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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Essex H, Parrott S, Atkin K, Ballard K, Bland M, Eldred J, Hewitt C, Hopton A, Keding A, Lansdown H, Richmond S, Tilbrook H, Torgerson D, Watt I, Wenham A, Woodman J, MacPherson H. An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS). PLoS One 2017; 12:e0178918. [PMID: 29211741 PMCID: PMC5718562 DOI: 10.1371/journal.pone.0178918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 05/19/2017] [Indexed: 02/01/2023] Open
Abstract
Objectives To assess the cost-effectiveness of acupuncture and usual care, and Alexander Technique lessons and usual care, compared with usual GP care alone for chronic neck pain patients. Methods An economic evaluation was undertaken alongside the ATLAS trial, taking both NHS and wider societal viewpoints. Participants were offered up to twelve acupuncture sessions or twenty Alexander lessons (equivalent overall contact time). Costs were in pounds sterling. Effectiveness was measured using the generic EQ-5D to calculate quality adjusted life years (QALYs), as well as using a specific neck pain measure–the Northwick Park Neck Pain Questionnaire (NPQ). Results In the base case analysis, incremental QALY gains were 0.032 and 0.025 in the acupuncture and Alexander groups, respectively, in comparison to usual GP care, indicating moderate health benefits for both interventions. Incremental costs were £451 for acupuncture and £667 for Alexander, mainly driven by intervention costs. Acupuncture was likely to be cost-effective (ICER = £18,767/QALY bootstrapped 95% CI £4,426 to £74,562) and was robust to most sensitivity analyses. Alexander lessons were not cost-effective at the lower NICE threshold of £20,000/QALY (£25,101/QALY bootstrapped 95% CI -£150,208 to £248,697) but may be at £30,000/QALY, however, there was considerable statistical uncertainty in all tested scenarios. Conclusions In comparison with usual care, acupuncture is likely to be cost-effective for chronic neck pain, whereas, largely due to higher intervention costs, Alexander lessons are unlikely to be cost-effective. However, there were high levels of missing data and further research is needed to assess the long-term cost-effectiveness of these interventions.
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Affiliation(s)
- Holly Essex
- Department of Health Sciences, University of York, York, United Kingdom
- * E-mail:
| | - Steve Parrott
- Department of Health Sciences, University of York, York, United Kingdom
| | - Karl Atkin
- Department of Health Sciences, University of York, York, United Kingdom
| | - Kathleen Ballard
- Society of Teachers of the Alexander Technique, London, United Kingdom
| | - Martin Bland
- Department of Health Sciences, University of York, York, United Kingdom
| | - Janet Eldred
- Department of Health Sciences, University of York, York, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ann Hopton
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ada Keding
- Department of Health Sciences, University of York, York, United Kingdom
| | - Harriet Lansdown
- Department of Health Sciences, University of York, York, United Kingdom
- British Acupuncture Council, London, United Kingdom
| | - Stewart Richmond
- Sydera Research Associates, Market Weighton, York, United Kingdom
| | - Helen Tilbrook
- Department of Health Sciences, University of York, York, United Kingdom
| | - David Torgerson
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ian Watt
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | - Aniela Wenham
- Department of Health Sciences, University of York, York, United Kingdom
| | - Julia Woodman
- Department of Health Sciences, University of York, York, United Kingdom
- Society of Teachers of the Alexander Technique, London, United Kingdom
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, United Kingdom
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MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, Atkin K, Bland M, Eldred J, Essex H, Hewitt C, Hopton A, Keding A, Lansdown H, Parrott S, Torgerson D, Wenham A, Watt I. Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial. Ann Intern Med 2015; 163:653-62. [PMID: 26524571 DOI: 10.7326/m15-0667] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Management of chronic neck pain may benefit from additional active self-care-oriented approaches. OBJECTIVE To evaluate clinical effectiveness of Alexander Technique lessons or acupuncture versus usual care for persons with chronic, nonspecific neck pain. DESIGN Three-group randomized, controlled trial. (Current Controlled Trials: ISRCTN15186354). SETTING U.K. primary care. PARTICIPANTS Persons with neck pain lasting at least 3 months, a score of at least 28% on the Northwick Park Questionnaire (NPQ) for neck pain and associated disability, and no serious underlying pathology. INTERVENTION 12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total) plus usual care versus usual care alone. MEASUREMENTS NPQ score (primary outcome) at 