The McKenzie Method and its association with psychosocial outcomes in low back pain: a systematic review

Female teleworkers with pain have the highest presenteeism, where its primary contributing variable was not those of musculoskeletal disability

Presenteeism, among desk workers with pain can be affected by musculoskeletal disabilities (MSDs), working styles, and gender. In this study, teleworkers were defined as those who teleworked >70% of the time at home, while others were defined as non-full teleworkers. This study aimed to (1) compare the magnitude of presenteeism among four groups: male and female teleworkers with pain and male and female non-full teleworkers with pain, and (2) create a regression model of presenteeism with 66 independent biopsychosocial variables for each group. Data were collected through an anonymous online survey. Presenteeism was evaluated using the work functioning impairment scale. The 66 independent biopsychosocial variables included four disability measures, namely, stiff neck/shoulders, low back pain, and upper or lower limb problems, along with other factors relevant to presenteeism in previous studies, such as age, body mass index, comorbidities, work-related variables, pain catastrophizing, and various psychological distress measures. Data from 1,068 male non-full teleworkers, 1,043 female non-full teleworkers, 282 male teleworkers, and 307 female teleworkers were analyzed. Presenteeism was the highest among female teleworkers with pain. Furthermore, in all models, overall psychological distress, rather than the four MSD measures, was the primary contributing factor for presenteeism.

Reliability of the McKenzie Method of Mechanical Diagnosis and Therapy in the examination of spinal pain, including the OTHER classifications: Reliability of the McKenzie Method in spinal pain

BACKGROUND

The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is used worldwide to classify and manage musculoskeletal (MSK) problems. The assessment includes a detailed patient history and a specific physical examination. Research has investigated the reliability of the MDT spinal classification system (Derangement syndrome, Dysfunction syndrome, Postural syndrome, and OTHER), however no study has assessed the reliability of the 10 classifications grouped together as OTHER.

OBJECTIVE

To investigate the inter-rater reliability of MDT trained clinicians when utilising the full breadth of the MDT system for patients with spinal pain.

METHODS

Six experienced MDT clinicians each submitted potentially eligible MDT assessment forms of 30 consecutive patients. A MSK physician and a faculty of the McKenzie Institute checked the 180 forms for eligibility and completeness, where a provisional MDT classification was blinded. Apart from their own assessment forms, the six MDT clinicians each classified 150 forms. Each patient could be classified into 1 of 13 diagnostic classifications (Derangement syndrome, Dysfunction syndrome, Postural syndrome, and 10 classifications grouped as OTHER). Reliability was determined using Fleiss' Kappa (k).

RESULTS

The reliability among six MDT clinicians classifying 150 patient assessment forms was almost perfect (Fleiss' κ = 0.82 [95% CI 0.80, 0.85]).

CONCLUSIONS

Among experienced MDT clinicians, the reliability in classifying patient assessment forms of patients with spinal pain is almost perfect when the full breadth of the MDT system is used. Future research should investigate the reliability of the full breadth of the MDT system among clinicians with lower levels of training.

Japanese Clinical Physical Therapists With the Mechanical Diagnosis and Therapy License Are More Competent and Confident in Pain Management Than Those Without It: A Cross-Sectional Study

Background The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) has long been misunderstood as a biomedical approach. In fact, it is a biopsychosocial approach with an up-to-date evidence-based educational curriculum. Recently, it has become possible to partially measure competence in clinical decision-making based on contemporary pain understanding and confidence in pain management using the Pain Understanding and Confidence Questionnaire (PUnCQ). The primary aim of this study was to compare the following outcomes between physical therapists with and without credential license in MDT (Cred.MDT) and the PUnCQ as well as attitudes toward the biopsychosocial perspective, adherence to evidence-based management for low back pain (LBP), and knowledge of modern pain science. The secondary aim was to explore relevant factors in the PUnCQ. Methodology Clinical physical therapists who were managing patients with pain were recruited from two associations (the Japanese Society of Allied Health and Rehabilitation and the Japan Branch of the International McKenzie Institute, who had all acquired at least the Cred.MDT). The following outcomes were measured: (1) the PUnCQ-1 for partial competence in evidence-based clinical decision-making for pain management; (2) part 2 scores of the PUnCQ for confidence in pain management; (3) the Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT) biopsychosocial/biomedical ratio for treatment perspectives; (4) the Knowledge and Attitudes of Pain (KNAP) for knowledge of modern pain science; and (5) a questionnaire for adherence to LBP practice guidelines. Two group comparisons were conducted for the primary aim and a multiple regression analysis for the independent variable of the PUnCQ-1 was conducted for the secondary aim. Results Data from 122 physical therapists (63 and 59 participants with and without the Cred.MDT, respectively) were analyzed. Statistically significantly higher scores were detected for physical therapists with Cred.MDT compared to those without (all p<0.05) for all of the above outcomes. The multiple regression analysis demonstrated that statistically significant contributors to the PUnCQ-1 were part 2 scores of the PUnCQ for the pain management factor (p = 0.016) and acquisition of the Cred.MDT (p = 0.038) (R2 = 0.12). Conclusion Competence and confidence in pain management, attitudes toward biopsychosocial approaches, knowledge of modern pain science and guideline adherence are higher in physical therapists with the Cred.MDT than those without it. Confidence in pain management and acquisition of the Cred.MDT contributed to competence in evidence-based clinical decision-making for pain management.

Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: a scoping review of systematic reviews

BACKGROUND

Musculoskeletal injuries can cause distress, and distress is associated with delayed recovery. Numerous interventions have been developed to facilitate recovery from injury, and several systematic reviews evaluate the efficacy of these interventions for reducing psychological distress.

OBJECTIVES

This scoping review aims to map the synthesised evidence for the relationship between treatment interventions and distress-related outcomes following acute injury. The objectives were (1) to describe the types of interventions that have been evaluated in relation to distress-related outcomes following accidental injury, (2) to examine the scope of distress-related outcomes that have been measured in relation to these interventions and (3) to explore the range of clinical professions that deliver these interventions.

DESIGN

We searched nine electronic databases and grey literature (to 21 April 2022). We included any systematic review reporting on the relationship between interventions delivered in the time following injury and distress-related outcomes. Data relevant to the specific objectives of this scoping review were extracted and described using narrative synthesis.

RESULTS

From 8412 systematic reviews imported for screening, 8266 unique records were screened. 179 were selected for full-text review. 84 systematic reviews were included in the study. Interventional types were pharmacological, psychological, exercise based, physical/manual therapies, virtual reality based, multimodal and workplace based. Interventions were delivered digitally, face to face and using virtual reality by a variety of healthcare professionals, including doctors, nurses, psychologists and physiotherapists. The most frequently reported distress-related variables included anxiety, depression, post-traumatic stress disorder diagnosis.

CONCLUSION

A wide range of interventions may help to mitigate distress following acute accidental musculoskeletal or orthopaedic injury. Even interventions that were not designed to reduce distress were found to improve distress-related outcomes. In view of the important role of distress in recovery from injury, it is recommended that distress-related variables are measured as core outcomes in the evaluation of treatments for acute injuries.

Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis

Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.

Trials and tribulations of transparency related to inconsistencies between plan and conduct in peer-reviewed physiotherapy publications: A methodology review

RATIONALE

The physiotherapy profession strives to be a leader in providing quality care and strongly recognizes the value of research to guide clinical practice. Adherence to guidelines for research reporting and conduct is a significant step towards high-quality, transparent and reproducible research.

AIM/OBJECTIVE

Assess integrity between planned and conducted methodology in randomized controlled trials (RCTs) and systematic reviews (SRs) published in physiotherapy journals.

METHODS

Eighteen journals were manually searched for RCTs and SRs published from 1 July 2021 through 31 December 2021. Studies were included if the journal or specific study was indexed in PubMed and published/translated in English. Descriptive statistics determined congruence between preregistration data and publication.

RESULTS

Forty RCTs and 68 SRs were assessed. Forty-three SRs included meta-analysis (MA). Of the 34 registered RCTs, 7 (20.6%) had no discrepancy between the registration and publication. Two trials (5.9%) addressed all discrepancies, 4 (11.8%) addressed some and 21 (61.8%) did not address any discrepancies. Of the 36 registered MAs, 33 (91.7%) had discrepancies between the registration and publication. Two (5.6%) addressed all discrepancies and three (8.3%) had no discrepancies. Eight SRs without MA published information not matching their registration, and none provided justification for the discrepancies.

CONCLUSION

Most RCTs/SRs were registered; the majority had discrepancies between preregistration and publication, potentially influencing the outcomes and interpretations of findings. Journals should require preregistration and compare the submission with the registration information when assessing publication suitability. Readers should be aware of these inconsistencies and their implications when interpreting and translating results into practice.

