title: Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review.
abstract: BACKGROUND
  Complementary medicine and alternative approaches to chronic and intractable health conditions are increasingly being used, and require critical evaluation.
  
  
  OBJECTIVE
  The aim of this review was to systematically evaluate available evidence for the effectiveness and safety of instruction in the Alexander Technique in health-related conditions.
  
  
  METHODS
  PUBMED, EMBASE, PSYCHINFO, ISI Web-of-Knowledge, AMED, CINHAL-plus, Cochrane library and Evidence-based Medicine Reviews were searched to July 2011. Inclusion criteria were prospective studies evaluating Alexander Technique instruction (individual lessons or group delivery) as an intervention for any medical indication/health-related condition. Studies were categorised and data extracted on study population, randomisation method, nature of intervention and control, practitioner characteristics, validity and reliability of outcome measures, completeness of follow-up and statistical analyses.
  
  
  RESULTS
  Of 271 publications identified, 18 were selected: three randomised, controlled trials (RCTs), two controlled non-randomised studies, eight non-controlled studies, four qualitative analyses and one health economic analysis. One well-designed, well-conducted RCT demonstrated that, compared with usual GP care, Alexander Technique lessons led to significant long-term reductions in back pain and incapacity caused by chronic back pain. The results were broadly supported by a smaller, earlier RCT in chronic back pain. The third RCT, a small, well-designed, well-conducted study in individuals with Parkinson's disease, showed a sustained increased ability to carry out everyday activities following Alexander lessons, compared with usual care. The 15 non-RCT studies are also reviewed.
  
  
  CONCLUSIONS
  Strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson's-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the elderly, in general chronic pain, posture, respiratory function and stuttering, but there is insufficient evidence to support recommendations in these areas.
authors.affiliation: Department of Health Sciences, University of York, York, UK. julia@woodman.eclipse.co.uk
authors.forename: J P
authors.initials: JP
authors.lastname: Woodman
authors.forename: N R
authors.initials: NR
authors.lastname: Moore
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001416:Back Pain / Q000534:rehabilitation; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D000529:Complementary Therapies / Q000009:adverse effects / Q000379:methods*; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005544:Forecasting; D006801:Humans; D007859:Learning Disabilities / Q000534:rehabilitation; D010300:Parkinson Disease / Q000534:rehabilitation; D061214:Patient Safety; D004856:Postural Balance / Q000502:physiology; D011187:Posture; D012119:Respiration; D013342:Stuttering / Q000534:rehabilitation; D016896:Treatment Outcome