Abstract
Background and purposeA large randomised controlled trial found that the provision of either Alexander Technique lessons or acupuncture, for those with chronic neck pain, resulted in significantly increased self-efficacy when compared with usual care alone. In turn, enhanced self-efficacy was associated with significant reductions in neck pain at 6 and 12 months. In this analysis we explore the perspectives of participants within the trial, with the aim of gaining a better understanding of how these interventions had an impact. MethodsWe used a longitudinal qualitative approach; in-depth interviews, informed by a topic guide, were conducted with a sample of the trial population. Participants were interviewed twice: at around six months (n = 30) and twelve months (n = 26) after trial entry. Analysis was guided by the principles of grounded theory, and key themes were developed. ResultsFive key themes emerged: pre-trial experiences of biomedical treatment against which subsequent interventions were compared; emergence of tangible benefits from the interventions; factors that contributed to the observed benefits, notably growing self-care and self-efficacy; a developing sense of embodiment as an integral part of the transformative process; and contribution of these factors to sustaining benefits over the longer term. ConclusionsIn-depth interviews revealed a rich array of experiences. They gave insight into the positive impact of the interventions on development of self-care, self-efficacy and embodiment. These findings complement the quantitative trial data, providing a more nuanced understanding of the factors that underpin the previously quantified improvement in self-efficacy and its association with longer-term reductions in pain.
Highlights
In a recent randomised controlled trial of Alexander Technique Lessons or Acupuncture Sessions (ATLAS), both interventions led to long-term benefits for primary care patients with chronic neck pain, with significantly reduced pain and associated disability at 12 months when compared with usual care alone [1]
Drawing on the evidence from the interviews, five key themes emerged in relation to the participants' engagement with the Alexander Technique (AT) or acupuncture (ACU): 1.) Pre-trial experiences of biomedical treatment against which the subsequent intervention was compared
We have reported on the participants' experiences of usual care in the acupuncture and Alexander groups, we have not reported on the experiences of those allocated to the usual care arm of the trial because of limitations of space
Summary
In a recent randomised controlled trial of Alexander Technique Lessons or Acupuncture Sessions (ATLAS), both interventions led to long-term benefits for primary care patients with chronic neck pain, with significantly reduced pain and associated disability at 12 months when compared with usual care alone [1]. For both interventions, increasing self-efficacy was found to be an important factor associated with reduced pain at both 6 and 12 months [1]. These findings complement the quantitative trial data, providing a more nuanced understanding of the factors that underpin the previously quantified improvement in self-efficacy and its association with longer-term reductions in pain
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