1
|
Gilanyi YL, Shah B, Cashin AG, Gibbs MT, Bellamy J, Day R, McAuley JH, Jones MD. Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence. Pain 2024:00006396-990000000-00578. [PMID: 38635470 DOI: 10.1097/j.pain.0000000000003234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/25/2024] [Indexed: 04/20/2024]
Abstract
ABSTRACT Exercise is a first-line treatment for chronic low back pain (CLBP), reducing pain and disability in the short term. However, exercise benefits decrease over time, with a lack of long-term exercise adherence a potential reason for this. This study aimed to synthesize the perceptions and beliefs of individuals with CLBP and identify their barriers and enablers to exercise adherence. We searched CENTRAL, Embase, CINAHL, SPORTDiscus, PubMed, PsycINFO, and Scopus databases from inception to February 28, 2023, for qualitative studies that explored the factors influencing exercise adherence for people with CLBP. A hybrid approach combining thematic synthesis with the Theoretical Domains Framework was used to analyze data. We assessed methodological quality using the Critical Appraisal Skills Programme checklist and the level of confidence of the themes generated using the Confidence in the Evidence from Reviews of Qualitative Studies. Twenty-three papers (n = 21 studies) were included (n = 677 participants). Four main themes affected exercise adherence: (1) exercise, pain, and the body, (2) psychological factors, (3) social factors, and (4) external factors. These themes contained 16 subthemes that were predominantly both barriers and enablers to exercise adherence. The individual's experiences of barriers and enablers were most appropriately represented across a spectrum, where influencing factors could be a barrier or enabler to exercise adherence, and these could be specific to pre-exercise, during-exercise, and post-exercise situations. These findings may be used to improve exercise adherence and ultimately treatment outcomes in people with CLBP.
Collapse
Affiliation(s)
- Yannick L Gilanyi
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Brishna Shah
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Mitchell T Gibbs
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Jessica Bellamy
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Richard Day
- St Vincent's Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| |
Collapse
|
2
|
’I am teaching them and they are teaching me’: Experiences of teaching Alexander Technique to people with dementia. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
3
|
Self-care for family carers: Can the Alexander Technique help? Complement Ther Clin Pract 2022; 46:101546. [DOI: 10.1016/j.ctcp.2022.101546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/22/2022]
|
4
|
The effect of the Alexander Technique on pain intensity in patients with chronic low back pain: A randomized controlled trial. J Bodyw Mov Ther 2022; 29:54-59. [DOI: 10.1016/j.jbmt.2021.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/19/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022]
|
5
|
Kinsey D, Glover L, Wadephul F. How does the Alexander Technique lead to psychological and non-physical outcomes? A realist review. Eur J Integr Med 2021. [DOI: 10.1016/j.eujim.2021.101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
6
|
Davies J. Alexander Technique classes improve pain and performance factors in tertiary music students. J Bodyw Mov Ther 2020; 24:1-7. [PMID: 31987527 DOI: 10.1016/j.jbmt.2019.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/02/2019] [Accepted: 04/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Professional and student instrumental musicians experience high rates of playing-related pain (PR pain) and other playing-related musculoskeletal disorders (PRMDs). This significant occupational health risk signals an urgent need for preventive education at the college level. During tertiary studies however, music students may be more focused on musical skill development than health outcomes. Alexander Technique (AT) is reputed to be beneficial for factors relating to both PR pain and the improvement of performance quality in musicians, therefore AT training for music students could be relevant for prevention. OBJECTIVES To examine the effects of AT classes for tertiary music students on PR pain, associated risk factors for PR pain, and factors associated with improvements in music performance quality. METHODS Responses were collected from 23 volunteer music performance students at an Australian University who undertook weekly AT classes for one semester using a curriculum specifically designed for music students. RESULTS The majority of participants rated AT classes as beneficial for all factors, particularly reduction of PR pain, posture, ability to release excess muscle tension, improvements in instrumental technique, and improvements in performance level. Benefits to practice effectiveness and a reduction in non-playing-related pain, stress levels and performance anxiety were also reported. CONCLUSIONS Purpose-designed AT classes may contribute to the management of PR pain and pertinent risk factors in music students, thus further investigation of the potential role of AT classes in pain prevention programs is warranted. Reports of benefit across a range of performance-related skills strengthen relevance to music practice and performance.
