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Efficacy of Alexander Technique in the Treatment
of Chronic Non-Specific Neck Pain: A Randomized
Controlled Trial
Romy Lauche (1), Mareike Schuth (2), Myriam Schwickert (1),
Rainer Lu
¨dtke (3), Frauke Musial (4), Andreas Michalsen (5),
Gustav Dobos (1), Kyung-Eun Choi (1)
(1) Department of Internal and Integrative Medicine, Kliniken
Essen-Mitte, Faculty of Medicine, University of Duisburg-
Essen, Germany
(2) Department of Anesthesiology, Witten/Herdecke University,
Herdecke, Germany
(3) Karl and Veronica Carstens-Foundation, Essen, Germany
(4) The National Research Center in Complementary and Al-
ternative Medicine (NAFKAM), Department of Community
Medicine, Faculty of Health Science, University of Tromso, Norway
(5) Immanuel Hospital Berlin, Department of Internal and
Complementary Medicine, Charite
´University Medical Center
Berlin, Germany
Purpose: Alexander Technique (AT) is an educational method
aiming at increased sensory awareness and kinesthetic control to
modify postural and movement patterns which might be asso-
ciated with musculoskeletal disorders. It has been proven ef-
fective for chronic low back pain; however no study has yet
determined its effects on chronic non-specific neck pain.
Methods: A randomized controlled trial with 3 parallel groups
was conducted. Patients were randomly allocated to either 5
weekly sessions of AT, heat pack application (HEAT) or guided
imagery (GI) each. The primary outcome measure at week 5 was
the neck pain intensity on a 100-mm visual analogue scale;
secondary outcomes included neck disability, quality of life,
satisfaction and safety. Analyses of covariance were applied on
an intention-to-treat population testing ordered hypotheses AT
vs. HEAT and AT vs. GI.
Results: 72 patients were included (65 females, 40.7 7.9
years), 52 of them received all 5 interventions. No significant
group difference was found for neck pain intensity when AT was
compared to HEAT (Difference 4.5; 95% CI: -8.1, 17.1;
p=0.48), but exploratory analysis revealed superiority of AT
over GI (Difference -12.9; 95% CI: -22.6, -3.1, p =0.01).
Significant group differences were also found for physical
quality of life in favor of AT vs. HEAT or GI (p <0.05). Ad-
verse events mainly included slightly increased pain and mus-
cle soreness. Besides high levels of benefit from AT, patients
also reported increased body awareness and control over the
body, relaxing or stimulating effects and mood changes after the
Conclusion: Five sessions of AT were no better than a heat
pack application for relieving chronic non-specific neck pain.
Therefore it cannot be recommended as routine intervention
at this time. Since exploratory analysis revealed some im-
provements of AT further trials are warranted for conclusive
Contact: Romy Lauche,
Qualitative Study in a Randomized Trial Comparing
Yoga, Physical Therapy, and Education for Low Back
Pain in a Predominantly Minority Population
Chelsey Lemaster (1), Julia Keosaian (1), Eric Dorman (2),
Ruth Paris (3), Robert Saper (1)
(1) Boston University School of Medicine, Boston, MA, USA
(2) Department of Religion, Boston University, Boston, MA,
(3) School of Social Work, Boston University, Boston, MA, USA
Purpose: Explore perceived effects of treatments and compare
responses between yoga, physical therapy (PT), and education
participants in a RCT for chronic low back pain (cLBP) with a
predominantly low-income minority population.
Methods: This qualitative study was embedded in a parent RCT
for adults with moderate to severe cLBP who spoke English.
Participants were randomized to yoga, PT, or education arms for
a 12-week treatment phase. Ninety participants who agreed to be
contacted for additional research opportunities were asked to
take part in individual semi-structured interviews. The protocol
included open-ended questions about motivation for participa-
tion, experience with treatment, and perceived effects associated
with participation. Interviews were audio-taped, transcribed,
uploaded into Atlas.ti software and analyzed using a thematic
analysis approach.
