Trial reportBMJ (Clinical research ed.)2008
Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation.
Trial report in BMJ (Clinical research ed.), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 8 syntheses or guidelines pooled it, 134 citations in OpenAlex.
- Pooled it
- Which interactions matter in economic evaluations? A systematic review and simulation study.BMC medical research methodology · 2020Pooled it
- The effect of journal impact factor, reporting conflicts, and reporting funding sources, on standardized effect sizes in back pain trials: a systematic review and meta-regression.BMC musculoskeletal disorders · 2015Pooled it
- Massage for low-back pain.The Cochrane database of systematic reviews · 2015Pooled it
- Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2011Pooled it
- Cost-effectiveness of general practice care for low back pain: a systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2011Pooled it
- Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence.The British journal of general practice : the journal of the Royal College of General Practitioners · 2011Pooled it
- Costing Methodology and Key Drivers of Health Care Costs Within Economic Analyses in Musculoskeletal Community and Primary Care Services: A Systematic Review of the Literature.Journal of primary care & community healthPooled it
- Stratified primary care versus non-stratified care for musculoskeletal pain: findings from the STarT MSK feasibility and pilot cluster randomized controlled trial.BMC family practice · 2020Trial
- Trial
- Relationship of meeting physical activity guidelines with quality-adjusted life-years.Seminars in arthritis and rheumatism · 2014Trial
- Trial
- Trial
- Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups.Annals of the rheumatic diseases · 2012Trial
- Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial.Lancet (London, England) · 2011Trial
- Article
- Cost-Effectiveness of a Team-Based Integrative Medicine Approach to the Treatment of Back Pain.Journal of alternative and complementary medicine (New York, N.Y.) · 2019Observational
- Cost-equivalence and Pluralism in Publicly-funded Health-care Systems.Health care analysis : HCA : journal of health philosophy and policy · 2018Article
- Handling Missing Data in Within-Trial Cost-Effectiveness Analysis: A Review with Future Recommendations.PharmacoEconomics - open · 2017Review
- Alexander Technique Training Coupled With an Integrative Model of Behavioral Prediction in Teachers With Low Back Pain.Iranian Red Crescent medical journal · 2016Article
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 2 countries.
Funding
Abstract
objectiveAn economic evaluation of therapeutic massage, exercise, and lessons in the Alexander technique for treating persistent back pain.
designCost consequences study and cost effectiveness analysis at 12 month follow-up of a factorial randomised controlled trial.
participants579 patients with chronic or recurrent low back pain recruited from primary care.
interventionsNormal 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 measuresCosts 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.
resultsIntervention 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).
conclusionsAn 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.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.