J Orthop Sports Phys Ther, Epub 30 Mar 2018. doi:10.2519/jospt.2018.7562
Olivier T. Lam, PT
Study Design
Literature review with meta-analysis.
Background
Mechanical Diagnosis and Therapy (MDT), a classification-based system, aims to classify patients into homogenous subgroups to direct treatment.
Objectives
To examine MDT’s effectiveness for improving pain and disability in patients with either acute (<12 weeks duration) or chronic (>12 weeks duration) low back pain (LBP).
Methods
Randomized controlled trials examining MDT in patients with LBP were identified from 6 databases. Independent investigators assessed the studies for exclusion, extracted data, and assessed risk of bias. The standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated to compare the effects of MDT to other interventions in patients with acute or chronic LBP.
Results
Of the 17 studies meeting inclusion criteria, 12 yielded valid data for analysis. In acute LBP, there was no significant difference for pain resolution (P=.11) and disability (P=.61) between MDT and other interventions. In chronic LBP, there was a significant difference in disability (SMD=-0.45) with results favoring MDT compared to exercise alone. There were no significant differences between MDT and manual therapy plus exercise (P>.05) for pain and disability outcomes.
Conclusion
There is moderate to high evidence that MDT is not superior than other rehabilitation interventions for reducing pain and disability in patients with acute LBP. In patients with chronic LBP, there is moderate to high evidence that MDT is superior to other rehabilitation interventions for reducing pain and disability; however, this depends on the type of intervention being compared to MDT.