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

• Paul Little, professor of primary care research,
• George Lewith, reader,
• Fran Webley, overall trial coordinator and trial manager for Southampton site,
• Maggie Evans, trial manager for Bristol site,
• Angela Beattie, trial manager for Bristol site,
• Karen Middleton, trial data manager,
• Jane Barnett, research nurse,
• Kathleen Ballard, teacher of the Alexander technique,
• Frances Oxford, teacher of the Alexander technique,
• Peter Smith, professor of statistics,
• Lucy Yardley, professor of health psychology,
• Sandra Hollinghurst, health economist,
• Debbie Sharp, professor of primary care

Abstract

Objective

To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain.

Design

Factorial randomised trial.

Setting

64 general practices in England.

Participants

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

Interventions

Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling.

Main

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

Results

Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage −0.58, 95% confidence interval −1.94 to 0.77, six lessons −1.40, −2.77 to −0.03, 24 lessons −3.4, −4.76 to −2.03, and exercise −1.29, −2.25 to −0.34). Exercise after 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 lower after lessons (compared with control median 21 days: 24 lessons −18, six lessons −10, massage −7) and quality of life improved significantly. No significant harms were reported.

Conclusions

One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.

Trial registration

National Research Register N0028108728.

The above is the abstract from the full study which may be viewed by visiting:
http://www.bmj.com/content/337/bmj.a884.full