Results: To date, 18 yoga, 13 PT, and 8 education participants
have been interviewed post-intervention. They were predomi-
nantly female (77%), black (77%), mean age 50 years (SD 7.8),
earned £$30,000 annually (56%), and had moderate-severe pain
(mean 7.3, SD 1.3). Major themes from preliminary transcript
analysis included: similar expectations for the specific treat-
ments; mental and physical effects of each treatment; and in-
creased knowledge and self-efficacy from all treatments. Most
interviewees mentioned both decreased pain and psychological
effects (improved mood, decreased anxiety, and/or improved
self-efficacy) that they attributed to their intervention. Regarding
most valued effects, a majority of education participants felt
emotional effects were more important than physical effects
while only one PT participant expressed this sentiment. In
contrast to PT and education, yoga participants more often dis-
cussed ‘‘relaxation’’ and feelings of ‘‘peace’’ from their inter-
vention while describing mental effects.
Conclusion: While perceived physical and psychological effects
were reported by participants in all arms, differences in the way
participants regard and convey their experiences with the study
have emerged.
Contact: Chelsey Lemaster,
Randomized Controlled Trial of ‘‘The Work’’
Meditation-Based Intervention for BRCA1/2 Mutation
Shahar Lev-Ari (1), Carla Landau (1), Jiska Cohen-Mensfild
(1), Eitan Friedman (1)
(1) Tel-Aviv University, Tel-Aviv, Israel
Purpose: Female BRCA1/2 mutation carriers have a substan-
tially increased risk for developing breast and ovarian cancer.
Such risks may be associated with emotional distress, sleeping
disorders and fatigue. Although body-mind techniques are
practiced by BRCA1/2 mutation carriers, the effect of medita-
tion interventions in this population has not been reported. Ob-
jective the effectiveness of ‘‘The Work’’ technique, a
meditation-based intervention, on quality of life and psycho-
logical stress parameters among BRCA1/2 mutation carriers.
Methods: 67 Jewish Israeli women carriers of one of the
predominant Jewish mutations in BRCA1/2 genes, who were
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followed-up at the high-risk clinic at Sheba Medical Center
between January 1, 2000 and December 31, 2010 participated
in the study. They were randomly assigned to intervention or
control groups. The intervention program included 12 weekly
group meetings and an individual weekly practice of ‘‘The
Work’’ technique. Outcomes Sleep quality, Clinical distress,
Cancer-related worries and perceived family support were as-
sessed at the beginning and completion of the intervention.
Results: Of the 67 recruited women (mean age 49 8.3 years),
41 were BRCA1 carriers and 26 were BRCA2 carriers. Thirty-
three women were assigned to the intervention group and 34
served as controls. Fifty-six women completed the study. There
was a significant improvement in perceived family support after
the intervention compared with controls F(1,54) =5.04
(P =.029). Sleep quality improved by 30% and Cancer-Related
Worries improved by 6% in the intervention group, but these
differences were not significant. Levels of clinical distress levels
were similar for all women.
Conclusion: ‘‘The Work’’ intervention improved BRCA1/2
mutation carriers’ perception of their family support. Further
controlled studies should evaluate the clinical implementation of
‘‘The Work’’ meditation among women who carry the mutation
in BRCA1/2 genes.
Contact: Shahar Lev-ari,
Alexander Technique and Supervised Physiotherapy
Exercises in Back Pain (ASPEN) Feasibility Trial
Paul Little (1), Beth Stuart (1), Maria Stokes (1), Carolyn Ni-
cholls (2), Lisa Roberts (1), Steve Preece (3), Tim Cacciatore
(4), Simon Brown (1), Colin Steel (5), George Lewith (1),
Adam Geraghty (1), Lucy Yardley (1), Gilly O’Reilly (1),
Caroline Chalk (6), Debbie Sharp (7)
(1) University of Southampton, Hampshire, UK
(2) Brighton Alexander Technical College, Brighton, Sussex,
(3) University of Salford, Lancashire, UK
(4) University College London, UK
(5) Charity Back Care, UK
(6) Bristol Alexander Technique Training School Association,
Bristol, Avon, UK
(7) University of Bristol, Avon, UK
Purpose: To undertake a feasibility trial and perform explor-
atory biomechanical marker analyses. Our previous large study
on Alexander Technique (AT) suggested that it helps back pain
but what mechanisms might be involved.
Methods: Feasibility RCT Participants. Patients with chronic or
recurrent back pain ( >=3 weeks duration) Interventions. Par-
ticipants were allocated by an external randomization line to
four groups: 1) Normal care; 2) 10 weekly AT lessons; 3) 12
weekly EC; 4) 10 AT lessons +12 EC. Main outcome. Roland-
Morris Disability questionnaire (Primary). Days in pain, Von
Korff scale; Overall improvement (Health transition); Fear of
activity; Enablement; Oswestry Index; Aberdeen scale.
