Movement disorders: is the Feldenkrais method effective? IQWiG Reports - Commission
Cologne; IQWiG; Version 1.0; Feb. 1, 2023. 53 p. tab.
Monography
in En
| BIGG
| ID: biblio-1415726
Responsible library:
BR1.1
ABSTRACT
The Feldenkrais method is presumably preferred by social groups who generally strive to use non-drug and non-surgical interventions for preventing and treating diseases. Since chronic pain is more common in advanced age, older people are likely to be more interested in this method. This health technology assessment (HTA) report investigates the use of the Feldenkrais method as a therapeutic intervention, i.e. only in people with movement disorders, rather than for preventive purposes or in persons with mobility impairments which are not defined in more detail. Demand is nurtured, in part, by the Feldenkrais method being expected to favourably affect private and social life due to greater self-perceived physical mobility. Since the Feldenkrais method's trademark protection is viewed positively, these groups may harbour erroneous assumptions with regard to the benefits to be expected. From an ethical perspective, this tends to be viewed critically because users who do not reap any benefit may have incurred costs to be paid out of pocket (the relevance of this aspect differs between social groups) and not utilized effective therapies. A total of 6 randomized controlled trials (RCTs), all with a high risk of bias, were identified for 5 therapeutic indications, and hints of (greater) benefit were determined for 2 therapeutic indications. For patients with Parkinson's disease, there is a hint of greater benefit of the Feldenkrais method in comparison with the passive strategy of an educational programme in the form of lectures. This benefit consists of improved mobility and health-related quality of life at the end of treatment. In the comparison with active strategies, the available evidence for patients with chronic low back pain is inconsistent. Compared with an educational programme involving trunk stabilization exercises, there is a hint of greater benefit of the Feldenkrais method with regard to improved mobility and health-related quality of life at the end of the 5-week treatment period. In comparison with back school, there is a hint of greater benefit of the Feldenkrais method with regard to pain reduction, but also a hint of lesser benefit of this method with regard to health-related quality of life after 3 months. However, no differences in effects were found directly at the end of therapy. There is no hint of either long-term benefit of the Feldenkrais method or for its benefit in other therapeutic indications. It was also impossible to derive any hint of harm from the Feldenkrais method, with the studies failing to provide data on deaths and adverse events. The question about the benefit of the Feldenkrais method in comparison with active strategies such as extensive physiotherapy generally remains open. The determined evidence is based on group interventions in the "Awareness Through Movement" (ATM) format rather than one-on-one interventions in the "Functional Integration" format (only 4 sessions investigated in 1 study). The intervention costs equal 10 to 20 per person and group session or 60 to 90 per one-on-one session. These costs are typically to be paid out of pocket by patients, a fact which is of differing relevance for different social groups. No studies on health economic aspects are available. If greater benefit were to be confirmed for certain therapeutic indications, some problematic issues might arise from an ethical or organizational perspective, particularly in view of limited access to the method. Since liability issues are conceivable in case of demonstrable physical injuries, the use of the Feldenkrais method as a therapeutic intervention would require corresponding basic medical qualifications of Feldenkrais teachers, possibly with state accreditation. From a social and organizational perspective, use of the Feldenkrais method requires some patient collaboration (to ensure continuity of the intervention) and potentially leads to lower utilization of medically trained healthcare providers. If the costs of the Feldenkrais method were to be covered by statutory health insurance for therapeutic indications with established benefit, the service would need to be offered nationwide by appropriately trained personnel. Additional resources would likely be needed. Overall, little evidence is available. From an ethical perspective, the absence of evidence from RCTs is problematic for informed decision making but does not constitute evidence of an absent benefit. Only 2 small, ongoing RCTs of questionable relevance were identified, and therefore, the availability of evidence is not expected to change in the short term. Due to the limited availability of data, further research is needed, particularly regarding long-term effects of the Feldenkrais method, its application in various therapeutic indications, and in comparison with further active comparator therapies typically used in practice, e.g. physiotherapy.
Key words
Full text:
1
Collection:
05-specialized
Database:
BIGG
Main subject:
Technology Assessment, Biomedical
/
Cost-Benefit Analysis
/
Pain Management
/
Feldenkrais Method
/
Movement Disorders
Type of study:
Clinical_trials
/
Guideline
/
Health_technology_assessment
/
Prognostic_studies
/
Systematic_reviews
Aspects:
Ethics
/
Patient_preference
Language:
En
Year:
2023
Document type:
Monography
Publication country:
ALEMANHA
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ALEMANIA
/
DE
/
DEUSTCHLAND
/
GERMANY