Collapse
Affiliation(s)
- Janet Davies
- Sydney Conservatorium, University of Sydney, Macquarie St, Sydney, NSW, 2000, Australia.
| |
Collapse
|
7
|
Education of Teachers with Chronic Low Back Pain Based on Integrative Model of Behavioral Prediction. HEALTH SCOPE 2019. [DOI: 10.5812/jhealthscope.82753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
8
|
Nascimento DP, Costa LOP, Gonzalez GZ, Maher CG, Moseley AM. Abstracts of low back pain trials are poorly reported, contain spin of information and are inconsistent with the full text: An overview study. Arch Phys Med Rehabil 2019; 100:1976-1985.e18. [PMID: 31207219 DOI: 10.1016/j.apmr.2019.03.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/09/2019] [Accepted: 03/20/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate trials abstracts evaluating treatments for low back pain with regards to completeness of reporting, spin (i.e., interpretation of study results that overemphasizes the beneficial effects of the intervention), and inconsistencies in data with the full text. DATA SOURCES The search was performed on Physiotherapy Evidence Database (PEDro) in February 2016. STUDY SELECTION This is an overview study of a random sample of 200 low back pain trials published between 2010 and 2015. The languages of publication were restricted to English, Spanish and Portuguese. DATA EXTRACTION Completeness of reporting was assessed using the CONSORT for Abstracts checklist (CONSORT-A). Spin was assessed using a SPIN-checklist. Consistency between abstract and full text were assessed by applying the assessment tools to both the abstract and full text of each trial and calculating inconsistencies in the summary score (paired t test) and agreement in the classification of each item (Kappa statistics). Methodological quality was analyzed using the total PEDro score. DATA SYNTHESIS The mean number of fully reported items for abstracts using the CONSORT-A was 5.1 (SD 2.4) out of 15 points and the mean number of items with spin was 4.9 (SD 2.6) out of 7 points. Abstract and full text scores were statistically inconsistent (P=0.01). There was slight to moderate agreement between items of the CONSORT-A in the abstracts and full text (mean Kappa 0.20 SD 0.13) and fair to moderate agreement for items of the SPIN-checklist (mean Kappa 0.47 SD 0.09). CONCLUSIONS The abstracts were incomplete, with spin and inconsistent with the full text. We advise health care professionals to avoid making clinical decisions based solely upon abstracts. Journal editors, reviewers and authors are jointly responsible for improving abstracts, which could be guided by amended editorial policies.
Collapse
Affiliation(s)
- Dafne P Nascimento
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil.
| | - Leonardo O P Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Gabrielle Z Gonzalez
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Christopher G Maher
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, Australia
| | - Anne M Moseley
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
9
|
Chou L, Ranger TA, Peiris W, Cicuttini FM, Urquhart DM, Briggs AM, Wluka AE. Patients' perceived needs for allied health, and complementary and alternative medicines for low back pain: A systematic scoping review. Health Expect 2018; 21:824-847. [PMID: 29983004 PMCID: PMC6186543 DOI: 10.1111/hex.12676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Allied health and complementary and alternative medicines (CAM) are therapeutic therapies commonly accessed by consumers to manage low back pain (LBP). We aimed to identify the literature regarding patients' perceived needs for physiotherapy, chiropractic therapy and CAM for the management of LBP. METHODS A systematic scoping review of MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016) was conducted to identify studies examining patients' perceived needs for allied health and CAM for LBP. Data regarding study design and methodology were extracted. Areas of patients' perceived need for allied health and CAM were aggregated. RESULTS Forty-four studies from 2202 were included: 25 qualitative, 18 quantitative and 1 mixed-methods study. Three areas of need emerged: (i) physiotherapy was viewed as important, particularly when individually tailored. However, patients had concerns about adherence, adverse outcomes and correct exercise technique. (ii) Chiropractic therapy was perceived to be effective and needed by some patients, but others were concerned about adverse outcomes. (iii) An inconsistent need for CAM was identified with some patients perceiving a need, while others questioning the legitimacy and short-term duration of these therapies. CONCLUSIONS Our findings regarding patients' perceived needs for allied health and CAM for LBP may assist in informing development of more patient-centred guidelines and service models for LBP. Understanding patients' concerns regarding active-based physiotherapy, which is recommended in most guidelines, and issues surrounding chiropractic and CAM, which are generally not, may help inform management that better aligns patient's perceived needs with effective treatments, to improve outcomes for both patients and the health-care system.