0, 3, 6, and 12 months (primary end point) and Chronic Pain Self-Efficacy Scale score, quality of life, and adverse events (secondary outcomes). RESULTS 517 patients were recruited, and the median duration of neck pain was 6 years. Mean attendance was 10 acupuncture sessions and 14 Alexander lessons. Between-group reductions in NPQ score at 12 months versus usual care were 3.92 percentage points for acupuncture (95% CI, 0.97 to 6.87 percentage points) (P = 0.009) and 3.79 percentage points for Alexander lessons (CI, 0.91 to 6.66 percentage points) (P = 0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons. Participant self-efficacy improved for both interventions versus usual care at 6 months (P < 0.001) and was significantly associated (P < 0.001) with 12-month NPQ score reductions (acupuncture, 3.34 percentage points [CI, 2.31 to 4.38 percentage points]; Alexander lessons, 3.33 percentage points [CI, 2.22 to 4.44 percentage points]). No reported serious adverse events were considered probably or definitely related to either intervention. LIMITATION Practitioners belonged to the 2 main U.K.-based professional associations, which may limit generalizability of the findings. CONCLUSION Acupuncture sessions and Alexander Technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained. PRIMARY FUNDING SOURCE Arthritis Research UK.
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Affiliation(s)
- Hugh MacPherson
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Helen Tilbrook
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Stewart Richmond
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Julia Woodman
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Kathleen Ballard
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Karl Atkin
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Martin Bland
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Janet Eldred
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Holly Essex
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Catherine Hewitt
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Ann Hopton
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Ada Keding
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Harriet Lansdown
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Steve Parrott
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - David Torgerson
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Aniela Wenham
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
| | - Ian Watt
- From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom
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Tozer R, Atkin K, Wenham A. Continuity, commitment and context: adult siblings of people with autism plus learning disability. Health Soc Care Community 2013; 21:480-488. [PMID: 23638906 DOI: 10.1111/hsc.12034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2013] [Indexed: 06/02/2023]
Abstract
Sibling relationships are usually lifelong and reciprocal. They can assume particular significance when a brother or sister has a learning disability. Until recently, adult siblings of people with disabilities such as severe autism have been ignored by policy, practice and research. This qualitative study contributes to an emerging literature by exploring how adult siblings, who have a brother or sister with autism (plus learning disability) and living in England, give meaning to their family (and caring) relationships and engage with service delivery. We spoke to 21 adult siblings using semi-structured interviews and met with 12 of their siblings with autism. Our analysis, using a broad narrative approach, demonstrates the continuity of the sibling relationship and an enduring personalised commitment. The nature of this relationship, however, is sensitive to context. How non-disabled adult siblings relate to their childhood experience is fundamental when making sense of this, as is their need to fulfil other social and family obligations, alongside their 'sense of duty' to support their disabled brother or sister. Sibling experience was further mediated by negotiating their 'perceived invisibility' in social care policy and practice. Our work concludes that by understanding the way relationships between siblings have developed over time, adult siblings' contribution to the lives of their brother or sister with autism can be better supported for the benefit of both parties. Such an approach would support current policy developments.
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Affiliation(s)
- Rosemary Tozer
- Department of Health Sciences, University of York, York, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- Hugh MacPherson
- Department of Health Sciences, University of York, York, UK.
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Wenham A. The role of Dr Johan Arvedson (1862-1936) in the emergence and development of physiotherapy. Adler Mus Bull 1999; 25:15-7. [PMID: 11624221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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