Can the Alexander Technique improve pain processing and reduce joint loading in patient with knee osteoarthritis?

ISRCTN ISRCTN74086288
DOI https://doi.org/10.1186/ISRCTN74086288
Secondary identifying numbers Protocol v5
Submission date
22/12/2015
Registration date
04/01/2016
Last edited
14/02/2018
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Musculoskeletal Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Osteoarthritis (OA) is the most common type of arthritis, which most often affects the knee. It occurs when the protective cartilage on the end of bones wears away. The bones then rub against one another, which can cause stiffness, pain and a reduction in a person’s range of movement. A number of recent studies have shown that there is no link between perceived pain and the degree of joint wear, when measured with an x-ray. It has been suggested that this may happen because some OA patients are “over-reactive” to pain, because their brains amplify the pain signals coming from the affected joints. This over-reactivity to pain may trigger high levels of inappropriate muscle tension, which in-turn will increase joint loading (the force put on a weight-bearing joint during activity). The Alexander Technique (AT) teaches people how to avoid movements that cause unnecessary tension in their daily lives by increasing self-awareness and “unlearning” bad habits (such as patterns of muscle tension). It is taught by a qualified teacher who uses gentle hand contact and verbal instruction to guide movement, helping patients to become aware of, and to avoid, harmful muscle movements which can be applied to daily actions such as sitting or standing. The aim of this study is to find out whether the AT could help to lower pain and improve joint function in people suffering from knee OA.

Who can participate?
Adults over 40 years of age with knee osteoarthritis, and healthy adults of the same age.

What does the study involve?
All participants take part in 20 sessions over 14 weeks. During each 40 minute session, participants are taught the Alexander Technique by an experienced AT practitioner on a one-to-one basis. During the sessions, patients are encouraged to develop an awareness of patterns of muscle tension which can be triggered when they move which can interfere with practical tasks, such as standing up out of a chair. At the start of the study and at 15 weeks (after the 14 week AT course), participants are assessed in order to measure their pain and joint stiffness and function.

What are the possible benefits and risks of participating?
Participants could benefit from taking part as the AT is considered to be a beneficial form of health education which can affect other areas of health, such as improving breathing technique and reducing back pain. There are no risks for participants taking part in the study.

Where is the study run from?
Centre for Health Sciences Research, University of Salford (UK)

When is the study starting and how long is it expected to run for?
March 2011 to December 2015

Who is funding the study?
The BUPA Foundation (UK)

Who is the main contact?
Dr Stephen Preece
s.preece@salford.ac.uk

Contact information

Dr Stephen Preece
Scientific

Centre for Health Sciences Research
Blatchford Building
Stratham Street
Salford
Manchester
M6 6PU
United Kingdom

ORCiD logoORCID ID 0000-0002-2434-732X
Phone +44 1612 952273
Email s.preece@salford.ac.uk

Study information

Study designNon randomised study
Primary study designInterventional
Secondary study designNon randomised study
Study setting(s)Other
Study typeTreatment
Participant information sheet Not available in web format. Please use the contact details below to request a patient information sheet.
Scientific titleCan neuromuscular re-education with the Alexander Technique improve pain processing and reduce joint loading in patient with knee osteoarthritis?
Study acronymKOAT (Knee Osteoarthritis and and Alexander Technique)
Study objectivesThe primary hypotheses of the study are:
1. The Alexander Technique (AT) would improve clinical measures of pain and function in patients with knee osteoarthritis.
2. The AT would reduce muscle co-contraction in patients with knee osteoarthritis
3. The AT would improve pain processing in patients with knee osteoarthritis
4. Improvements in pain would be related to improvements in muscle co-contraction and improvements in pain processing
Ethics approval(s)1. Ethics Committee of the University of Salford, 10/06/2011, ref: REP11/024
2. NHS North West 10 Research Ethics Committee - Greater Manchester North, 28/03/2011, ref: 11/NW/0057
Health condition(s) or problem(s) studiedKnee osteoarthritis
InterventionAll participants receive the intervention which consists of 20 sessions over a period of 14 weeks. Each session lasts for 40 minutes and is delivered on a one-to-one basis by an experienced Alexander Technique (AT) practitioner. During the lessons patients were encouraged to develop an awareness of patterns of muscle tension which can be triggered as movement is initiated and also which can interfere with functional tasks, such as standing up out of a chair.

Patients are followed up immediately after the end of the intervention (14 weeks post baseline) and then again at 12 months after the end of the intervention (15 months post baseline).
Intervention typeOther
Primary outcome measure1. Pain is measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain component at baseline, immediately after the intervention and 15 months
2. Pain, joint stiffness & function an is measured using the full Western Ontario and McMaster Universities Arthritis Index (WOMAC) at baseline, immediately after the intervention and 15 months
Secondary outcome measuresJoint movement and activity is determined by measuring muscle co-contraction between the medial quadriceps and medial hamstrings during the stance phase of walking and also during a sit-to-stand activity at baseline and after the intervention.
Overall study start date01/03/2011
Completion date01/12/2015

Eligibility

Participant type(s)Mixed
Age groupAdult
SexBoth
Target number of participantsn=20 patients with knee OA and n=20 healthy participants
Key inclusion criteriaKnee osteoarthritis (OA) patients:
1. Over the age of 40
2. Identified on GP record as having knee OA
3. Knee pain on walking
4. Able to speak and write fluent English
5. Able to attend at the University of Salford on two occasions for an assessment
6. Willing to attend for 20 AT lessons with a local practitioner
7. Willing to attend for a knee x-ray

Healthy participants
1. Over the age of 40
2. No musculoskeletal pain
3. Able to speak and write fluent English
4. Able to attend at the University of Salford on two occasions for an assessment
Key exclusion criteria1. Systemic disorders, such as rheumatoid arthritis.
2. Balance or mobility disorders limiting their ability to perform the assessment.
3. Neurological or psychiatric disorder.
4. Malignancy
5. Diabetes
6. BMI greater than 33
Date of first enrolment01/10/2011
Date of final enrolment01/10/2014

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

University of Salford
Centre for Health Sciences Research
Blatchford Building
Stratham Street
Salford
Manchester
M6 6PU
United Kingdom

Sponsor information

University of Salford
University/education

Allerton Building
Frederick Road
Salford
Manchester
M6 6PU
England
United Kingdom

Website www.salford.ac.uk
ROR logo "ROR" https://ror.org/01tmqtf75

Funders

Funder type

Charity

The BUPA Foundation

No information available

Results and Publications

Intention to publish date15/01/2016
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planWe plan to publish the results of this work as 2 separate journal papers, reporting clinical, biomechanical and physiological effects of the AT.
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 27/08/2016 Yes No

Editorial Notes

14/02/2018: Publication reference added.