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

Abstract

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.