title: Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.
abstract: OBJECTIVE
  To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain.
  
  
  METHODS
  Factorial randomised trial. Setting 64 general practices in England.
  
  
  METHODS
  579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription.
  
  
  METHODS
  Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling.
  
  
  METHODS
  Roland Morris disability score (number of activities impaired by pain) and number of days in pain.
  
  
  RESULTS
  Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage -0.58, 95% confidence interval -1.94 to 0.77, six lessons -1.40, -2.77 to -0.03, 24 lessons -3.4, -4.76 to -2.03, and exercise -1.29, -2.25 to -0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score -2.98 and -4.14, respectively). Number of days with back pain in the past four weeks were lower after lessons (compared with control median 21 days: 24 lessons -18, six lessons -10, massage -7) and quality of life improved significantly. No significant harms were reported.
  
  
  CONCLUSIONS
  One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.
authors.affiliation: Community Clinical Sciences Division, Southampton University, Aldermoor Health Centre, Southampton, UK. psl3@soton.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: George
authors.initials: G
authors.lastname: Lewith
authors.forename: Fran
authors.initials: F
authors.lastname: Webley
authors.forename: Maggie
authors.initials: M
authors.lastname: Evans
authors.forename: Angela
authors.initials: A
authors.lastname: Beattie
authors.forename: Karen
authors.initials: K
authors.lastname: Middleton
authors.forename: Jane
authors.initials: J
authors.lastname: Barnett
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ballard
authors.forename: Frances
authors.initials: F
authors.lastname: Oxford
authors.forename: Peter
authors.initials: P
authors.lastname: Smith
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
authors.forename: Sandra
authors.initials: S
authors.lastname: Hollinghurst
authors.forename: Debbie
authors.initials: D
authors.lastname: Sharp