Reliability of the Mechanical Diagnosis and Therapy System in Patients With Spinal Pain: A Systematic Review.

BACKGROUND: An updated summary of the evidence for the reliability of the Mechanical Diagnosis and Therapy (MDT) system in patients with spinal pain is needed. OBJECTIVE: To investigate the evidence on the intrarater and interrater reliability of MDT in patients with spinal pain. METHODS: Searches in MEDLINE, CINAHL, Embase, PEDro, and Scopus were conducted for this systematic review. We included any study design as long as reliability of the MDT method was tested in patients with spinal pain. We collected data on the reliability of MDT to identify main and subsyndromes, directional preference, the centralization phenomenon, and lateral shift. The methodological quality of studies was assessed using the Quality Appraisal of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement Studies checklists. RESULTS: Twelve studies were included (8 studies on back pain, pooled n = 2160 patients; 3 studies on neck pain, pooled n = 45 patients; and 3 studies recruited mixed spinal conditions, pooled n = 389 patients). Studies investigating patients with back pain reported kappa estimates ranging from 0.26 to 1.00 (main and subsyndromes), 0.27 to 0.90 (directional preference), and 0.11 to 0.70 (centralization phenomenon). Kappa estimates for studies investigating neck pain ranged from 0.47 to 0.84 (main and subsyndromes) and 0.46 (directional preference). In mixed populations, kappa estimates ranged from 0.56 to 0.96 (main and subsyndromes). CONCLUSION: The MDT system appears to have acceptable interrater reliability for classifying patients with back pain into main and subsyndromes when applied by therapists who have completed the credentialing examination, but unacceptable reliability in other therapists. We found conflicting evidence regarding the reliability of the MDT system in patients with neck pain or mixed pain locations. J Orthop Sports Phys Ther 2018;48(12):923-933. Epub 22 Jun 2018. doi:10.2519/jospt.2018.7876.

Efficacy of the McKenzie method in patients with chronic nonspecific low back pain: a protocol of randomized placebo-controlled trial.

BACKGROUND: The McKenzie method is widely used as an active intervention in the treatment of patients with nonspecific low back pain. Although the McKenzie method has been compared with several other interventions, it is not yet known whether this method is superior to placebo in patients with chronic low back pain. OBJECTIVE: The purpose of this trial is to assess the efficacy of the McKenzie method in patients with chronic nonspecific low back pain. DESIGN: An assessor-blinded, 2-arm, randomized placebo-controlled trial will be conducted. SETTING: This study will be conducted in physical therapy clinics in São Paulo, Brazil. PARTICIPANTS: The participants will be 148 patients seeking care for chronic nonspecific low back pain. INTERVENTION: Participants will be randomly allocated to 1 of 2 treatment groups: (1) McKenzie method or (2) placebo therapy (detuned ultrasound and shortwave therapy). Each group will receive 10 sessions of 30 minutes each (2 sessions per week over 5 weeks). MEASUREMENTS: The clinical outcomes will be obtained at the completion of treatment (5 weeks) and at 3, 6, and 12 months after randomization. The primary outcomes will be pain intensity (measured with the Pain Numerical Rating Scale) and disability (measured with the Roland-Morris Disability Questionnaire) at the completion of treatment. The secondary outcomes will be pain intensity; disability and function; kinesiophobia and global perceived effect at 3, 6, and 12 months after randomization; and kinesiophobia and global perceived effect at completion of treatment. The data will be collected by a blinded assessor. LIMITATIONS: Therapists will not be blinded. CONCLUSIONS: This will be the first trial to compare the McKenzie method with placebo therapy in patients with chronic nonspecific low back pain. The results of this study will contribute to better management of this population.

Psychometric testing confirms that the Brazilian-Portuguese adaptations, the original versions of the Fear-Avoidance Beliefs Questionnaire, and the Tampa Scale of Kinesiophobia have similar measurement properties.

STUDY DESIGN: Translation, cross-cultural adaptation, and psychometric testing of 2 questionnaires. OBJECTIVE: The objectives of this study were to translate and cross-culturally adapt the Fear-Avoidance Beliefs Questionnaire (FABQ) to Brazilian-Portuguese and to test the psychometric properties of the Brazilian-Portuguese versions of the FABQ and the Tampa Scale of Kinesiophobia (TSK). SUMMARY OF BACKGROUND DATA: Self-report measures of fear-avoidance have been widely used in clinical practice and in research. To date there is no Brazilian-Portuguese version of the FABQ and the Brazilian-Portuguese TSK has not yet been comprehensively tested. METHODS: The FABQ was cross-culturally adapted after the recommendations from the Guidelines for the process of cross-cultural adaptation of self-report measures. The Brazilian-Portuguese versions of the FABQ and the TSK were tested for internal consistency, reproducibility, ceiling and floor effects, construct validity, and internal and external responsiveness. RESULTS: Both instruments yielded high values for internal consistency and reproducibility [(Cronbach's alpha FABQ = 0.93 and TSK = 0.82) and (Intraclass Correlation Coefficient FABQ = 0.96 and TSK = 0.93)]. No ceiling and floor effects were detected in either questionnaire. The FABQ and TSK were highly correlated (r = 0.86) and they were moderately correlated with the pain numerical rating scale at baseline (r = 0.42 and r = 0.43, respectively) showing good construct validity. The TSK was shown to be more responsive than the FABQ in all internal and external responsiveness analyses. CONCLUSION: Both the Brazilian-Portuguese versions of the FABQ and the TSK are equally useful in terms of description and identification of patients with fear-avoidance behavior; however, in situations that clinicians or researchers aimed to use fear-avoidance as a follow-up measurement for treatment outcomes it seems that the TSK is the better option due to its better capacity to identify change over time.