Service users of a hospital based Alexander Technique service for pain have decreased pain levels and reduce their NHS costs associated with pain by half: Results of a mixed methods service evaluation

Abstract

Background: Recent evidence indicates that Alexander Technique (AT) is helpful for relieving the pain of backache (Little et al. 2008), which costs the NHS an estimated £480 million per annum with non NHS costs (such as private consultations and prescriptions) being an additional £197 million (HMSO 1994). The STAT (Society of Teachers of Alexander Technique) approach to AT is a taught approach, where once learned, the ‘student’ (service user) can practise the technique themselves, emphasising self-management. This service evaluation was conducted on the basis that commissioners require information on impact of services on quality of life, health status and NHS costs within a real-world out-patient Pain Management service. The aim of this presentation is to present the results of this service evaluation and discuss with the audience how to disseminate the findings further. Aims and Objectives: The aim of this exploratory mixed methods service evaluation was to explore the role, acceptability and impact of an Alexander Technique service at a hospital out-patient Pain Management Clinic, including service users’ (n=43) experiences of the service and the perceived benefits to the NHS. Methodology: To capture changes in health and quality of life status, as well as record personal and NHS costs amongst service users, we administered four validated, widely used questionnaires: the Brief Pain Inventory, the EQ-5D, MYMOP and the Client Service Resource Inventory at three time points. Independent statisticians analysed each data source separately. For each outcome measure, we calculated mean values at each time point and also the mean change between each pair of time points (baseline and 6 weeks, baseline and 3 months, 6 weeks and 3 months). For all mean values we calculated the associated 95% confidence interval (CI). We also carried out 27 semi-structured telephone interviews with patients, 3 months from baseline. The qualitative data was analysed using a grounded thematic approach, looking for similarities and differences across the accounts to identify patterns and search for ‘deviant cases’. Results: Findings from BPI and MYMOP suggested that overall there was a general trend towards a decrease in scores of approximately one point between baseline and 6 weeks. This improvement was maintained at three months, once the service users were no longer attending Alexander Technique lessons. EQ-5D did not show statistically significant change. Resource use analysis showed that total costs for service users at the three time points did not change over time but standard weekly NHS costs related to pain reduced by over half between baseline and three months (baseline mean = £27.43 [95% CI £19.26 to £35.60], 3 month mean £11.68 [95% CI £4.55 to £18.81]. Thematic analysis of the qualitative data of patient interviews suggest that AT emerged as a technique for managing the perception of pain and patient response to pain; this also led to some behaviour change and changes in self knowledge from the patient. Interviews with Alexander teachers revealed organisational challenges of setting up a new service and the process of learning about a different system with different kinds of patients, which offered a real learning experience. Conclusion: These pilot data appear to suggest that services users of an Alexander Technique service for pain found that their pain decreased and their relationship to their pain changed. Moreover, resource data suggest that these AT service users reduced their NHS costs related to pain by half. This has important implications for the future use of Alexander Technique in pain clinics.