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Taking charge, choosing a new direction:
A Service Evaluation of Alexander Technique Lessons for Pain Clinic Patients (SEAT):
An Approach to Pain Management

Stuart McClean and Lesley Wye
June 2012

University of the West of England (UWE), Bristol
Faculty of Health and Life Sciences, Department of Health and Applied Social Sciences

The paper is available to read as a pdf by clicking here
It is also available from the UWE online research repository: http://eprints.uwe.ac.uk/16903/

SUMMARY

Introduction
A high quality clinical trial carried out in an experimental setting has demonstrated the therapeutic value and effectiveness of Alexander Technique (AT) lessons for chronic back pain, but little is known about the use of AT in NHS outpatient pain clinics.

Aims and study design
The aim of this exploratory mixed methods service evaluation was to explore the role, acceptability and impact of an Alexander Technique teaching service at a hospital outpatient NHS Pain Clinic, including service users? (n=43) experiences of the service and the perceived benefits to the NHS. To capture changes in health, wellbeing, quality of life status and resource use amongst service users, we administered four validated, widely used questionnaires at three time points: baseline, 6 weeks and three months after baseline. We also carried out 27 semi-structured qualitative telephone interviews with service users, three months from baseline. The views and experiences of Pain Clinic staff and Alexander Teachers were explored in a series of face-to-face interviews.

Findings
The findings suggest that the AT teaching service is feasible, acceptable, and beneficial (in terms of improving service users? quality of life and improving patients? management of pain). Greatest changes were found in how service users managed their pain, for example more than half stopped or reduced their medication, and the impact that the pain had on their daily life. This also led to some behaviour change and changes in awareness and self-knowledge from the service users. These attitudinal and behavioural changes may explain the finding that users of the AT teaching service appeared to reduce their pain related NHS costs by half.

Conclusions
Over time participants' relationship to their pain may change as a result of Alexander Technique lessons, which may lead to reductions in medication use and other NHS pain related costs.

Recommendations
Alexander Technique lessons can be seen as a useful adjunct to other pain management services provided in secondary Pain Clinics.

Randomized controlled trial of the Alexander Technique for idiopathic Parkinson's disease

Journal: Clinical Rehabilitation (2002) 16 705-718

Authors: C Stallibrass, School of Integrated Medicine, University of Westminster;
P Sissons, Peta Sissons Consultancy;
C Chalmers, Department of Statistics, London School of Economics
Received 20th April 2002; returned for revisions 18th June 2002; revised manuscript accepted 3rd July 2002.

Abstract:
OBJECTIVE
To determine whether the Alexander Technique, alongside normal treatment, is of benefit to people suffering disability from idiopathic Parkinson's disease. Design: A randomized controlled trial with three groups, one receiving lessons in the Alexander Technique, another receiving massage and one with no additional treatment. Measures were taken pre- and post-intervention, and at follow-up, six months later.

SETTING
The Polyclinic at the University of Westminster, Central London.

SUBJECTS
Ninety-three subjects with clinically confirmed idiopathic Parkinson's disease.

INTERVENTIONS
The Alexander Technique group received 24 lessons in the Alexander Technique and the massage group received 24 sessions of massage. Main outcome measures: The main outcome measures were the Self-assessment Parkinson's Disease Disability Scale (SPDDS) at best and at worst times of day. Secondary measures included the Beck Depression Inventory and an Attitudes to Self Scale.

RESULTS
The Alexander Technique group improved compared with the no additional treatment group, pre-intervention to post-intervention, both on the SPDDS at best, p = 0.04 (confidence interval (CI) -6.4 to 0.0) and on the SPDDS at worst, p = 0.01 (CI -11.5 to -1.8). The comparative improvement was maintained at six-month follow-up: on the SPDDS at best, p = 0.04 (CI -7.7 to 0.0) and on the SPDDS at worst, p = 0.01 (CI -11.8 to -0.9). The Alexander Technique group were comparatively less depressed post-intervention, p = 0.03 (CI -3.8 to 0.0) on the Beck Depression Inventory, and at six-month follow-up had improved on the Attitudes to Self Scale, p = 0.04 (CI -13.9 to 0.0).

CONCLUSIONS
There is evidence that lessons in the Alexander Technique are likely to lead to sustained benefit for people with Parkinson's disease.

