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Effect of Yoga on Sleep Quality among Adult Cancer Patients: A Systematic Review Protocol

Alexander, Gina PhD, MPH, MSN, RN; Lockwood, Suzy PhD, MSN, RN, OCN, CHPN

Author Information
JBI Database of Systematic Reviews and Implementation Reports: January 2013 - Volume 11 - Issue 1 - p 260-269
doi: 10.11124/jbisrir-2013-612
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Inclusion criteria

Types of participants

This review will consider studies that include adults over the age of 18 years diagnosed with cancer (regardless of the type of cancer, stage, or presence of co-morbidities) who are currently undergoing conventional treatment for cancer (regardless of treatment modality, intensity, delivery, frequency, or duration of treatment).

Types of intervention

This review will consider studies that evaluate the effects of yoga intervention (regardless of mode of delivery, timing, frequency, duration) on sleep quality among adult cancer patients over the age of 18 years who are concurrently undergoing conventional treatment for cancer.

The review will exclude studies using yoga as part of a multimodal intervention (including mindfulness-based stress reduction), rather than yoga as the main intervention.

For the purposes of this review, yoga intervention will include practices that incorporate the use of yoga skills (including but not limited to Hatha yoga, Iyengar yoga, and restorative yoga).

Types of outcomes

This review will consider studies that include the following outcome measures: sleep quality, measured by standardized, validated instruments, such as the Pittsburgh Sleep Quality Index and other measures.

Types of studies

The review will consider any randomized controlled trials (RCTs); in the absence of RCTs, other research designs, such as non-randomized controlled trials and before and after studies, will be considered for inclusion to enable the identification of current best evidence regarding yoga practice.

Search strategy

The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilised in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Studies published in English will be considered for inclusion in this review. All published studies will be considered for inclusion in this review.

The databases to be searched include:



Cochrane Library (CENTRAL)



The search for unpublished studies will include:

Dissertation Abstracts Online

ProQuest Dissertations and Theses

Initial keywords to be used will be:



sleep quality

Assessment of methodological quality

Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

Data collection

Data will be extracted from papers included in the review using the standardised data extraction tool from JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives.

Data synthesis

Quantitative papers will, where possible, be pooled in a statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Effect sizes expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed using the standard Chi-square. Where statistical pooling is not possible the findings will be presented in narrative form, including tables and figures to aid in data presentation where appropriate.

Conflicts of interest

No conflict of interest is anticipated.


None to declare.


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                                                                Appendix I: Appraisal instruments

                                                                MAStARI Appraisal instrument


                                                                Appendix II: Data extraction instruments

                                                                MAStARI data extraction instrument


                                                                Cancer; yoga; sleep quality

                                                                © 2013 by Lippincott williams & Wilkins, Inc.