Collapse
Affiliation(s)
- Louisa Chou
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Tom A. Ranger
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Waruna Peiris
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Flavia M. Cicuttini
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Donna M. Urquhart
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Andrew M. Briggs
- School of Physiotherapy and Exercise ScienceCurtin UniversityPerthWAAustralia
- Move: Muscle, Bone & Joint HealthMelbourneVicAustralia
| | - Anita E. Wluka
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| |
Collapse
|
10
|
Wenham A, Atkin K, Woodman J, Ballard K, MacPherson H. Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial. Complement Ther Clin Pract 2018; 31:308-314. [PMID: 29705473 PMCID: PMC5941320 DOI: 10.1016/j.ctcp.2018.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Abstract
Background and purpose A large randomised controlled trial found that the provision of either Alexander Technique lessons or acupuncture, for those with chronic neck pain, resulted in significantly increased self-efficacy when compared with usual care alone. In turn, enhanced self-efficacy was associated with significant reductions in neck pain at 6 and 12 months. In this analysis we explore the perspectives of participants within the trial, with the aim of gaining a better understanding of how these interventions had an impact. Methods We used a longitudinal qualitative approach; in-depth interviews, informed by a topic guide, were conducted with a sample of the trial population. Participants were interviewed twice: at around six months (n = 30) and twelve months (n = 26) after trial entry. Analysis was guided by the principles of grounded theory, and key themes were developed. Results Five key themes emerged: pre-trial experiences of biomedical treatment against which subsequent interventions were compared; emergence of tangible benefits from the interventions; factors that contributed to the observed benefits, notably growing self-care and self-efficacy; a developing sense of embodiment as an integral part of the transformative process; and contribution of these factors to sustaining benefits over the longer term. Conclusions In-depth interviews revealed a rich array of experiences. They gave insight into the positive impact of the interventions on development of self-care, self-efficacy and embodiment. These findings complement the quantitative trial data, providing a more nuanced understanding of the factors that underpin the previously quantified improvement in self-efficacy and its association with longer-term reductions in pain.
Collapse
Affiliation(s)
- Aniela Wenham
- Department of Social Policy & Social Work, University of York, York, YO10 5DD, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Julia Woodman
- Department of Health Sciences, University of York, York, YO10 5DD, UK; Society of Teachers of the Alexander Technique, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, UK
| | - Kathleen Ballard
- Society of Teachers of the Alexander Technique, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, UK
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, YO10 5DD, UK.
| |
Collapse
|
11
|
Woodman J, Ballard K, Hewitt C, MacPherson H. Self-efficacy and self-care-related outcomes following Alexander Technique lessons for people with chronic neck pain in the ATLAS randomised, controlled trial. Eur J Integr Med 2018. [PMID: 29527245 PMCID: PMC5842361 DOI: 10.1016/j.eujim.2017.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
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.
Collapse
Affiliation(s)
- Julia Woodman
- Society of Teachers of the Alexander Technique, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, UK.,Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Kathleen Ballard
- Society of Teachers of the Alexander Technique, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, UK
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| |
Collapse
|
12
|
Glover L, Kinsey D, Clappison DJ, Gardiner E, Jomeen J. “I never thought I could do that…”: Findings from an Alexander Technique pilot group for older people with a fear of falling. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2017.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
13
|
Pour Kamali T, Yazdkhasti F, Oreyzi HR, Chitsaz A. A Comparison of Effectiveness of Dohsa-hou and the Alexander Technique on Happiness, Social Adjustment, Hope, Mental Health, and Quality of Life in Patients with Parkinson's Disease. JAPANESE PSYCHOLOGICAL RESEARCH 2017. [DOI: 10.1111/jpr.12184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
Keay L, Saich F, Clemson L, Middlemiss L, Johnson J, Tumanik H, Taylor J, Munro J, Borkowski E, Tinsley F. Feasibility and acceptability of orientation and mobility instructors delivering the LiFE falls prevention program to older people with vision impairment. INTERNATIONAL JOURNAL OF ORIENTATION & MOBILITY 2017. [DOI: 10.21307/ijom-2017-053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
15
|
Kamalikhah T, Morowatisharifabad MA, Rezaei-Moghaddam F, Ghasemi M, Gholami-Fesharaki M, Goklani S. Alexander Technique Training Coupled With an Integrative Model of Behavioral Prediction in Teachers With Low Back Pain. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e31218. [PMID: 28144457 PMCID: PMC5253206 DOI: 10.5812/ircmj.31218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/15/2015] [Accepted: 07/29/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND Individuals suffering from chronic low back pain (CLBP) experience major physical, social, and occupational disruptions. Strong evidence confirms the effectiveness of Alexander technique (AT) training for CLBP. OBJECTIVES The present study applied an integrative model (IM) of behavioral prediction for improvement of AT training. METHODS This was a quasi-experimental study of female teachers with nonspecific LBP in southern Tehran in 2014. Group A contained 42 subjects and group B had 35 subjects. In group A, AT lessons were designed based on IM constructs, while in group B, AT lessons only were taught. The validity and reliability of the AT questionnaire were confirmed using content validity (CVR 0.91, CVI 0.96) and Cronbach's α (0.80). The IM constructs of both groups were measured after the completion of training. Statistical analysis used independent and paired samples t-tests and the univariate generalized linear model (GLM). RESULTS Significant differences were recorded before and after intervention (P < 0.001) for the model constructs of intention, perceived risk, direct attitude, behavioral beliefs, and knowledge in both groups. Direct attitude and behavioral beliefs in group A were higher than in group B after the intervention (P < 0.03). CONCLUSIONS The educational framework provided by IM for AT training improved attitude and behavioral beliefs that can facilitate the adoption of AT behavior and decreased CLBP.
