The Effectiveness of the Feldenkrais Method: A Systematic Review of the Evidence

Table 3

Randomised controlled trials of FM (Ernst and Canter, 2005 [4], ) with updated RCTs .

Author (year)	Study design	Sample	Intervention	Control	Outcome	Results	Comments
Ruth and Kegerreis (1992) [6]	RCT; 2 parallel groups	30 healthy volunteers	Single FM sequence	Participation in other random activities	Degree of neck flexion (goniometer); perceived effort during flexion	Greater degree of neck flexion (goniometer) (); less perceived effort during flexion ()	Study has pilot character
Johnson et al. (1999) [7]	RCT; 2-group crossover (2 phases)	20 people with MS	FM:  min sessions at weekly intervals	8 weeks sham nontherapeutic body work	L and R hand dexterity (pegboard test); 8 symptom/performance scores; 5 mood scales	NSD; Less perceived stress following FM ()	Positive result could be due to multiple testing for significance
Lundblad et al. (1999) [8]	RCT; 3 parallel groups	97 females with neck and shoulder problems	FM: 4 individual sessions, 12 group sessions of 50 mins pw, for 16 weeks, home audio tapes	(C1) physiotherapy 2 50 mins per week for 16 weeks; home exercises; (C2) no intervention	Clinical assessments (4 measures); physiological tests (18 measures) complaint indices (5 measures); VAS pain ratings (2 measures); disability and sick leave measures (4 measures)	Prevalence of neck pain and disability during leisure decreased in FM versus C1 or C2 (); 31 of 33 measures NSD	Important baseline differences, possible regression to the mean. High dropout rate and per protocol analysis. Multiple testing for significance
Stephens et al. (2001) [9]	RCT; 2 parallel groups	12 people with MS	FM: 8 2–4 hours sessions over 10 weeks	Educational sessions over 10 weeks	3 clinical tests of balance; 3 symptom scales	Significant improvement in FM compared to C for mCTSIB and Balance Confidence Scale; other 4 outcomes NSD	Very small sample size. No baseline data or statistical analysis available
Smith et al. (2001) [10]	RCT; 2 parallel groups	26 patients with chronic low back pain	FM: one 30-minute session	Attention control	Pain (McGill); anxiety (STAI)	FM not C reduced affective dimension of pain pre-post () C not FM improved sensory dimension of pain pre/posttest (); NSD for evaluative dimension of pain or anxiety	Only acute effects were measured. Baseline differences between FM and C in duration of back pain may be important
Grübel et al. (2003) [11]	RCT; 2 parallel groups	66 patients with cancer	FM: minutes sessions of functional integration in addition to conventional therapies	C: no adjunct therapy	Body image questionnaire; Frankfurter body concept scales; quality of life; sense of movement; and body awareness	Both groups improved in all outcome measures	Nonsignificant trend favoured FM
Additional RCTs
Brown and Kegerreis (1991) [12]	RCT; 2 parallel groups	21 (12 men and 9 women) volunteers pain-free	FM: 45 min audio tape “activating the flexors” lesson	C: listened to the same 45 min audio tape modified to include only instructions pertaining to exercise movements	EMG activity of flexors and extensors (UL); Perception of effort during flexion movement	NSD	There was an overall decrease in mean flexor activity with no change in mean extensor activity for both groups.
Chinn et al. (1994) [13]	RCT; 2 parallel groups	23 subjects with upper back, neck, or shoulder discomfort	FM: single ATM lesson; 22 min audio tape	C: single sham treatment; 30 mins gentle neck and shoulder exercises	Functional reach task; perceived effort during the task	NSD; Reduced perceived effort in FM group ()	Small sample size
Laumer et al. (1997) [14]	RCT; 2 parallel groups	30 patients with eating disorder	FM: 9-hour course	C: did not participate in FM	Body Cathexis Scale; Body Parts Satisfaction Scale; Body perception; emotion inventory; Anorexia- Nervosa-Inventory for Self-Rating; eating disorder inventory-2	FM participants showed increasing contentment with regard to problematic zones of their body and their own health and acceptance and familiarity with their body	Full article in German
James et al. (1998) [15]	RCT; 3 parallel groups	48 healthy undergraduate students	FM: -minute sessions over 2 weeks of 4 different ATM lessons recorded on audiocassette	Relaxation:  min sessions over 2 weeks listened to relaxation training audiocassette; C: no supervised lessons	Hamstring length (modified AKE test)	NSD	Insufficient exposure, low statistical power
Hopper et al. (1999) [16]	Study 1: RCT; 2 parallel groups; Study 2: subsample of Study 1	Study 1: 75 undergrad physio students; Study 2: 39 participants from Study 1	Study 1: FM: single ATM, 45 min audio cassette lesson (no prior FM experience); Study 2: 4 different ATM lessons over 2 weeks	Study 1: C: listened to soft nonverbal music; Study 2: same ATM lessons over 4 sessions in 2 weeks when subjects had prior FM experience	Modified AKE test (hamstring length); Sit and Reach test; Borg’s 6–20 rating of perceived exertion (during sit and reach test)	Study 1: NSD; Study 2: for perceived exertion significant main effect .; NSD others	In both studies there was a significant difference in exertion levels between males and females with males exerting more irrespective of group