Results: 83 patients consented, 69 were randomized and 56
(81%) followed-up at 6 months. RMDQ and other instruments
were sensitive to change, and the preliminary evidence suggests
the Aberdeen scale could be a useful additional measure. Study
procedures were feasible, and three methods of recruitment were
successfully piloted. Exploratory analysis of most clinical out-
comes did not reach significance at the 5% level although some
reached a 10% level by 3 and 6 months, particularly in the com-
bined group. The improvement following each session suggested
ongoing benefit until the last class or lesson, and the overall
improvement was clinically important, comparable to previous
more intensive interventions. Novel biomechanical variables
strongly associated with RMDQ score at 6 months were muscle
tone (beta-coefficient 0.94, 95% confidence intervals 0.48 to
1.40; p <0.0001), proprioception (1.48, 0.83 to 2.12; p <0.0001)
and muscle elasticity ( -4.86, -0.01 to -9.72, p <0.05). AT
improved proprioception at 3 months and elasticity at 6 months,
and physiotherapy also affected elasticity – providing important
mechanistic links between intervention, proprioception, muscle
elasticity, and outcome.
Conclusion: The trial is feasible, and the interventions may
provide clinically important benefits. Muscle tone, elasticity and
proprioception are strongly associated with outcome, and are
likely to be modified by the interventions.
Contact: George Lewith,
Mindfulness for the Fatigue, Anxiety and Depression
in Women with Metastatic Breast Cancer:
A Mixed Method Feasibility Study
Caroline Eyles (1), Geraldine Leydon (1), Caroline Hoffman
(2), Ellen Copson (1), Philip Prescott (1), George Lewith (1)
(1) University of Southampton, Hampshire, United Kingdom
(2) The Haven, Breast Cancer Support, London, United Kingdom
Purpose: The impact of living with metastatic breast cancer
(MBC) is considerable and psychosocial support is beneficial.
Mindfulness-based stress reduction (MBSR) helps the self-
management of anxiety, depression, quality of life (QoL) and
fatigue and has been evaluated in early stage breast cancer but
not MBC. This study investigated the acceptability and feasi-
bility of providing MBSR for women with MBC and of MBSR
in the National Health Service (NHS) setting.
Methods: A mixed method concurrent design. Eligible women
with MBC, an ECOG score of 0–2; stable disease and life ex-
pectancy of 6 months were invited by their oncologist to attend
an 8 week MBSR course. Qualitative interviews with patients
and a focus group with NHS staff were held to explore accept-
ability and feasibility of MBSR and of MBSR within the NHS.
Questionnaires measuring fatigue, anxiety and depression,
mindfulness, disease specific QoL and generic QoL were as-
sessed at baseline, during and after the course.
Results: Nineteen women took part in 3 groups. Commitment to
8 weeks was a reason for non-participation and proved chal-
lenging. Participants reported the course as acceptable with
many benefits. There was high attendance, completion of course
sessions, adherence to home practice, excellent follow-up rates
and questionnaire return rates. Questionnaire data showed sta-
tistically significant and clinically meaningful improvements in
anxiety (3.63,CI: 2.04,5.22), QoL ( -11.84,CI: -19.69, -4.00),
cognitive functioning ( -18.42,CI: -32.81, -4.03), physical func-
tioning ( -5.96,CI: -11.52, -0.41) and insomnia (24.56,CI:7.76,
41.36) when comparing initial baseline measures to those at 24
Conclusion: MBSR is acceptable to patients with MBC and
effective in managing anxiety and improving QoL; but requires a
high commitment of time. There is scope to tailor the inter-
vention so it is less intensive.
Contact: George Lewith,
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... Our own research supports the use of meditation for reducing anxiety and improving quality of life. [9][10][11] As part of MD Anderson's Integrative Medicine Center clinical services, we offer one-on-one meditation consultations and meditation group classes to cancer patients and their caregivers. All patients receiving an individual meditation consultation are asked to complete the Edmonton Symptom Assessment Scale (ESAS) before and after their visit, and overall, patients have reported clinically significant improvements in anxiety, fatigue, sleep, and depression symptoms after meditation sessions. ...