Collapse
Affiliation(s)
- Tahereh Kamalikhah
- Department of Health Education, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
| | | | - Farid Rezaei-Moghaddam
- Physical Medicine and Rehabilitation, Army University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Ghasemi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | | | - Salma Goklani
- Rehabilitation Faculty, Tehran University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
16
|
Lauche R, Schuth M, Schwickert M, Lüdtke R, Musial F, Michalsen A, Dobos G, Choi KE. Efficacy of the Alexander Technique in treating chronic non-specific neck pain: a randomized controlled trial. Clin Rehabil 2016; 30:247-258. [DOI: 10.1177/0269215515578699] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
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 favor of the Alexander Technique were also found for physical quality of life ( P<0.05). Adverse events mainly included slightly increased pain and muscle soreness. 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.
Collapse
Affiliation(s)
- Romy Lauche
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia
| | - Mareike Schuth
- Department of Anesthesiology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Myriam Schwickert
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Migräne- und Kopfschmerzklinik Königstein, Königstein im Taunus, Germany
| | - Rainer Lüdtke
- Karl and Veronica Carstens-Foundation, Essen, Germany
| | - Frauke Musial
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, Uit The Arctic University of Norway, Tromsö Norway
| | - Andreas Michalsen
- Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Kyung-Eun Choi
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
17
|
What are patient beliefs and perceptions about exercise for nonspecific chronic low back pain? A systematic review of qualitative studies. Clin J Pain 2015; 30:995-1005. [PMID: 24300225 DOI: 10.1097/ajp.0000000000000044] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The global burden of low back pain is the highest ranked condition contributing to years of living with disability. Exercise is moderately effective, and adherence to exercise may improve if participants are engaged. Identification of elements that enhance engagement would enable clinicians to prescribe appropriate interventions. The review objective was to identify and synthesize qualitative empirical studies that have explored beliefs about exercise therapy of people with nonspecific chronic low back pain. METHODS Two independent reviewers conducted a structured review and metasynthesis informed by Cochrane and Campbell Collaboration guidelines and the PRISMA statement. Fifteen papers were included for data extraction, method quality assessment, and thematic analysis. RESULTS Four key themes emerged: (1) perceptions and classification of exercise; (2) role and impact of the health professional; (3) exercise and activity enablers/facilitators; (4) exercise and activity barriers. Participants believed that there were distinctions between general activity, real/fitness exercise, and medical exercise. Levels of acquired skills and capability and participant experience with exercise culture require consideration in program design. People participating in exercise classes and group work may be more comfortable when matched for abilities and experience. When an intervention interferes with everyday life and appears to be ineffective or too difficult to implement, people make a reasoned decision to discontinue. DISCUSSION People are likely to prefer and participate in exercise or training programs and activities that are designed with consideration of their preferences, circumstances, fitness levels, and exercise experiences.
