Talk:Feldenkrais Method

Missing systematic reviews
I'm aware evidence quality matters. Below I offer three systematic reviews, and/or meta-analyses and would balance and improve the definition and efficacy sections. We seem to be excluding sources because they study alternative medicine, kinesiology, or public health when they otherwise conform to methods and standards of evidence quality.

Proposed Additions

 * A 2015 systematic review in Evidence-Based Complementary and Alternative Medicine found that Feldenkrais has "broad application in populations interested in improving awareness, health, and ease of function". Meta-analysis showed significant improvements in both balance and functional reach. The authors noted, "as a body of evidence, effects seem to be generic, supporting the proposal that [Feldenkrais] works on a learning paradigm rather than disease-based mechanisms. Further research is required; however, in the meantime, clinicians and professionals may promote the use of [Feldenkrais] in populations interested in efficient physical performance and self-efficacy."


 * A 2020 review of recent literature in Kinesiology Review studied the effectiveness of Feldenkrais for "improving balance, mobility, and coordination and its effectiveness for management of chronic pain." The authors found that "research clearly supports the effectiveness of the [Feldenkrais Method] for improvement of balance and chronic pain management."


 * A 2022 systematic review and meta-analysis in The International Journal of Environmental Research and Public Health sought to "identify the populations and conditions for which the FM can be used in physiotherapy and to determine the intervention modalities." It found:
 * Elderly people: "Significantly improved gait, balance, mobility and quality of life."
 * Cervical, dorsal, or shoulder pain: "Significantly improved pain, functional balance, and perceived exertion on subjects with cervical, dorsal, or shoulder pain."
 * Chronic low back pain: "Improvements in pain, disability, quality of life and interoceptive awareness."
 * Multiple sclerosis: "Improvement in functional capacity in subjects."
 * Parkinson’s disease: "Significant effects on quality of life and functional tests."
 * It concluded: "Evidence shows that FM has therapeutic effects comparable to other physiotherapy techniques in patients with spine pain. In addition, improvements in mobility and balance were seen in the elderly and people with neurodegenerative diseases." Ocaasit &#124; c 13:43, 3 July 2024 (UTC)


 * Evidence quality does matter. For example, we tend not to use stuff from predatory publishers (like MDPI/IJERP), or from journals that have been stripped of their impact factors due to functioning as paper mills (like both Evidence-Based Complementary and Alternative Medicine and IJERP). MrOllie (talk) 13:17, 4 July 2024 (UTC)


 * Thank you @MrOllie. I still feel there's a shifting of the goalposts. CAM can't use its own sources, or mere RCTs, so researchers publish recent systematic reviews and meta-analyses. Then the journals they publish in are deemed predatory, even if those distinctions are themselves controversial and not universal. These are still indexed journals by PubMed, Scopus, and Web of Science. There is a downgrading by Clarivate, but Impact Factor is itself very disputed. It seems like there's nothing CAM can do to have its worth represented. This is an old concern of mine, dating back to 2009 (!) but I feel like it's raising its head again here. Ocaasit &#124; c 17:55, 4 July 2024 (UTC)
 * It is not a 'shifting of the goalposts' to note that CAM advocates can't seem to get their stuff published in reputable journals. The goalposts' are where they always have been - CAM advocates just can't get past them. MrOllie (talk) 17:58, 4 July 2024 (UTC)
 * Notifying you of this discussion about the 2nd source, at RSN:
 * Reliable_sources/Noticeboard
 * Cheers, Ocaasit &#124; c 17:16, 7 July 2024 (UTC)

Definition: Somatics
I've updated the definition with seven varied sources, from journals, to books, to articles, to websites that broadly locate, or categorize, FM within the field of Somatics. These sources are not superseded by one Australian systematic review, as WP:MEDRS applies to medical claims not definitions, categorizations, types, or kinds of movement practices, some of which, like Yoga and Tai chi, date back thousands of years. FM, by its own definition, and that of many others, is a somatic practice. If there's a dispute in the sources, we describe the debate, we don't ignore it. Ocaasit &#124; c 19:01, 4 July 2024 (UTC)
 * Overciting, especially at the beginning of an article, is a red flag. One good reference is all we need. If none exist, then the content probably should not be at the beginning of the article, nor presented with Wikipedia's voice.
 * Judging by the references, it appears to be an in-world term, so a POV vio. --Hipal (talk) 17:36, 9 July 2024 (UTC)
 * These are seven broad and varied RS. So, "in-world" compared to what? What do you mean by that term? Ocaasit &#124; c 18:47, 9 July 2024 (UTC)
 * So, "in-world" compared to what? Compared to a perspective where Wikipedia's voice is valid rather than alt-med viewpoints, especially those where there's a conflict of interest. As I said, I'm concerned about the use of Wikipedia's voice. I'll add that I have FRINGE and NOT concerns with the choice of references and the weight given them. I hope that answers your questions.
 * Two questions for you:
 * Why are seven references needed?
 * Why are sources from within the Feldenkrais world needed? Within the alt-med world? --Hipal (talk) 21:53, 9 July 2024 (UTC)

