title: What is the perceived impact of Alexander technique lessons on health status, costs and pain management in the real life setting of an English hospital? The results of a mixed methods evaluation of an Alexander technique service for those with chronic back pain.
abstract: BACKGROUND
  Randomised controlled trial evidence indicates that Alexander Technique is clinically and cost effective for chronic back pain. The aim of this mixed methods evaluation was to explore the role and perceived impact of Alexander Technique lessons in the naturalistic setting of an acute hospital Pain Management Clinic in England.
  
  
  METHODS
  To capture changes in health status and resource use amongst service users, 43 service users were administered three widely used questionnaires (Brief Pain Inventory, MYMOP and Client Service Resource Inventory) at three time points: baseline, six weeks and three months after baseline. We also carried out 27 telephone interviews with service users and seven face-to-face interviews with pain clinic staff and Alexander Technique teachers. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically.
  
  
  RESULTS
  Those taking Alexander Technique lessons reported small improvements in health outcomes, and condition-related costs fell. However, due to the non-randomised, uncontrolled nature of the study design, changes cannot be attributed to the Alexander Technique lessons. Service users stated that their relationship to pain and pain management had changed, especially those who were more committed to practising the techniques regularly. These changes may explain the reported reduction in pain-related service use and the corresponding lower associated costs.
  
  
  CONCLUSIONS
  Alexander Technique lessons may be used as another approach to pain management. The findings suggests that Alexander Technique lessons can help improve self-efficacy for those who are sufficiently motivated, which in turn may have an impact on service utilisation levels.
authors.affiliation: Department of Health and Applied Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK. stuart.mcclean@uwe.ac.uk.
authors.forename: Stuart
authors.initials: S
authors.lastname: McClean
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. sam.brilleman@bristol.ac.uk.
authors.forename: Sam
authors.initials: S
authors.lastname: Brilleman
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. Lesley.wye@bristol.ac.uk.
authors.forename: Lesley
authors.initials: L
authors.lastname: Wye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000628:therapy*; D059350:Chronic Pain / Q000628:therapy*; D000529:Complementary Therapies; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D006282:Health Personnel; D006304:Health Status; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D055815:Young Adult