Kolt and McConville (2000) [17]	RCT; 2 parallel groups	54 undergrad physiotherapy students with no prior FM experience	FM:  min ATM lessons via audiocassette over a 2-week period	Relaxation:  min relaxation sessions via audiocassette over a 2-week period; C: no specific tasks over 2-week period	Bipolar form of the profile of mood states (POMS-BI)	NSD; Composed-anxious scores of the POMS-BI did vary significantly over time () for all participants. Females in FM and relaxation groups reported significantly lower anxiety scores at completion compared with control	No differences between FM and relaxation groups
Löwe et al. (2002) [18]	Pseudorandomized, consecutive allocation	60 patients transferred to normal ward after acute treatment for MI	FM:  min individual sessions	Relaxation:  min individual PMR; C: no body-oriented interventions	Body image questionnaire (FKB-20, German version); Hospital Anxiety and Depression Scale-German version (HADS-D); Munich Quality of Life Dimensions List (MLDL); German version Generalized Self-Efficacy Scale (GSES)	NSD	Overall improvements were seen in MLDL, GSES, and FKB-20
Stephens et al. (2006) [19]	RCT; 2 parallel groups	38 graduate students	FM:  min ATM sessions/wk, audiotape over 3-week period	C: regular daily activities	AKE (hamstring muscle length)	Significant increase in hamstring muscle length () in ATM group compared with control	Participants varied greatly in the duration and number of home sessions completed
Quintero et al. (2009) [20]	RCT; 2 group (crossover design for control)	3- to 6-year-old children with sleep bruxism	FM: 3 hr sessions 10 during 10-week period based on ATM	C: no details	Various measures of joint function; nocturnal bruxism	Statistically significant increase of CVA angle () for FM c.f. C.; After intervention 77% parents in FM reported no nocturnal bruxism c.f. 15.38% for C	At baseline two groups were comparable
Vrantsidis et al. (2009) [21]	RCT; 2 groups (crossover design for control)	55 participants aged ≥55 years	FM: getting grounded gracefully program (based on ATM) –60 min sessions/wk over 8 weeks	C: continue with usual activity	Frenchay Activity Index; Human Activity Profile; Assessment of Quality of Life; Modified Falls Efficacy Scale; Abbreviated Mental Test Score; four-square step test; timed up and go test; the Step Test; Timed Sit-To-Stand Test; Clinical Stride Analyzer; force-platform measures of gait, mobility, and function; satisfaction survey	Significant effects for gait speed () and Modified Falls Efficacy Scale () for FM group; near significant effect for timed up and go test (); Positive feedback from survey	No significant baseline differences between groups.; High class attendance
Ullmann et al. (2010) [22]	RCT; 2 groups	47 relatively healthy independently living ≥65-year-olds	FM: 1 hour ATM sessions 3x/week for 5 weeks (provided by instructor)	C: waitlist	Falls Efficacy Scale; Activities Specific Balance Confidence Scale; timed up and go and TUG with added cognitive task; GAITRite Walkway System; tandem stance	Balance () and mobility () increased for FM, whilst fear of falling decreased ().	At baseline groups comparable except for higher BMI in intervention group
Hillier et al. (2010) [23]	Pseudorandomized control trial; 2 groups	22 healthy people postretirement	FM: ATM class, 1 hr/week for 8 weeks	C: generic balance class 1 hr/week for 8 weeks	SF-36; Patient Specific Functional Scale (PSFS); timed up and go test; functional reach test (FRT); Single Leg Stance Time (SLS); Walk on Floor Eyes closed (WOFEC)	Significant time effect for all measures except for WOFEC; Significant improvements for both groups for SF-36, PSFS, and FRT.; SLS improved FM ()	Post hoc individual analysis comparisons made
Bitter et al. (2011) [24]	RCT; 3 arms	29 healthy university students	FM1: ATM lesson  min, dominant hand; FM2: same but nondominant hand	C: relaxation lesson  min	Purdue Pegboard Test; Grip-lift test; subjective changes	FM1 significant group by time intervention effect when compared to control group for dexterity
Nambi et al. (2014) [25]	RCT; 3 arms	60 institutionalized ageing people	FM: ATM classes weeks	PI: Pilates classes weeks; C: sham walking weeks.	Functional reach test; timed up and go test; Dynamic gait index; RAND-36 for quality of life	Both FM and PI improved all measures (); C improved TUG and DGI only

RCT: randomised controlled trial; FM: Feldenkrais Method; MS: multiple sclerosis; L: left; R: right; C: control; pw: per week; VAS: visual analogue scale; mCTSIB: Modified Clinical Test of Sensory Integration and Balance; NSD: no significant difference; STAI: State/Trait Anxiety Index; EMG: electromyography; UL: upper limb; ATM: awareness through movement (lesson); min: minutes; AKE: active knee extension test; MI: myocardial infarct; PMR: progressive muscle relaxation; c.f.: compared with; SF-36: short form 36; PI: Pilates.