Self-efficacy and self-care-related outcomes following Alexander Technique lessons for people with chronic neck pain in the ATLAS randomised, controlled trial

European Journal of Integrative Medicine 2017; doi: 10.1016/j.eujim.2017.11.006

Woodman J, Ballard K, Hewitt C, MacPherson H.


This study is part of the large clinical trial called ATLAS (Alexander Technique lessons or acupuncture sessions for people with chronic neck pain). It reports findings additional to those included in the clinical paper. The study shows that people were able to improve the way they lived their daily lives and managed their pain following one-to-one Alexander lessons. Learning the Alexander Technique led to increased self-efficacy* and ability for self-care, and these improvements were found to be linked with a long-term reduction in chronic neck pain and in associated disability.

*Self-efficacy is confidence in one’s ability to carry out behaviour required to produce a desired outcome. In this instance it means confidence in ability to engage in behaviour that leads to less neck pain.



Introduction: ATLAS was a pragmatic randomised (1:1:1 ratio), controlled trial recruiting patients with chronic neck pain (N=517) and evaluating one-to-one Alexander Technique lessons, or acupuncture, each plus usual care, compared with usual care alone. The primary outcome (12-month Northwick Park Neck Pain Questionnaire [NPQ]) demonstrated significant and clinically meaningful reductions in neck pain and associated disability for both interventions compared with usual care alone. Here we describe pre-specified, self-efficacy and other self-care-related outcomes for the Alexander group compared with usual care. 

Methods: Participants reported on 11 self-efficacy/self-care-related outcome measures at 6 and 12 months. Linear or logistic regression models evaluated changes in parameters and impact on NPQ. Alexander teachers reported on lesson content.

Results: Lesson content reflected standard UK practice. The Alexander group (n=172) reported significantly greater improvements, compared with usual care alone (n=172), in most of the self-efficacy/self-care measures (9/11 measures at 6 months, and 8/11 at 12 months), including the ability to reduce pain in daily life. At 6 months, 81% (106/131) of Alexander participants reported significant improvement in the way they lived and cared for themselves (versus 23% for usual care), increasing to 87% (117/135) at 12 months (usual care: 25%). NPQ scores at both 6 and 12 months were related to improvement in self-efficacy and ability to reduce pain during daily life.

Conclusions: Alexander Technique lessons led to long-term improvements in the way participants lived their daily lives and managed their neck pain. Alexander lessons promote self-efficacy and self-care, with consequent reductions in chronic neck pain. 

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More on the ATLAS trial here