Efficacy Contradiction
This article contains two sentences that can't both be right:


 * 1) "There is no medical evidence that the Feldenkrais method improves health outcomes..." (2015)
 * 2) "There is limited evidence that workplace-based use of the Feldenkrais Method may help aid rehabilitation of people with upper limb complaints." (2019)

Either (2) is inaccurate, insufficient, or unreputable; or (1) can't be stated as a plain fact (especially in the lede). Ocaasit &#124; c 14:42, 5 July 2024 (UTC)
 * For context, what (2) says is "The Feldenkrais group showed a significant decrease in neck/shoulder complaints, compared with the physiotherapy and control groups...The authors postulated that this could be because Feldenkrais has a stronger focus on participants’ perceptions and experiences than physiotherapy, and that Feldenkrais has some features in common with relaxation and biofeedback techniques, which have been found to be effective at reducing pain...Feldenkrais should be implemented with caution, as only one study supported [this intervention]...more research needs to be conducted on these interventions." Ocaasit &#124; c 14:47, 5 July 2024 (UTC)
 * Don't use Wikipedia's voice, and don't discard DUE points of view. --Hipal (talk) 17:37, 9 July 2024 (UTC)

Efficacy Contradiction Part 2: The lede
We now have two superseding studies after the Australian 2015 systematic review which found "no evidence". Now we have n=2 of "yes/some evidence". How do we summarize this mix in the lede? Ocaasit &#124; c 19:30, 6 July 2024 (UTC)
 * 1) "There is no medical evidence that the Feldenkrais method improves health outcomes..." (2015)
 * 2) "It is concluded that FM proved to be effective [for LBP], but not in all people with musculoskeletal disorders..." (Elsevier, 2017)
 * 3) "There is limited evidence that workplace-based use of the Feldenkrais Method may help aid rehabilitation of people with upper limb complaints." (Springer, 2019)


 * Usual solution is to summarise by saying "no good evidence". Bon courage (talk) 05:21, 8 July 2024 (UTC)
 * Agree. We need to avoid SYN and POV problems. --Hipal (talk) 17:39, 9 July 2024 (UTC)
 * But there is limited evidence for benefit from three MEDRS quality sources. We don't just disregard them. Ocaasit &#124; c 18:38, 9 July 2024 (UTC)

RSN thread on Kinesiology Review
Please note, I've posted about the Kinesiology Review at RS/N. Feel free to share comments there:

Reliable_sources/Noticeboard

Cheers, Ocaasit &#124; c 17:15, 7 July 2024 (UTC)

IQWIG report
While responding to the above-mentioned RSN query, I came across this 2022 report on the effectiveness of Feldenkrais Method by the German Institute for Quality and Efficiency in Health Care, which is not currently cited in the wikipedia article. Worth considering. Abecedare (talk) 23:58, 7 July 2024 (UTC)
 * Great find! It concludes:
 * "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."
 * "The question about the benefit of the Feldenkrais method in comparison with active strategies such as extensive physiotherapy generally remains open. 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."
 * "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." Ocaasit &#124; c 01:45, 8 July 2024 (UTC)

"From the IQWiG perspective, the studies included in the benefit assessment do not allow drawing any conclusions on the benefit of Feldenkrais as a therapeutic intervention for treating movement disorders."
 * Thanks for the summary though none of the first three points belong in the wikipedia article since following the "benefit assessment" section in which the finding of the studies are summarized, the reports' authors conclude:


 * As the report spells out in great detail, the quality of the reviewed studies in FM is so poor that any hint of benefits they found cannot be taken seriously. Abecedare (talk) 19:11, 9 July 2024 (UTC)

Outdated 2014 Effectiveness Sentence
Paragraph two of the Effectiveness section states:
 * Proponents claim that the Feldenkrais Method can benefit people with a number of medical conditions, including children with autism, and people with multiple sclerosis. However, no studies in which participants were clearly identified as having an autism spectrum disorder or developmental disabilities have been presented to back these claims.

Yet, there is a 2017 Elsevier published RCT of exactly such a study:
 * Title: "The Feldenkrais Method improves functioning and body balance in people with intellectual disability in supported employment: A randomized clinical trial", Journal: Research in Developmental Disabilities, Publisher: Elevier.

As such, the 2nd sentence needs to be augmented or removed to reflect the recent evidence.