Collapse
|
18
|
MacPherson H, Tilbrook HE, Richmond SJ, Atkin K, Ballard K, Bland M, Eldred J, Essex HN, Hopton A, Lansdown H, Muhammad U, Parrott S, Torgerson D, Wenham A, Woodman J, Watt I. Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial. Trials 2013; 14:209. [PMID: 23841901 PMCID: PMC3720220 DOI: 10.1186/1745-6215-14-209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/25/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Chronic neck pain is a common condition in the adult population. More research is needed to evaluate interventions aiming to facilitate beneficial long-term change. We propose to evaluate the effect of Alexander Technique lessons and acupuncture in a rigorously conducted pragmatic trial with an embedded qualitative study. METHODS/DESIGN We will recruit 500 patients who have been diagnosed with neck pain in primary care, who have continued to experience neck pain for at least three months with 28% minimum cut-off score on the Northwick Park Neck Pain Questionnaire (NPQ). We will exclude patients with serious underlying pathology, prior cervical spine surgery, history of psychosis, rheumatoid arthritis, ankylosing spondylitis, osteoporosis, haemophilia, cancer, HIV or hepatitis, or with alcohol or drug dependency currently or in the last 12 months, or actively pursuing compensation or with pending litigation.The York Trials Unit will randomly allocate participants using a secure computer-based system. We will use block randomisation with allocation to each intervention arm being unambiguously concealed from anyone who might subvert the randomisation process.Participants will be randomised in equal proportions to Alexander Technique lessons, acupuncture or usual care alone. Twenty 30-minute Alexander Technique lessons will be provided by teachers registered with the Society of Teachers of the Alexander Technique and twelve 50-minute sessions of acupuncture will be provided by acupuncturists registered with the British Acupuncture Council. All participants will continue to receive usual GP care.The primary outcome will be the NPQ at 12 months, with the secondary time point at 6 months, and an area-under-curve analysis will include 3, 6 and 12 month time-points. Adverse events will be documented. Potential intervention effect modifiers and mediators to be explored include: self-efficacy, stress management, and the incorporation of practitioner advice about self-care and lifestyle. Qualitative material will be used to address issues of safety, acceptability and factors that impact on longer term outcomes. DISCUSSION This study will provide robust evidence on whether there are significant clinical benefits to patients, economic benefits demonstrating value for money, and sufficient levels of acceptability and safety. TRIAL REGISTRATION Current Controlled Trials ISRCTN15186354.
Collapse
Affiliation(s)
- Hugh MacPherson
- Department of Health Sciences, University of York, York, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Jones T, Glover L. Exploring the Psychological Processes Underlying Touch: Lessons from the Alexander Technique. Clin Psychol Psychother 2012; 21:140-53. [DOI: 10.1002/cpp.1824] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 09/09/2012] [Accepted: 09/25/2012] [Indexed: 11/06/2022]
Affiliation(s)
- T. Jones
- Department of Clinical Psychology and Psychological Therapies; University of Hull; Hull UK
| | - L. Glover
- Department of Clinical Psychology and Psychological Therapies; University of Hull; Hull UK
| |
Collapse
|
20
|
Woodman JP, Moore NR. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review. Int J Clin Pract 2012; 66:98-112. [PMID: 22171910 DOI: 10.1111/j.1742-1241.2011.02817.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Complementary medicine and alternative approaches to chronic and intractable health conditions are increasingly being used, and require critical evaluation. OBJECTIVE The aim of this review was to systematically evaluate available evidence for the effectiveness and safety of instruction in the Alexander Technique in health-related conditions. METHODS PUBMED, EMBASE, PSYCHINFO, ISI Web-of-Knowledge, AMED, CINHAL-plus, Cochrane library and Evidence-based Medicine Reviews were searched to July 2011. Inclusion criteria were prospective studies evaluating Alexander Technique instruction (individual lessons or group delivery) as an intervention for any medical indication/health-related condition. Studies were categorised and data extracted on study population, randomisation method, nature of intervention and control, practitioner characteristics, validity and reliability of outcome measures, completeness of follow-up and statistical analyses. RESULTS Of 271 publications identified, 18 were selected: three randomised, controlled trials (RCTs), two controlled non-randomised studies, eight non-controlled studies, four qualitative analyses and one health economic analysis. One well-designed, well-conducted RCT demonstrated that, compared with usual GP care, Alexander Technique lessons led to significant long-term reductions in back pain and incapacity caused by chronic back pain. The results were broadly supported by a smaller, earlier RCT in chronic back pain. The third RCT, a small, well-designed, well-conducted study in individuals with Parkinson's disease, showed a sustained increased ability to carry out everyday activities following Alexander lessons, compared with usual care. The 15 non-RCT studies are also reviewed. CONCLUSIONS Strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson's-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the elderly, in general chronic pain, posture, respiratory function and stuttering, but there is insufficient evidence to support recommendations in these areas.
Collapse
Affiliation(s)
- J P Woodman
- Department of Health Sciences, University of York, York, UK.
| | | |
Collapse
|
21
|
Current world literature. Curr Opin Support Palliat Care 2011; 5:174-83. [PMID: 21521986 DOI: 10.1097/spc.0b013e3283473351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|