19 August 2008
Little et al.
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 backpain; 144 were randomised to normal care, 147 to massage, 144to 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, –2.77to –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.
