亚历山大技术课程、体育锻炼以及按摩（ATEAM）治疗慢性复发性腰背痛的随机对照试验

Randomised controlled trial of Alexander technique lessons, exercise, and massage （ATEAM） for chronic and recurrent back pain

目的确定亚历山大技术课程、按摩疗法以及按照医生运动处方在护士指导下进行体育锻炼对慢性或复发性腰背痛治疗的效果。设计析因随机试验。地点英格兰的64个全科医疗机构。参试者579例慢性复发性腰背痛患者；144例随机接受常规治疗，147例接受按摩治疗，144例接受6节亚历山大技术课程，144例接受24节亚历山大技术课程；每组均有半数患者随机给予运动处方。干预常规治疗（对照）、6次按摩、6或24节亚历山大技术课程以及按照医生运动处方在护士指导下进行体育锻炼。主要结局指标RolandMorris残疾评分（疼痛受损活动数）和疼痛天数。结果体育锻炼和亚历山大技术课程，而非按摩，1年时依然有效（与对照组RolandMorris残疾评分8.1比较：按摩组为-0.58，95％可信区间-1.94－0.77；6节亚历山大技术课程-1.40，-2.77－-0.03；24节亚历山大技术课程-3.4，-4.76－-2.03；体育锻炼组-1.29，-2.25－-0.34）。6节课程之后体育锻炼的疗效为单独24节亚历山大技术课的72％（Roland Morris残疾评分分别为-2.98和-4.14）。课程后前4周腰背痛天数减少（与对照组中位数21天相比，24节课程-18天，6节课程-10天，按摩组-7天）；而且生活质量显著改善。没有明显的损害报告。结论由注册教师提供的一对一亚历山大技术课程可使慢性腰背痛患者长期受益。6节亚历山大技术课程后辅以体育锻炼处方的效果接近24节亚历山大技术课程。

Objective To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise （exercise prescription） along with nurse delivered behavioural counselling for patients with chronic or recurrent hack pain. Design Factorial randomised trial. Setting 64 general practices in England. Parlidpants 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription. Interventions Normal care （control）, six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling. Main outcome measures Roland Morris disability score （number of activities impaired by pain） and number of days in pain. Results Exercise and lessons in the Alexander technique, but not massage, remained effective at one year （compared with control Roland disability score 8.1： massage -0.58, 95% confidence interval -1.94 to 0.77, six lessons -1.40, -2.77 to -0.03, 24 lessons -3.4, -4.76 to -2.03, and exercise -1.29, -2.25 to -0.34）. Exercise after six lessons achieved 72% of the effect of 24 lessons alone （ Roland disability score - 2.98 and -4.14, respectively ） .Number of days with back pain in the past four weeks was lower after lessons （compared with control median 21 days： 24 lessons -18, six lessons -10, massage -7） and quality of life improved significantly. No significant harms were reported. Conclusions One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.