Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial

Abstract

BackgroundChronic 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/DesignWe 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.DiscussionThis 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 registrationCurrent Controlled Trials ISRCTN15186354

An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS)

“…Full details of the trial are published elsewhere [ 14 , 22 ]. Briefly, the ATLAS (Alexander Technique Lessons or Acupuncture Sessions) study was a pragmatic, multi-centre, three-armed RCT comparing acupuncture or Alexander lessons with usual GP care alone, for people with chronic, non-specific neck pain.…”

Randomized trial within a trial of yellow ‘post‐it notes’ did not improve questionnaire response rates among participants in a trial of treatments for neck pain

“…We undertook a trial within a trial, that is, we nested the randomized trial of 'post-it notes' within the ATLAS trial, which is a large pragmatic randomized controlled trial of acupuncture or Alexander training or usual care for the treatment of neck pain [4]. The aim of this trial within a trial was to assess whether the use of a simple intervention, post-it notes, would result in a decrease in study attrition.…”

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

“…The earlier ATEAM trial demonstrated that, compared with usual care alone, one-to-one Alexander lessons led to significant long-term reduction in chronic or recurrent back pain and associated disability, [ 18 ]. ATLAS compared usual care alone with either Alexander lessons or acupuncture (both plus usual care) for primary care patients with chronic (median 6 years) non-specific neck pain [ [16] , [29] ]. The ATLAS trial clinical findings have already been reported, with the primary outcome of the Northwick Park Neck Pain Questionnaire demonstrating statistically significant and clinically meaningful reductions in pain and associated disability for both Alexander lessons and for acupuncture sessions compared with usual care alone, with the benefit maintained to at least 12 months [ 16 ].…”