Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation

doi:10.1136/bmj.a2656

Published 11 December 2008, doi:10.1136/bmj.a2656
Cite this as: BMJ 2008;337:a2656

Research

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation

Sandra Hollinghurst, senior lecturer in health economics¹, Debbie Sharp, professor of primary health care¹, Kathleen Ballard, Alexander technique teacher³, Jane Barnett, research nurse², Angela Beattie, trial manager¹, Maggie Evans, trial manager¹, George Lewith, reader², Karen Middleton, data manager², Frances Oxford, Alexander technique teacher³, Fran Webley, trial coordinator², Paul Little, professor of primary care research²

¹ Academic Unit of Primary Health Care, University of Bristol, Bristol BS8 2AA, ² Primary Care Group, CCS Division, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, ³ Society of Teachers of the Alexander Technique, Linton House, London NW5 1RS

Correspondence to: S Hollinghurst s.p.hollinghurst{at}bristol.ac.uk

Objective An economic evaluation of therapeutic massage, exercise,and lessons in the Alexander technique for treating persistentback pain.

Design Cost consequences study and cost effectiveness analysisat 12 month follow-up of a factorial randomised controlled trial.

Participants 579 patients with chronic or recurrent low backpain recruited from primary care.

Interventions Normal care (control), massage, and six or 24lessons in the Alexander technique. Half of each group wererandomised to a prescription for exercise from a doctor plusbehavioural counselling from a nurse.

Main outcome measures Costs to the NHS and to participants.Comparison of costs with Roland-Morris disability score (numberof activities impaired by pain), days in pain, and quality adjustedlife years (QALYs). Comparison of NHS costs with QALY gain,using incremental cost effectiveness ratios and cost effectivenessacceptability curves.

Results Intervention costs ranged from £30 for exerciseprescription to £596 for 24 lessons in Alexander techniqueplus exercise. Cost of health services ranged from £50for 24 lessons in Alexander technique to £124 for exercise.Incremental cost effectiveness analysis of single therapiesshowed that exercise offered best value (£61 per pointon disability score, £9 per additional pain-free day,£2847 per QALY gain). For two-stage therapy, six lessonsin Alexander technique combined with exercise was the best value(additional £64 per point on disability score, £43per additional pain-free day, £5332 per QALY gain).

Conclusions An exercise prescription and six lessons in Alexandertechnique alone were both more than 85% likely to be cost effectiveat values above £20 000 per QALY, but the Alexander techniqueperformed better than exercise on the full range of outcomes.A combination of six lessons in Alexander technique lessonsfollowed by exercise was the most effective and cost effectiveoption.

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How does the Alexander Technique work? What are the authors findings about the clinical and cost effectiveness of the treatment? Watch this video to find out (12 mins).

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