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

• Published in: The journal of orthopaedic and sports physical therapy 2018-12, Vol.48 (12), p.1-933
• Main Authors: Garcia, Alessandra Narciso, Costa, Lucíola da Cunha Menezes, de Souza, Fabrício Soares, de Almeida, Matheus Oliveira, Araujo, Amanda Costa, Hancock, Mark, Costa, Leonardo Oliveira Pena
• Format: Article
• Language: English
• ISSN: 0190-6011; 1938-1344
• DOI: 10.2519/jospt.2018.7876

Study Design Systematic review. Background An updated summary of the evidence for the reliability of Mechanical Diagnosis and Therapy (MDT) System in patients with spinal pain is needed. Objective To investigate the evidence on the intra and inter-rater reliability of MDT system in patients with spinal pain. Methods Search strategies on MEDLINE, CINAHL, EMBASE, PEDro and Scopus were conducted. 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 sub-syndromes, directional preference, centralization phenomenon and lateral shift. The methodological quality of studies was assessed using the Quality appraisal tool for studies of diagnostic reliability and The Guidelines for Reporting Reliability and Agreement Studies checklists. Results Twelve studies were included (eight studies on back pain, pooled n=2160 patients; three studies on neck pain, pooled n=45 patients; and three studies recruited mixed spinal conditions, pooled n=389 patients). Studies investigating back pain patients reported kappa estimates ranging from 0.26-1.0 (main and sub-syndromes); 0.27-0.90 (directional preference) and 0.11-0.70 (centralization phenomenon). Kappa estimates for studies investigating neck pain ranged from 0.47 to 0.84 (main and sub-syndromes) and 0.46 (directional preference). In mixed populations kappa estimates ranged from 0.56-0.96 (main and sub-syndromes). Conclusion The MDT system appears to have acceptable inter-rater reliability for classifying patients with back pain into main/sub-syndromes, when applied by therapists who have completed the credentialing examination, but unacceptable reliability in other therapists. We found conflicting evidence regarding the reliability of MDT system in patients with neck pain or mixed pain locations. J Orthop Sports Phys Ther, Epub 22 Jun 2018. doi:10.2519/jospt.2018.7876.