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Recently completed research into the Alexander Technique and work in progress
As interest increases in designing and funding studies of complementary forms of intervention in health, STAT is pleased to record the most recent and current initiatives in universities in the United Kingdom and the USA. Contact details are provided for further correspondence with the researchers.

The texts are reprinted as they appeared in publications or were submitted by the researchers, and do not necessarily represent the views of STAT.

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

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
Expected finish date: 2005

SUMMARY OF PROTOCOL
The principal research questions to be addressed in this trial are:

1 What is the effectiveness for randomly selected NHS patients with chronic and recurrent back pain of:

  1. introductory (6 lessons) or longer (24 lessons) courses of AT
  2. massage therapy
  3. GP exercise prescription in a free setting with a nurse follow-up appointment
2 What is the cost-effectiveness of these interventions compared to normal GP care?

A secondary aim is to assess how much of any benefit gained from attending AT lessons and learning and applying the AT in daily life is due to taught and learnt skills rather than to the unavoidable placebo effects of skilled hand contact, individual attention and encouragement from the teacher.

An experimental group of 550 patients with recurrent and chronic back pain will take part in the trial. The trial will be conducted in several areas of the UK.

Contacts for correspondence: Dr Kathleen Ballard or Frances Oxford at STAT
Email: Please state for the attention of Kathleen Ballard (or Frances Oxford) in the Subject line.

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:

The effect of AT lessons in improving automatic and voluntary coordination of subjects with low back pain

Researchers: TW Cacciatore, K Ames, V Gurfinkel, P Cordo, FB Horak

A follow-up to the previous study is currently underway at the Neurological Sciences Institute in Portland, Oregon to further study changes in the coordination of people with low back pain after AT lessons. This study is following 10 subjects through 20 AT lessons as well as 20 massage sessions. All subjects are being tested longitudinally over 6 months to establish their baseline responses as well as those after each intervention (Alexander Technique and massage). Both automatic and voluntary aspects of coordination are being measured using support surface translations, voluntary trunk bends, as well as sit-to-stand. Subjects' coordination is being quantified by kinematics, surface forces, and muscle activity and in addition axial muscle tone is being measured.

Testing is expected to be completed by May 2003.

Contact for Correspondence: Tim Cacciatore (details above)

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