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The University of Southampton

Research project: Pre-GRACE - GRoup Alexander lessons for Chronic musculoskeletal pain in Everyday practice (GRACE): preliminary development

Currently Active: 

The GRACE study aims to develop an effective and cost-efficient Alexander Technique (AT) intervention for the treatment of chronic or recurrent musculoskeletal pain comprising a mix of group and individual lessons. This study is based on two previous projects, primary evidence for effectiveness stems from the ATEAM RCT and first phase feasibility from the GREAT study. However, the ATEAM intervention was not likely to be cost effective as it was not delivered in a group format (unlike physiotherapy). The GREAT feasibility project was focused on the development of an intervention for back pain only whereas the GRACE study is expanding this to hip, neck and knee pain.  


Pain from back, neck, hip or knee, and often at several sites, are the commonest causes of chronic pain, but treatment options are limited. Improving self-management of chronic illness is a national priority.   
Lessons in Alexander Technique (AT) aim to improve posture and whole body use to help sufferers better manage and prevent pain. Studies indicate that for back pain AT is probably effective and cost-effective, and it may possibly also help neck, hip and knee pain. However 1:1 lessons are costly and do not help people maximise learning opportunities from each other. We have developed a course of mixed individual and group lessons for AT for back pain which was mostly acceptable to patients and teachers, with very encouraging initial results: the outcome patients most care about, functional disability (the number of activities that could not be done because of pain), was reduce by half. We wish to develop a similar course work for a course for hip, knee and neck pain. This will help us make a much stronger case to argue for research funding to support the full development of these interventions to tackle chronic pain. 

Developing the course for chronic neck/hip/knee pain

We will a) set up a PPI  panel as a key stakeholder group for consultation throughout the project b) develop draft teacher training and patient materials using the material developed for back pain as a starting point c) interview patients in advance of the course to understand and barriers participation and to discuss outcome measures  
Initial feasibility study

Having developed the initial materials we will aim to run at least 3 groups of participants with pain in neck, hip or knee pain to receive AT lessons (6 group lessons;4 individual lessons) in groups of 4-6 people.  
Follow-up will be for 3 months in each group to assess pain and quality of life (QOL)and people interviewed to see how acceptable they found the study.  

3 collaborators (involved already) and the wider PPI panel will contribute to the development, study management, and interpretation  

Lead Investigator(s): Prof Paul Little 
Co-applicants: Dr Adam Geraghty and Mr Joseph Little 
FunderNIHR SPCR project 535
Duration: 1 July 2021-30 June 2022  
Contact: Joseph Little -

This study is being conducted by the Primary Care Research Centre.

Related Research Groups

Research theme – Supporting self-management
Content area – Long-term conditions

Related research groups

Primary Care, Population Sciences and Medical Education
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