Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain

doi:10.1136/bmj.a884

Published 19 August 2008, doi:10.1136/bmj.a884
Cite this as: BMJ 2008;337:a884

Research

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain

Paul Little, professor of primary care research¹, George Lewith, reader¹, Fran Webley, overall trial coordinator and trial manager for Southampton site¹, Maggie Evans, trial manager for Bristol site⁴, Angela Beattie, trial manager for Bristol site⁴, Karen Middleton, trial data manager¹, Jane Barnett, research nurse¹, Kathleen Ballard, teacher of the Alexander technique⁵, Frances Oxford, teacher of the Alexander technique⁵, Peter Smith, professor of statistics³, Lucy Yardley, professor of health psychology², Sandra Hollinghurst, health economist⁴, Debbie Sharp, professor of primary care⁴

¹ Primary Care Group, Community Clinical Sciences Division, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, ² School of Psychology, University of Southampton, ³ Department of Social Statistics, University of Southampton, ⁴ Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, ⁵ Society of Teachers of the Alexander Technique, London

Correspondence to: P Little psl3{at}soton.ac.uk

Objective To determine the effectiveness of lessons in the Alexandertechnique, massage therapy, and advice from a doctor to takeexercise (exercise prescription) along with nurse deliveredbehavioural counselling for patients with chronic or recurrentback pain.

Design Factorial randomised trial.

Setting 64 general practices in England.

Participants 579 patients with chronic or recurrent low backpain; 144 were randomised to normal care, 147 to massage, 144to six Alexander technique lessons, and 144 to 24 Alexandertechnique lessons; half of each of these groups were randomisedto exercise prescription.

Interventions Normal care (control), six sessions of massage,six or 24 lessons on the Alexander technique, and prescriptionfor exercise from a doctor with nurse delivered behaviouralcounselling.

Main outcome measures Roland Morris disability score (numberof activities impaired by pain) and number of days in pain.

Results Exercise and lessons in the Alexander technique, butnot massage, remained effective at one year (compared with controlRoland disability score 8.1: massage –0.58, 95% confidenceinterval –1.94 to 0.77, six lessons –1.40, –2.77to –0.03, 24 lessons –3.4, –4.76 to –2.03,and exercise –1.29, –2.25 to –0.34). Exerciseafter six lessons achieved 72% of the effect of 24 lessons alone(Roland disability score –2.98 and –4.14, respectively).Number of days with back pain in the past four weeks was lowerafter lessons (compared with control median 21 days: 24 lessons–18, six lessons –10, massage –7) and qualityof life improved significantly. No significant harms were reported.

Conclusions One to one lessons in the Alexander technique fromregistered teachers have long term benefits for patients withchronic back pain. Six lessons followed by exercise prescriptionwere nearly as effective as 24 lessons.

Trial registration National Research Register N0028108728.

Click on image to view video

How does the Alexander Technique work? What are the authors findings about the clinical and cost effectiveness of the treatment? Watch this video to find out (12 mins).

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

A trial subject’s perspective: Peter Lewis
BMJ 2009 338: b1059. [Extract] [Full Text]

Innovations in publishing BMJ research: Trish Groves and Fiona Godlee
BMJ 2008 337: a3123. [Extract] [Full Text]

Acupuncture in mainstream health care: David Wonderling
BMJ 2006 333: 611-612. [Extract] [Full Text] [PDF]

Treatment of low back pain by acupressure and physical therapy: randomised controlled trial: Lisa Li-Chen Hsieh, Chung-Hung Kuo, Liang Huei Lee, Amy Ming-Fang Yen, Kuo-Liong Chien, and Tony Hsiu-Hsi Chen
BMJ 2006 332: 696-700. [Abstract] [Full Text] [PDF]

Quality at general practice consultations: cross sectional survey: John G R Howie, David J Heaney, Margaret Maxwell, Jeremy J Walker, George K Freeman, and Harbinder Rai
BMJ 1999 319: 738-743. [Abstract] [Full Text] [PDF]

Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences: Jennifer Klaber Moffett, David Torgerson, Sally Bell-Syer, David Jackson, Hugh Llewlyn-Phillips, Amanda Farrin, and Julie Barber
BMJ 1999 319: 279-283. [Abstract] [Full Text] [PDF]

Open randomised trial of prescribing strategies in managing sore throat: P Little, I Williamson, G Warner, C Gould, M Gantley, and A L Kinmonth
BMJ 1997 314: 722. [Abstract] [Full Text]

This article has been cited by other articles:

Lewis, P. (2009). A trial subject's perspective. BMJ 338: b1059-b1059 [Full text]
Groves, T., Godlee, F. (2008). Innovations in publishing BMJ research. BMJ 337: a3123-a3123 [Full text]
Hollinghurst, S., Sharp, D., Ballard, K., Barnett, J., Beattie, A., Evans, M., Lewith, G., Middleton, K., Oxford, F., Webley, F., Little, P. (2008). Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation. BMJ 337: a2656-a2656 [Abstract] [Full text]
Fischer, J. M (2008). BMA members requested study of Alexander technique in 1937. BMJ 337: a1502-a1502 [Full text]
van Tulder, M. (2008). Conservative non-pharmacological treatment for chronic low back pain. BMJ 337: a974-a974 [Full text]

Rapid Responses:

Read all Rapid Responses

Interpreting clinically meaningful change versus statistical significance: Steven M McPhail, et al.
bmj.com, 21 Aug 2008 [Full text]
Evidence on the effect of Alexander Technique: RJ Nash
bmj.com, 22 Aug 2008 [Full text]
Treatment for low back pain--who does best?: Brian J Sweetman
bmj.com, 22 Aug 2008 [Full text]
Are Scientific Standards Being Maintained by the BMJ & MRC?: Tim Germon
bmj.com, 24 Aug 2008 [Full text]
No-one ever mentions mattesses!: Lesley A M Evans
bmj.com, 24 Aug 2008 [Full text]
Sub-grouping, an important issue to be considered: Gydhia Zuhair AL-CHALABY
bmj.com, 25 Aug 2008 [Full text]
"Are scientific standards being maintained...": Dyfan A Lewis
bmj.com, 26 Aug 2008 [Full text]
Are Scientific Standards Being Maintained by the BMJ & MRC?: Giles T Smith
bmj.com, 27 Aug 2008 [Full text]
Decompress the spine: Roderic S MacDonald
bmj.com, 27 Aug 2008 [Full text]
BMA members requested investigation of the Alexander Technique in 1937: Jean M. Fischer
bmj.com, 28 Aug 2008 [Full text]
Re: Are Scientific Standards Being Maintained by the BMJ & MRC?: Timothy W Cacciatore
bmj.com, 28 Aug 2008 [Full text]
Comparison of group means: Jennifer E. Bolton
bmj.com, 29 Aug 2008 [Full text]
difference in approach: Dirk Verelst
bmj.com, 16 Sep 2008 [Full text]
Prejudice against alternative therapies: Shamil Haroon
bmj.com, 19 Dec 2008 [Full text]
A trial subject's perspective: Peter Lewis
bmj.com, 2 Mar 2009 [Full text]