Research question of the HTA report:

The aims of this investigation are to

• assess the benefit of treatment with the Feldenkrais method in comparison with treatment without the use of the Feldenkrais method in patients with movement disorders with regard to patient-relevant outcomes,
• determine the costs (intervention costs) and assess the cost effectiveness of treatment with the Feldenkrais method in comparison with treatment without the Feldenkrais method in patients with movement disorders as well as
• review ethical, social, legal, and organizational aspects associated with the use of the Feldenkrais method.

Conclusion of the HTA report:

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.

Publisher

Institute for Quality and Efficiency in Health Care (IQWiG)

Topic

Movement disorders: Is the Feldenkrais method effective?

HTA No.

HT20-05

Date of project start

28 August 2020

Address of publisher

Authors

• Dr. Dr. Vitali Gorenoi, Institute for Epidemiology, Social Medicine and Health Systems Research at Hanover University Hospital, Hanover, Germany
• Dr. Christian Sturm, Clinic for Rehabilitation Medicine, Hanover University Hospital, Hanover, Germany
• Frau Friederike Bonetti, occupational therapist, Clinic for Rehabilitation Medicine, Hanover University Hospital, Hanover, Germany
• Dr. Marcel Mertz, Institute for Ethics, History and Philosophy of Medicine at Hanover University Hospital, Hanover, Germany
• Dr. Hannes Kahrass, Institute for Ethics, History and Philosophy of Medicine at Hanover University Hospital, Hanover, Germany
• Frau Antje Schnarr, Institute for Ethics, History and Philosophy of Medicine at Hanover University Hospital, Hanover, Germany
• Prof. Dr. Christian Krauth, Institute for Epidemiology, Social Medicine and Health Systems Research at Hanover University Hospital, Hanover, Germany
• Prof. Dr. Susanne Beck, Chair of Criminal Law, Criminal Procedure Law, Comparative Criminal Law and Philosophy of Law at the Faculty of Law, Leibniz University Hanover, Hanover, Germany
• Dr. Anja Hagen, Institute for Epidemiology, Social Medicine and Health Systems Research at Hanover University Hospital, Hanover, Germany

Reviewer

• Ricarda Brender, Institute for Epidemiology, Social Medicine and Health SystemsResearch at Hanover University Hospital, Hanover, Germany

Involvement of patients or other persons affected

Three patients or other persons affected were consulted during the preparation of the report.

IQWiG coordinated the project, conducted the literature search for the domains “Benefit assessment“ and “Health economic evaluation”, and prepared the easily understandable summary “HTA compact”.

According to §139b (3) No. 2 of Social Code Book (SGB) V, Statutory Health Insurance, external experts who are involved in the Institute’s research commissions must disclose “all connections to interest groups and contract organizations, particularly in the pharmaceutical and medical devices industries, including details on the type and amount of any remuneration received”. The Institute received the completed Form for disclosure of potential conflicts of interest from each external expert. The information provided was reviewed by a Committee of the Institute specifically established to assess conflicts of interests. The information on conflicts of interest provided by the external experts and external reviewers is presented in Chapter A11 of the full report. No conflicts of interest were detected that could endanger professional independence with regard to the work on the present commission.