Takasaki H.1
1Saitama Prefectural University, Physical Therapy, Koshigaya, Japan
Background: Mechanical Diagnosis and Therapy (MDT) is a conservative treatment approach for musculoskeletal disorders. Certified MDT practitioners have more bio-psycho-social perspectives for the management of low back pain than general physiotherapists and a great emphasis is placed on patient education in MDT. It is important in MDT to educate patients to manage their symptoms by themselves, to maximize treatment effects and prevention of recurrence. Therefore, it was hypothesized that self-monitoring skills and acquisition of self-management skills, which are important factors of attitudes towards self-management, are enhanced through a course of treatment of MDT. According to the Assessment-Diagnosis-Treatment-Outcome model recommended for designing the body of musculoskeletal research, it was necessary to undertake a prospective cohort study before a randomized control trial (RCT).
Purpose: To investigate if MDT enhances attitude towards self-management in people with musculoskeletal disorders.
Methods: This study was a prospective cohort design with a 1-month follow-up. Participants were out-patients with musculoskeletal disorders who were referred to physiotherapy. The intervention was MDT given maximally twice per week for one month by a credentialed MDT physiotherapist. The primary outcome measures were the Self-monitoring and Insight (SMI) and Skill and Technique Acquisition (STA) scores of the Health Education Impact Questionnaire (HeiQ), whose validity and reliability has been established. The secondary outcome measures were the P4, the 7-point Global Perceived Change Scale (GPCS) (-3: Very much worse, 0: Unchanged, 3: Completely recovered), eight health status criteria assessed by the MOS 36-Item Short-Form Health Survey version 2-week and six other factor scores of the HeiQ.
Results: Forty-five patients participated in the study. Sample size was estimated a priori based on the primary outcomes in an internal pilot study. The three most common symptom locations were the low back (60.0%), neck (17.9%) and knee (8.9%). Consequently, 44 individuals (97.8%) completed the 1-month follow-up. The mean number of treatment sessions was 3.8. The proportion of GPCS≥2 was 71.1%. All outcome measures were significantly improved (All p 0.05) from baseline, particularly, effect size of Hedges´ g being 0.59 (p=0.002) in the SMI and 0.99 (p 0.001) in the STA, respectively.
Conclusion(s): MDT is an effective management strategy for various musculoskeletal disorders and enhances attitudes towards self-management.
Implications: It is suggested that the effect of MDT on the HeiQ scores in the current study were comparative to or greater than previous self-management programs except for the Emotional Distress scores. One explanation for the powerful impact that MDT has on the change of patients attitudes towards self-management may be explained by the educational strategy used in MDT. Education is incorporated in all phases of management with patients actively engaged at all times. MDT therapists maximize patients opportunities to perceive a difference by doing specific exercise. Passive treatments alone would deprive patients the chance to realize that they can manage their symptoms alone and reduces empowerment of patients. It is reported that providing educational material alone does not appear to change behavior. Therefore, this study implies that patients involvement is important to enhance attitudes towards self-management.
Funding acknowledgements: No funding.
Topic: Musculoskeletal
Ethics approval: Approved by The Saitama Prefectural University Ethics Committee (27018), Japan.
All authors, affiliations and abstracts have been published as submitted.