... All patients receiving an individual meditation consultation are asked to complete the Edmonton Symptom Assessment Scale (ESAS) before and after their visit, and overall, patients have reported clinically significant improvements in anxiety, fatigue, sleep, and depression symptoms after meditation sessions. 9 Prior research on the benefits of meditation combined with our own clinical experience suggests that novel, nonpharmaceutical strategies, such as meditation, could prove beneficial for improving mood in cancer patients. To date, there is no information on the ideal frequency and dosing of meditation as a bio-behavioral strategy to help improve mood symptoms. ...
Full-text available
Background We explored the use of a novel smart phone-based application (APP) for delivery and monitoring of meditation to treat mood symptoms experienced by cancer patients Methods We assessed the feasibility of using a meditation delivery and tracking APP over 2-weeks and its impact on cancer patients’ self-reported anxiety and depression. Outpatients reporting depression and/or anxiety were recruited and randomized to the APP or waitlist control group. Assessments included an expectancy scale, exit survey, mood rating before and after each meditation, and the Edmonton Symptom Assessment Scale (ESAS-FS), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI) at baseline and after 2-weeks. The primary aim was to assess feasibility; secondary aims included satisfaction with the APP, association between meditation frequency and length with self-reported symptoms, and change in symptom measures (symptoms, anxiety, depression, and sleep). Results Our study included 35 participants (17 meditation group; 18 controls) who were primarily female (94%) with breast cancer (60%). The 61% enrollment rate and 71% adherence rate met pre-specified feasibility criteria. Most meditation group participants described the APP as “Useful” to “Very Useful” and would “Probably” or “Definitely” recommend its use. Mixed model analysis revealed a statistically significant association between meditation length (5, 10, or 15 minutes) and change in anxiety, with 15-minute sessions associated with greater reductions in anxiety. In the exit survey, more meditation group vs. control group participants reported improved focus, mood, and sleep. Study groups differed significantly by ESAS fatigue score change; the meditation group decreased a median of 1.5 pts (IQR 2.5) and the control group increased a median of 0.5 points (IQR 2). The meditation group, but not the control group, experienced statistically significant improvement in ESAS fatigue, depression, anxiety, appetite, and physical, psychological, and global distress. Change in PSQI and HADS anxiety and depression scores did not reveal any statistically significant between-group differences. Conclusions This pilot study demonstrated the feasibility and acceptability of a meditation APP for cancer patients. Meditation APP users reported improvement in several measures of symptom distress. Future studies should explore ways to enhance the APP’s usability and clinical benefit.
... 10,11 Our research supports the use of meditation for reducing anxiety and sleep disturbance and improving quality of life and cognitive function in cancer patients. [12][13][14] In addition, mind-body programs incorporating meditation provide quality of life benefits for patients as well as their caregivers. 15,16 Although the evidence-base is strong for the efficacy of meditation in an oncology setting, little research has examined the clinical implementation of meditation as a standard of care alongside conventional medical care in a hospital setting. ...
Context: Complementary health approaches such as meditation may help improve cancer patient and caregiver symptoms, yet little research has examined the clinical application of these programs. Objectives: We explored the effects of a meditation group class, offered as part of an integrative medicine clinic at a comprehensive cancer center, on patient and caregiver self-reported symptoms. Methods: Participants (patients and caregivers) of any three meditation group classes offered - Power of Breath (PB), Sacred Sounds (SS), and Movement & Breath (MB) - were asked to complete the Edmonton Symptom Assessment System (ESAS; scale 0-10, 10 most severe) before and after participation. ESAS individual items and subscales were analyzed; distress subscales included global (GDS; score 0-90), physical (PHS, 0-60) and psychological (PSS, 0-20). Data were analyzed examining pre/post meditation scores using paired t-tests and between types of meditation using ANOVAs. Results: 142 unique participants (76 patients and 66 caregivers) attended one or more meditation groups (mean 1.84) from May to December 2015 (265 total attendance: PB n=92; SS n=87; MB n=86). For all participants, we observed clinically significant reduction/improvement in GDS scores (-5.17, SD 8; p< 0.0001) and in individual symptoms (ESAS decrease ≥ 1; means) of well-being (-1.36 SD 1.7; p< 0.0001), fatigue (-1.34 SD 1.9; p< 0.0001), anxiety (-1.26 SD 1.6; p< 0.001), and shortness of breath (-1.2 SD 2; p=0.001). Comparing class length (60 min vs 90 min), class content (PB vs SS vs MB), and participants (caregivers versus patients), there were no statistically significant differences in symptom score reduction. Conclusion: A single meditation group class offered as part of clinical care resulted in relief of multiple self-reported symptoms in both patients and caregivers.
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