.8)) following surgery. There was a rapid healing of the surgery wound as evidenced by shorter intervals for suture removal (95% CI (0.23 to 4.6)) and a decrease in the duration of hospital stay (95% CI (0.44 to 2.1)) following surgery in the yoga group as compared to controls [Table 2].
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Effects of groups on postoperative outcomes in subjects undergoing only mastectomy:
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Independent samples t test was done to assess the effects of groups on postoperative outcomes. There was a decrease in the number of days of drain retention (95% CI (0.8 to 3.1)) following surgery. There was a rapid healing of the surgery wound as evidenced by shorter intervals for suture removal (95% CI (0.23 to 5.5)) and a decrease in the duration of hospital stay (95% CI (0.32 to 2.2)) following mastectomy in the yoga group as compared to controls [Table 3].
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Effects of type of surgery on postoperative outcomes
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As subjects in both groups received either breast conservation surgery or mastectomy, we evaluated the effects of these two surgical procedures on postoperative outcomes. Independent samples t test done to assess the effects of type of surgery on postoperative outcomes showed significant decreases in the interval for suture removal (95% CI (0.78 to 5.4)) and the duration of hospital stay (95% CI (0.09 to 1.9)) in subjects who underwent breast conservation surgery as compared to mastectomy [Table 4].
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Postsurgery complications
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Postsurgery complications were assessed in both the groups based on consultants notes (blind to intervention) during the postoperative follow-up period. The presence or absence of such complications following surgery in each subject was noted as a category variable. Although there was a decrease in the number of postoperative complications in the yoga group, the independent samples nonparametric Chi square test did not show any significant difference in the proportion of presence/ absence of postoperative complications across the groups. There was also no significant difference in the postoperative complications between breast conservation vs mastectomy [Table 5].
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Cytokines
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There was no significant change in soluble IL-2r alpha and IFN-gamma levels following surgery between the groups (results not shown). Wicoxon Signed rank test
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showed a significant increase in the TNF-alpha levels following surgery in the control group alone (P = 0.049). There was a significant decrease in TNF-alpha following surgery in the yoga group (P < 0.001) as compared to the controls in the Mann Whitney U test indicative of better wound healing in the yoga group at four weeks following surgery [Table 6].
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Regression on postoperative outcomes
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A multiple hierarchical regression analysis was done to examine the variance in dependent variables (postoperative outcomes) explained by independent variables such as age in years, type of surgery, size of tumor, postoperative surgery complications (presence or absence), presurgery TNF-alpha levels (for postsurgery TNF-alpha as a dependent variable only) and intervention. Number of days of drain retention was explained by the combined effects of yoga intervention (95% CI (0.32 to 2.4)), presence of surgery complications (95% CI (0.001 to 2.93)) that was responsible for 27.4% of the variance in the model. The interval for suture removal was explained by the combined effects of surgery complications (95% CI (2.8 to 8.6)) and the type of surgery (95% CI (0.37 to 5.6)) that accounted for 33.8% of the variance in the model. Duration of hospital stay was explained by intervention alone (95% CI (0.21 to 1.9)) and accounted for 21.1% of the variance in the model. None of the predictors explained variance in the postoperative duration. Lastly, postsurgery TNF-alpha levels were explained by the combined effect of presurgery TNF-alpha levels (95% CI (0.63 to 0.72)), intervention (95% CI (9.7 to 20.4)), age (95% CI (0.14 to 0.74)) and the type of surgery (95% CI (0.46 to 13.5)) that predicted 94.2% variance in the model [Table 7].
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