Predictors of 1-Year Perceived Recovery, Absenteeism, and Expenses Due to Low Back Pain in Workers Receiving Mechanical Diagnosis and Therapy: A Prospective Cohort Study

This multicenter prospective cohort study aimed to preliminarily explore statistically relevant modifiable and predetermined factors for 1-year perceived recovery, absenteeism, and personal expenses in workers who received Mechanical Diagnosis and Therapy (MDT) for low back pain (LBP). Three stepwise multiple regression models were explored with 42 independent variables, including (1) socio-demographic factors; (2) risk stratification; (3) pain-related variables, psychological variables, and behavioral variables at baseline and changes after a month; (4) therapeutic alliance and exercise adherence at 1-month follow-up; and (5) MDT classification and therapist levels. Data from 58 participants were analyzed, after which a model with a medium effect size was developed for 1-year perceived recovery only. Consequently, patients with derangement syndrome were expected to have improved 1-year perceived recovery, with expected predetermined prognostic factors including shorter symptom duration, self-management skills to lead a healthy life, and less pain catastrophization at baseline. A stronger therapeutic alliance between patient and therapist during the 1-month MDT intervention was identified as an expected modifiable prognostic factor. It may be difficult to accurately predict the annual absenteeism and personal expenses due to LBP given the weak to low effect sizes of the developed models.

The association between self-efficacy on function and pain outcomes among patients with chronic low back pain managed using the McKenzie approach: a prospective cohort study

INTRODUCTION

Self-efficacy is a determinant of function and pain outcomes in patients with chronic low back pain receiving physiotherapy. The McKenzie approach is an effective intervention for patients with back pain that may affect self-efficacy. Study aims were to determine if, among patients with back pain being managed by McKenzie-credentialed physiotherapists: intake self-efficacy is correlated with intake function and pain; intake self-efficacy is associated with changes in function and pain during treatment; self-efficacy improves during treatment; and improvements in self-efficacy during treatment are associated with improvements in function and pain at discharge.

METHODS

Two-hundred-eighty-two subjects with chronic low back pain seen by McKenzie-credentialed clinicians provided data on self-efficacy, function and pain at intake and discharge.

RESULTS

Self-efficacy was correlated with function and pain at intake; however, intake self-efficacy was not associated with function or pain outcomes. Self-efficacy increased during treatment. This increase was associated with improvements in function and pain at discharge.

CONCLUSION

While intake self-efficacy was associated with function and pain when initiating physiotherapy, it did not result in improved treatment outcomes. Specific interventions may be necessary to improve self-efficacy. The increases in self-efficacy observed during treatment were associated with improvements in function and pain outcomes at discharge.

Virtual McKenzie extension exercises for low back and leg pain: a prospective pilot exploratory case series

INTRODUCTION

Current evidence supports the inclusion of directional preference exercises for a subgroup of patients with low back (LBP) and leg pain. Recent pain neuroscience strategies have suggested that cortical restructuring associated with movement activating the body map representation in the brain might account for the observed improvement with the directional preference approach.

OBJECTIVES

To explore whether or not a motor imagery directional preference approach would result in any changes in patients with LBP and leg pain.

METHODS

A consecutive convenience sample of patients with LBP and leg pain were recruited at two outpatient physical therapy clinics. Measurements of LBP, leg pain, fear-avoidance beliefs (FABQ), pain catastrophizing (PCS), active lumbar flexion, and straight leg raise (SLR) were compared before and immediately after a virtual (motor imagery) directional preference exercise.

RESULTS

Statistically significant differences for LBP, FABQ, PCS, active lumbar flexion, and SLR were observed, but only SLR changes met or exceeded the minimally clinically important difference (MCID).

CONCLUSIONS

A brief virtual motor imagery extension treatment yielded some immediate positive shifts in patients presenting to physical therapy with LBP and leg pain. Our results indicate that randomized comparison trials are needed to determine the effect of this intervention on the short- and longer-term outcomes in patients with LBP and leg pain.

Comparison of the effect of the McKenzie method and spiral stabilization in patients with low back pain: A prospective, randomized clinical trial

BACKGROUND

Low back pain (LBP) causes disability in daily life, and presents not only a health but also a socio-economic problem. New treatment options need to be tested and confirmed.

OBJECTIVE

Compare the effect of the McKenzie method and spiral stabilization in patients with LBP.

METHODS

Sixty patients with an average age of 47 years, which were included in our prospective, comparative study were randomly divided into two 30-member groups. One group exercised according to the McKenzie method (MDT), the other one according to the Spiral Stabilization Method (SPS). During the initial examination the Aberdeen Back Pain Scale was used to determine the degree of managing with daily activities and functionality, and the Roland-Morris Disability Questionnaire was used to determine the degree of disability. Check- up was performed after 2 and 6 weeks of treatment.

RESULTS

In both groups, there was a significant improvement in results after 2 and 6 weeks of treatment (p< 0.05). When comparing the effect of 2 and 6 weeks of treatment of both therapeutic procedures (MDT and SPS), the difference was insignificant (p> 0.05).

CONCLUSIONS

None of these two treatment methods achieved better results, as they both have a comparable effect on reducing disability and improving the management of daily activities and physical functions. Therefore, both are equally effective in patients with LBP.