Findings from the development of a novel course of both group and individual Alexander Technique lessons for neck, hip, and knee pain: a mixed-methods study.

Background: Musculoskeletal pain, often affecting multiple sites - including neck, hip, and knee - is common, with limited treatment options. Novel treatments are needed to support self-management, preferably addressing multiple pain sites.

Aim: To develop and explore the acceptability of a short, mixed course of individual (one-to-one) and group lessons in the Alexander Technique (AT), which addresses dysfunctional use of the musculoskeletal system.

Design & setting: A single-centre, mixed-methods study of patients with chronic or recurrent neck, hip, or knee pain from four general practices.

Method: Preliminary development of a course of 10 AT lessons (six group, four individual) took place with a group of AT teachers. Semi-structured interviews of participants were undertaken, which were analysed using inductive thematic analysis. Descriptive pre-post analysis of quantitative scales were used to assess improvement (Numerical pain scale [NRS]; modified Roland-Morris Disability Questionnaire (RMDQ); enablement (modified Patient Enablement Instrument used in the ATEAM trial); and global improvement (Health Transition scale).

Results: Twenty-three participants were included; 18 were interviewed. Commonly, participants found the mixture of group and individual lessons helpful, including helping multiple pain sites, and the mix of different problems enhanced learning. There was moderate improvement in standard quantitative measures over 12 weeks (NRS from 5.15 to 3.85; modified RMDQ 8.26 to 5.7) but with more substantial improvement in enablement and global improvement. Those who perceived underlying structural damage to the knee reported little benefit.

Conclusion: People with chronic or recurrent neck, hip, or knee pain found a course of mixed group and individual lessons in AT helpful in managing their pain, but not those with severe knee problems. Whether standard quantitative measures provide the best measures of effectiveness requires exploration.