Abstract
This article has been corrected. The original version (PDF) is appended to this article as a Supplement.
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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Author, Article, and Disclosure Information
Hugh MacPherson,
From University of York, York, and Society of Teachers of the Alexander Technique and British Acupuncture Council, London, United Kingdom.
Note: Dr. MacPherson (the manuscript's guarantor) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Acknowledgment: The authors thank the participants, Alexander teachers, acupuncturists, and general medical practitioners; David Laverack and Anthony Murray, their patient representatives; Elaine Hay, Debbie Sharp, and David Geddes, their collaborators; Matthew Bailey, Sue Collins, Ben Elliot, Pauline Holloway, Dionysios Pallas, Lucy Revell, and Val Wadsworth from the ATLAS research team; and Cindy Cooper (Chair), Sarah Brown, and Gareth Jones, who were members of the independent steering group.
Financial Support: The trial was sponsored by the University of York. This research was funded by clinical studies grant 19702 from Arthritis Research UK.
Disclosures: Drs. MacPherson and Lansdown report that they are members of the British Acupuncture Council. Drs. Woodman and Ballard report that they are members of the Society of Teachers of the Alexander Technique. Dr. Atkin reports a grant from Arthritis Research UK during the conduct of the study. Dr. Eldred reports a grant from Arthritis Research UK during the conduct of the study. Dr. Hewitt reports a grant from Arthritis Research UK during the conduct of the study. Dr. Torgerson reports a Programme Grant from the National Institute for Health Research during the conduct of the study. Dr. Watt reports a grant from Arthritis Research UK during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0667.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol: Available in reference 19. Statistical code and data set: Relevant anonymized patient-level data are available from Dr. MacPherson (e-mail, hugh.
Corresponding Author: Hugh MacPherson, BSc, PhD, Department of Health Sciences, University of York, York YO10 5DD, United Kingdom; e-mail, hugh.
Current Author Addresses: Drs. MacPherson, Atkin, Bland, Eldred, Essex, Hewitt, Torgerson, Wenham, and Watt; Ms. Tilbrook; Ms. Hopton; Ms. Keding; Ms. Lansdown; and Mr. Parrott: Department of Health Sciences, University of York, York YO10 5DD, United Kingdom.
Dr. Richmond: Sydera Research Associates, 34 Shipman Road, Market Weighton, York YO43 3RB, United Kingdom.
Drs. Woodman and Ballard: Society of Teachers of the Alexander Technique, Grove Business Park, Unit 48, 560-568 High Road, London N17 9TA, United Kingdom.
Author Contributions: Conception and design: H. MacPherson, H. Tilbrook, S. Richmond, J. Woodman, K. Ballard, K. Atkin, M. Bland, H. Lansdown, S. Parrott, D. Torgerson, I. Watt.
Analysis and interpretation of the data: H. MacPherson, H. Tilbrook, S. Richmond, J. Woodman, K. Ballard, K. Atkin, M. Bland, H. Essex, C. Hewitt, A. Keding, H. Lansdown, S. Parrott, D. Torgerson, I. Watt.
Drafting of the article: H. MacPherson, H. Tilbrook, S. Richmond, J. Woodman, K. Ballard, K. Atkin, J. Eldred, H. Essex, S. Parrott, D. Torgerson, I. Watt.
Critical revision of the article for important intellectual content: H. MacPherson, H. Tilbrook, S. Richmond, J. Woodman, K. Ballard, C. Hewitt, H. Lansdown, S. Parrott, D. Torgerson, I. Watt.
Final approval of the article: H. MacPherson, H. Tilbrook, S. Richmond, J. Woodman, K. Ballard, K. Atkin, M. Bland, J. Eldred, H. Essex, C. Hewitt, A. Hopton, A. Keding, H. Lansdown, S. Parrott, D. Torgerson, A. Wenham, I. Watt.
Provision of study materials or patients: H. MacPherson, J. Woodman, K. Ballard.
Statistical expertise: M. Bland, H. Essex, C. Hewitt, A. Keding.
Obtaining of funding: H. MacPherson, S. Richmond, J. Woodman, K. Ballard, K. Atkin, M. Bland, A. Hopton, S. Parrott, D. Torgerson, I. Watt.
Administrative, technical, or logistic support: H. MacPherson, H. Tilbrook, S. Richmond, J. Woodman, K. Ballard, J. Eldred, A. Hopton, D. Torgerson, I. Watt.
Collection and assembly of data: H. MacPherson, H. Tilbrook, S. Richmond, A. Wenham.
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