Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial

TY - JOUR

T1 - Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain

T2 - A Randomized Trial

AU - MacPherson, Hugh

AU - Tilbrook, Helen

AU - Richmond, Stewart

AU - Woodman, Julia

AU - Ballard, Kathleen

AU - Atkin, Karl

AU - Bland, Martin

AU - Eldred, Janet

AU - Essex, Holly

AU - Hewitt, Catherine

AU - Hopton, Ann

AU - Keding, Ada

AU - Lansdown, Harriet

AU - Parrott, Steve

AU - Torgerson, David

AU - Wenham, Aniela

AU - Watt, Ian

PY - 2015/11/3

Y1 - 2015/11/3

N2 - 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.

AB - 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.

U2 - 10.7326/M15-0667

DO - 10.7326/M15-0667

M3 - Article

C2 - 26524571

SN - 0003-4819

VL - 163

SP - 653

EP - 662

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

IS - 9

ER -