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Takasaki H1, Hirokado M2, Hashimoto S2
1Saitama Prefectural University, Physical Therapy, Koshigaya, Japan, 2Minami Shinjuku Orthopedic Clinic, Tokyo, Japan
Background: Mechanical Diagnosis and Therapy (MDT) has been used for the management of musculoskeletal disorders. MDT uses specific subgroups based on symptom and functional responses to mechanical loadings, not only pathoanatomy, to identify appropriate management strategies. One subgroup is the Derangement Syndrome, where mechanical loading in a specific direction results in symptomatic and functional improvements that rapidly occur and last after loading. There is growing evidence of the Derangement Syndrome of the Spine (Spinal Derangement) in patients with primary complaint of extremity problems. However, it is unknown what percentage of patients with a primary complaint of knee pain, who are classified as Spinal Derangement. Further, in MDT, detailed assessments of the extremity are undertaken after the MDT screening for a Spinal Derangement. Therefore, it may take several sessions for MDT therapists to be clear about the patient's presentation and response before concluding a subgroup.
Purpose: To preliminarily investigate 1) the proportion of patients with non-acute knee pain classified by MDT as Spinal Derangement, and 2) the number of sessions taken to identify the concluding MDT subgroup, in patients with a primary complaint of non-acute knee pain for more than one month.
Methods: The study design was a retrospective chart review. Pre-recorded medical records in a certified McKenzie clinic in Japan, where MDT is routinely used, from March 2012 to December 2016 were reviewed. The patients' identifying information was not used in this study. Evaluations and interventions were undertaken by three credentialed MDT therapists, who the McKenzie Institute International certifies as having at least a minimum level of skill in MDT and/or a diploma MDT therapist, who the McKenzie Institute International certifies as having the highest level of skill in MDT. The MDT therapist had a chance to alter the MDT subgroup based on the patient's symptom and functional changes at each follow-up. The concluding subgroup in this study was confirmed when a clear management strategy was determined and no further change of the subgroup was undertaken through the course of MDT management. A plain radiograph was routinely taken and the severity of knee osteoarthritis was evaluated using the Kellgren-Lawrence grade for knee osteoarthritis by an experienced orthopedic surgeon (Grade 0-1 or Grade 2-4). A two-tailed Fisher´s Exact Test was used to compare proportions of Spinal Derangements between patients with and without LBP, with and without the Kellgren-Lawrence Grade 2-4.
Results:
Data from 101 patients were extracted. The percentage of patients with the concluding subgroup of Spinal Derangement was 44.6%. This was greater in those patient's reporting concomitant LBP (P=.002) and without radiographic findings of knee osteoarthritis (P .001). A concluding subgroup was determined by the 4th session in 80% of patients.
Conclusion(s): Spinal Derangement was common in patients with a primary complaint of non-acute knee pain and four sessions were taken to identify a concluding subgroup for most patients.
Implications: These findings suggest the importance of careful screening assessments of the lumbar spine and follow-up sessions to identify the most appropriate management strategy for patients with a primary complaint of knee pain.
Keywords: Knee, McKenzie, Spine
Funding acknowledgements: No funding
Purpose: To preliminarily investigate 1) the proportion of patients with non-acute knee pain classified by MDT as Spinal Derangement, and 2) the number of sessions taken to identify the concluding MDT subgroup, in patients with a primary complaint of non-acute knee pain for more than one month.
Methods: The study design was a retrospective chart review. Pre-recorded medical records in a certified McKenzie clinic in Japan, where MDT is routinely used, from March 2012 to December 2016 were reviewed. The patients' identifying information was not used in this study. Evaluations and interventions were undertaken by three credentialed MDT therapists, who the McKenzie Institute International certifies as having at least a minimum level of skill in MDT and/or a diploma MDT therapist, who the McKenzie Institute International certifies as having the highest level of skill in MDT. The MDT therapist had a chance to alter the MDT subgroup based on the patient's symptom and functional changes at each follow-up. The concluding subgroup in this study was confirmed when a clear management strategy was determined and no further change of the subgroup was undertaken through the course of MDT management. A plain radiograph was routinely taken and the severity of knee osteoarthritis was evaluated using the Kellgren-Lawrence grade for knee osteoarthritis by an experienced orthopedic surgeon (Grade 0-1 or Grade 2-4). A two-tailed Fisher´s Exact Test was used to compare proportions of Spinal Derangements between patients with and without LBP, with and without the Kellgren-Lawrence Grade 2-4.
Results:
Data from 101 patients were extracted. The percentage of patients with the concluding subgroup of Spinal Derangement was 44.6%. This was greater in those patient's reporting concomitant LBP (P=.002) and without radiographic findings of knee osteoarthritis (P .001). A concluding subgroup was determined by the 4th session in 80% of patients.
Conclusion(s): Spinal Derangement was common in patients with a primary complaint of non-acute knee pain and four sessions were taken to identify a concluding subgroup for most patients.
Implications: These findings suggest the importance of careful screening assessments of the lumbar spine and follow-up sessions to identify the most appropriate management strategy for patients with a primary complaint of knee pain.
Keywords: Knee, McKenzie, Spine
Funding acknowledgements: No funding
Topic: Musculoskeletal: lower limb; Musculoskeletal: spine
Ethics approval required: Yes
Institution: Saitama Prefectural University
Ethics committee: Research Ethics Committee
Ethics number: 27098
All authors, affiliations and abstracts have been published as submitted.