Cheers, Ocaasit &#124; c 22:11, 8 July 2024 (UTC)

Ocaasit &#124; c 22:11, 8 July 2024 (UTC)


 * That's a study about people with 'mild to moderate' intellectual disabilities. It does not contradict lack of evidence about autism spectrum disorder or developmental disabilities. The current text is fine. MrOllie (talk) 22:21, 8 July 2024 (UTC)
 * Developmental disability characterizes Intellectual Disability (ID) as a subtype, so I'm not sure it's fine. How could we reword it to be verifiably, medically in line with the available research? Cheers, Ocaasit &#124; c 00:54, 9 July 2024 (UTC)
 * The claims that lack evidence are that Feldenkrais make the disability better somehow or 'benefit' people with severe disabilities.. The cite you've found is about how the exercise improves the gait and balance of elderly people with minor intellectual disability. It's comparing apples and oranges. There is no reason to change the article. MrOllie (talk) 00:57, 9 July 2024 (UTC)
 * Well then perhaps we should say that. "There's no evidence FM benefits people with severe developmental disabilities." That would at least be in line with the newer Elsevier RCT. Cheers, Ocaasit &#124; c 01:07, 9 July 2024 (UTC)
 * If we don't want to update our wording to be verifiable with recent evidence, we can also remove the older 2014 source entirely. That would be appropriate since it's been 10 years and there's a lot of intervening research. Ocaasit &#124; c 01:27, 9 July 2024 (UTC)
 * Also, can you show me where [...] FM Proponents even claim to cure MS? That is either unquoted (not there) or misattributed (from another uncited source). Ocaasit &#124; c 01:29, 9 July 2024 (UTC)
 * That you misread a later source does not make the 2014 source invalid. MrOllie (talk) 01:35, 9 July 2024 (UTC)
 * It's a secondary issue; I never made the claim, but Wikipedia is saying FM proponents did. If there's no source for that, we have to take it out.
 * Back to the original issue, the 2014 source is outdated with recent evidence and we're stating in plain language something directly contradicted by the research. That's not "just fine"; it's wrong and verifiably so.
 * Cheers, Ocaasit &#124; c 01:41, 9 July 2024 (UTC)
 * As I said, it is apples and oranges. The two citations do not contradict each other, directly or otherwise. MrOllie (talk) 01:47, 9 July 2024 (UTC)
 * Do you think ID is not part of DD? Because that's the implication, severe or not. Ocaasit &#124; c 01:52, 9 July 2024 (UTC)
 * I think that a cite about improving the gait of elderly people is irrelevant, as I've explained already. But we are now repeating ourselves. I will wait a bit to see if any other editors care to weigh in. MrOllie (talk) 01:54, 9 July 2024 (UTC)
 * Sounds good. Thank you for the discussion. Ocaasit &#124; c 01:56, 9 July 2024 (UTC)

Two notes: Clearly the Torres-Unda study shouldn't be cited or given any weight. Abecedare (talk) 19:02, 9 July 2024 (UTC)
 * Just add the qualifier "high-quality" before studies in the existing wikitext quoted above and update the citation to this 2017 re-review by the Wisconsin department of health services that uses that approach.
 * FWIW: The Torres-Unda study is a low-qaulity RCT as attested by the IQWIG report which fults it for using no intervantion as comparator (p. 26), lack of blinding (p. 28), inadequate implemented the intention to treat principle (p. 28), high risk of bias (p. 34) and concluded that the study offers no hint of benefit of the Feldenkrais method (...) versus no intervention at treatment end.


 * I'm fine with that @Abecedare. Ocaasit &#124; c 19:08, 9 July 2024 (UTC)

Rewrite of lede
Prior to rewrite: The Feldenkrais Method is a type of exercise therapy devised by Israeli Moshé Feldenkrais (1904–1984) during the mid-20th century. The method is claimed to reorganize connections between the brain and body and so improve body movement and psychological state.

Although there is no medical evidence that the Feldenkrais method improves health outcomes or if it is a cost-effective treatment option, researchers do not believe it poses serious risks.

Rewritten version: The Feldenkrais Method is a form of somatic education      "that integrates the body, mind and psyche through an educational model in which a trained Feldenkrais practitioner guides a client (the ‘student’) through movements with hands-on and verbally administered cues," according to Clinical Sports Medicine. Also studied as an exercise therapy, it was devised by Israeli Moshé Feldenkrais during the mid-20th century. The method is claimed to reorganize connections between the brain and body and so improve body movement and psychological state.

There is limited medical evidence that the Feldenkrais Method improves health outcomes in rehabilitation of people with upper limb complaints and lower back pain. There is very limited evidence FM benefits Parkinson's disease. For other conditions, "there is no solid evidence base on which to make recommendations", and the cost-effectiveness is unknown. Overall, the question of the benefit of FM remains open. Researchers do not believe FM poses serious risks.

Accordingly in 2017 the Australian government identified the Feldenkrais Method as a practice that would not qualify for insurance subsidy, saying this step would "ensure taxpayer funds are expended appropriately and not directed to therapies lacking evidence".

I think the lede should be rolled back, and we discuss what changes are needed. --Hipal (talk) 18:03, 9 July 2024 (UTC)


 * I agree that the old version was superior to what we currently have in the article, which is too focused on jargon, misleading quotes, and unhelpful technicalities. MrOllie (talk) 18:10, 9 July 2024 (UTC)
 * Strong disagree. The old version did not reflect updated evidence, it had a clear skeptical bias rather than an NPOV perspective on non-medical claims, and it was undersourced. It also incorrectly categorized the entire practice, as reflected in seven added RS. Ocaasit &#124; c 18:36, 9 July 2024 (UTC)