title: Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Chronic 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
  We 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.
  
  
  CONCLUSIONS
  This 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.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN15186354.
authors.affiliation: Department of Health Sciences, University of York, York, UK. hugh.macpherson@york.ac.uk
authors.forename: Hugh
authors.initials: H
authors.lastname: MacPherson
authors.forename: Helen E
authors.initials: HE
authors.lastname: Tilbrook
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Richmond
authors.forename: Karl
authors.initials: K
authors.lastname: Atkin
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ballard
authors.forename: Martin
authors.initials: M
authors.lastname: Bland
authors.forename: Janet
authors.initials: J
authors.lastname: Eldred
authors.forename: Holly N
authors.initials: HN
authors.lastname: Essex
authors.forename: Ann
authors.initials: A
authors.lastname: Hopton
authors.forename: Harriet
authors.initials: H
authors.lastname: Lansdown
authors.forename: Usman
authors.initials: U
authors.lastname: Muhammad
authors.forename: Steve
authors.initials: S
authors.lastname: Parrott
authors.forename: David
authors.initials: D
authors.lastname: Torgerson
authors.forename: Aniela
authors.initials: A
authors.lastname: Wenham
authors.forename: Julia
authors.initials: J
authors.lastname: Woodman
authors.forename: Ian
authors.initials: I
authors.lastname: Watt
mesh_terms: D015670:Acupuncture Therapy / Q000191:economics; D019540:Area Under Curve; D059350:Chronic Pain / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D004739:England; D017048:Health Care Costs; D006801:Humans; D019547:Neck Pain / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D018579:Patient Selection; D026741:Physical Therapy Modalities / Q000191:economics; D011237:Predictive Value of Tests; D036301:Qualitative Research; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome