Self-efficacy and self-care-related outcomes following Alexander Technique lessons for people with chronic neck pain in the ATLAS randomised, controlled trial

Abstract

IntroductionATLAS 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.MethodsParticipants 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.ResultsLesson 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.ConclusionsAlexander 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.

Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial

“…Our results are consistent with the findings of other studies of the Alexander Technique, including our sister papers, that provided quantitative data on the importance of self-efficacy for greater reductions in neck pain [ 1 , 4 ]. Interviews with participants who had attended Alexander lessons in the back pain clinical trial, as well as those in a pain clinic setting, revealed similar experiences of increased self-efficacy in managing pain, and feelings of gaining more control in general [ 16 , 17 ].…”

“…As previously reported, acupuncture can be seen as predominantly therapeutic but with an important educational component, primarily through lifestyle advice such as exercise and diet [ 3 ]. In contrast, while Alexander Technique lessons also have a therapeutic element, they are primarily principle-based education in the use of embodied thinking skills that enable people to improve muscle tone, postural support, movement coordination and balance, so reducing maladaptive musculoskeletal habits and the pain they cause [ 4 ].…”

“…Self-efficacy was defined as the extent of the participants' confidence in their ability to reduce their pain using methods other than medication, and was assessed using a validated measure [ 2 ]. Participants attending either Alexander lessons or acupuncture sessions reported significant improvements in the way they lived and cared for themselves compared with those receiving usual care alone [ 3 , 4 ].…”

Comparing the effect of foot and hand reflexology on pain severity after appendectomy: A randomized clinical trial

“…Today, public interest in the use of complementary and alternative medicine has increased. [131718] Reflexology is one of these alternative methods, which can be considered a part of nursing care, used to reduce pain. [1920] In Chinese medicine, Ch'i energy is defined as a vital force, forming part of any living creature.…”

Moving With Pain: What Principles From Somatic Practices Can Offer to People Living With Chronic Pain

“…To date, a set of somatic principles for supporting chronic pain management across a range of conditions has not been theorized or tested, while open structured approaches have been underexplored, and interdisciplinary research on the topic is lacking. 1 There is some research on structured forms such the Alexander Technique (e.g., Essex et al, 2017 ; Woodman et al, 2018 ) and Feldenkrais Method ( Ahmadi et al, 2020 ), while lay books on Hanna somatics for pain exist ( Peterson, 2012 ; St. Pierre, 2015 ). Open somatic frameworks that “rely on more autonomy in movement response lying with the client” ( Weber, 2009 , p. 239) with improvisatory, non-stylized guided sessions (such as Authentic Movement) are missing from research on chronic pain.…”