© Arnold 2002 10.1191/0269215502cr544oa. Reproduced by permission of the publisher.
Contact for Correspondence: Chloe Stallibrass, Flat 18, Manor Mansions, Belsize Grove, London NW3 4NB, UK.
Email:

To download the full paper visit website of principal researcher www.londonalexander.co.uk

A further paper (Retention of skills learnt in Alexander technique lessons: 28 people with idiopathic Parkinson's disease C Stallibrass, C Frank, K Wentworth)
recording additional results from the original research:
Journal of Bodywork and Movement Therapies (2005) 9 150-157
can be downloaded from: www.londonalexander.co.uk/Retentionofskills2004.pdf

A randomised factorial trial for patients with recurrent and chronic back pain of GP exercise prescription, the Alexander Technique and massage (ATEAM trial)

More information on this research can be found by clicking here

RESEARCHERS
Principal investigators: Professor Paul Little (MRC Clinical Scientist, Southampton University), Professor Debbie Sharp (Professor of Primary Care at Bristol University and senior MRC HSRC researcher)

Alexander Technique experts: Dr Kathleen Ballard and Frances Oxford

Other members of the trial management team: Maggie Evans, Dr George Lewith, Dr Peter Smith, Dr Jackie Brown, Prof Lucy Yardley, Fran Webley

INSTITUTION
University of Southampton and University of Bristol

FUNDING
Medical Research Council and NHS Support for Science

DATES
Start date: November 2001
Published: August 2008

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 was randomised to exercise prescription.

Interventions: Normal care (control), six sessions of massage, six or 24 lessons in 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;-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 were 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 (nrr.nhs.uk).

Improvement in automatic postural coordination following Alexander Technique lessons in a person with low back pain.

Journal: Physical Therapy (2005) 85 565-578

Authors: TW Cacciatore, FB Horak, SM Henry
Neurological Sciences Institute, Oregon Health and Sciences University, Portland, OR, USA

Background and purpose: The relationship between abnormal postural coordination and back pain is unclear. The Alexander Technique aims to improve postural coordination by using conscious processes to alter automatic postural coordination and ongoing muscular activity, and it has been reported to reduce low back pain. This case report describes the use of the AT with a client with low back pain and the observed changes in automatic postural responses and back pain.

Case description: The client was a 49-year-old woman with a 25-year history of left-sided, idiopathic, lumbrosacral back pain. Automatic postural coordination was measured using a force plate during horizontal platform translations and one-legged standing.

Outcomes: The client was tested monthly for 4 months before AT lessons and for 3 months after lessons. Before lessons, she consistently had laterally asymmetric automatic postural responses to translations. After AT lessons the magnitude and asymmetry of her responses and balance improved and her low back pain decreased.

Discussion: Further research is warranted to study whether AT lessons improve low back pain-associated abnormalities in automatic postural coordination and whether improving automatic postural coordination helps to reduce low back pain.

Contact for Correspondence:

Preliminary evidence that neuromuscular education reduces low back pain and improves coordination of automatic postural adjustments

Poster Presentation at Control of Posture and Gait conference, June 2001.

Rearchers: Timothy W. Cacciatore, Sharon M. Henry, Fay B. Horak

Institutions: Neurological Sciences Institute, Oregon Health Sciences University, University of Vermont

Abstract:
INTRODUCTION
Abnormal motor coordination is associated with low back pain (Rudy et al., 1995; Hodges & Richardson, 1996).

It has been hypothesized that:
1 back pain is associated with underlying motor control deficits and
2 these deficits cause and perpetuate the pain.

Alternatively, abnormal motor coordination could result from the pain itself, for example, in splinting to avoid pain. In this pilot study, we characterized the motor coordination of a single subject with unilateral left back pain before and after lessons in the Alexander Technique, a form of proprioceptive neuromuscular education reported to reduce back pain as well as thoracic stiffness (Austin and Ausubel, 1992) and to increase balance (Dennis, 1999).

We used two different tasks to characterize coordination: support surface translations and one-legged balance.

Testing over several months prior to lessons revealed consistent abnormalities (large lateral asymmetries) in standing spinal curvature, automatic postural responses and balance. After lessons, these abnormalities were largely absent, balance improved and the subject¹s pain was greatly reduced. These improvements suggest that, in some cases, back pain can be caused or perpetuated by poor motor control, and that methods in proprioceptive awareness and education, like the Alexander Technique, can be effective in improving motor control and reducing back pain.

Abstract reprinted with Permission from the authors.

Contact for Correspondence: Tim Cacciatore PhD Neurological Sciences Institute Oregon Health Sciences University 505 NW 185th Avenue Beaverton, OR 97006

Phone: +1 503 418 2603 Fax: +1 503 418 2501 Email:

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