Display Settings:

Format

Send to:

Choose Destination
We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
BMJ. 2008 Dec 11;337:a2656. doi: 10.1136/bmj.a2656.

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

Author information

  • 1Academic Unit of Primary Health Care, University of Bristol, Bristol BS8 2AA. s.p.hollinghurst@bristol.ac.uk

Abstract

OBJECTIVE:

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

DESIGN:

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

PARTICIPANTS:

579 patients with chronic or recurrent low back pain recruited from primary care.

INTERVENTIONS:

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

MAIN OUTCOME MEASURES:

Costs to the NHS and to participants. Comparison of costs with Roland-Morris disability score (number of activities impaired by pain), days in pain, and quality adjusted life years (QALYs). Comparison of NHS costs with QALY gain, using incremental cost effectiveness ratios and cost effectiveness acceptability curves.

RESULTS:

Intervention costs ranged from pound30 for exercise prescription to pound596 for 24 lessons in Alexander technique plus exercise. Cost of health services ranged from pound50 for 24 lessons in Alexander technique to pound124 for exercise. Incremental cost effectiveness analysis of single therapies showed that exercise offered best value ( pound61 per point on disability score, pound9 per additional pain-free day, pound2847 per QALY gain). For two-stage therapy, six lessons in Alexander technique combined with exercise was the best value (additional pound64 per point on disability score, pound43 per additional pain-free day, pound5332 per QALY gain).

CONCLUSIONS:

An exercise prescription and six lessons in Alexander technique alone were both more than 85% likely to be cost effective at values above pound20 000 per QALY, but the Alexander technique performed better than exercise on the full range of outcomes. A combination of six lessons in Alexander technique lessons followed by exercise was the most effective and cost effective option.

Comment in

PMID:
19074232
[PubMed - indexed for MEDLINE]
PMCID:
PMC3272680
Free PMC Article

Images from this publication.See all images (1)Free text

PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Write to the Help Desk