Clin Rehabil. 2015 Mar 31. pii: 0269215515578699. [Epub ahead of print]
BRIEF SUMMARY AND COMMENTARY
A small, short-term trial conducted with people with chronic neck pain has shown that attending a few Alexander Technique lessons led to reductions in neck pain intensity but that the benefit was not significantly greater than that obtained from the use of heat pads. However, neck pain intensity reduction following Alexander lessons was significantly greater than that achieved through attending guided imagery sessions. Significant benefits of the Alexander lessons compared with either heat pads or guided imagery were also observed for quality of life (on the physical scale).
In considering these results it is important to bear in mind that participants attended only five Alexander lessons, a lower number than generally recommended, and which may have been insufficient to establish the necessary skills. Furthermore, follow-up was conducted at 5 weeks which may have been too short a time period to allow substantial change to occur. In addition, the study was relatively small involving only 72 participants in total.
Results are awaited for the ATLAS trial of Alexander lessons or acupuncture, both compared with usual GP care, for people with chronic neck pain. ATLAS involved more than 500 participants and those who were randomised to the Alexander Technique arm were offered 20 lessons, with outcomes assessed over the long term (12 months). The selection of 20 lessons for ATLAS was informed by the findings for the main groups in the ATEAM back pain trial which showed that six Alexander lessons were only 41% as effective as 24 lessons in reducing back-pain associated disability (12-month Roland Morris score) and 56% as effective in reducing days in pain (Little et al. BMJ 2008).
OBJECTIVE: To test the efficacy of the Alexander Technique, local heat and guided imagery on pain and quality of life in patients with chronic non-specific neck pain.
DESIGN: A randomized controlled trial with 3 parallel groups was conducted.
SETTING: Outpatient clinic, Department of Internal and Integrative Medicine.
SUBJECTS: A total of 72 patients (65 females, 40.7±7.9 years) with chronic non-specific neck pain.
INTERVENTIONS: Patients received 5 sessions of the Alexander Technique - an educational method which aims to modify dysfunctional posture, movement and thinking patterns associated with musculoskeletal disorders. Control groups were treated with local heat application or guided imagery. All interventions were conducted once a week for 45 minutes each.
MAIN MEASURES: The primary outcome measure at week 5 was neck pain intensity on a 100-mm visual analogue scale; secondary outcomes included neck disability, quality of life, satisfaction and safety.
STATISTICS: Analyses of covariance were applied; testing ordered hypotheses.
RESULTS: No group difference was found for pain intensity for the Alexander Technique compared to local heat (difference 4.5mm; 95%CI:-8.1;17.1;p=0.48), but exploratory analysis revealed the superiority of the Alexander Technique over guided imagery (difference -12.9mm; 95%CI:-22.6;-3.1,p=0.01). Significant group differences in favour of the Alexander Technique were also found for physical quality of life (P
CONCLUSION: The Alexander Technique was not superior to local heat application in treating chronic non-specific neck pain. It cannot be recommended as routine intervention at this time. Further trials are warranted for conclusive judgment.