Open Access Highly Accessed Study protocol

Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial

Hugh MacPherson1*, Helen E Tilbrook1, Stewart J Richmond1, Karl Atkin1, Kathleen Ballard2, Martin Bland1, Janet Eldred1, Holly N Essex1, Ann Hopton1, Harriet Lansdown1, Usman Muhammad1, Steve Parrott1, David Torgerson1, Aniela Wenham1, Julia Woodman12 and Ian Watt3

Author Affiliations

1 Department of Health Sciences, University of York, York, YO10 5DD, UK

2 Society of Teachers of the Alexander Technique, 1st Floor, Linton House, 39-51, Highgate Road, London, NW5 1RS, UK

3 Department of Health Sciences and Hull York Medical School, University of York, York, YO10 5DD, UK

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Trials 2013, 14:209  doi:10.1186/1745-6215-14-209

Published: 10 July 2013

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/Design

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.

Discussion

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.

Trial registration

Current Controlled Trials ISRCTN15186354