Correspondence of diagnosis to initial treatment for neck pain

Abstract

Objectives A patient care model has been proposed linking patient assessment to diagnosis to treatment to outcomes. Validation of this method is required. McKenzie developed the mechanical diagnosis and therapy (MDT) process to diagnose neck pain and direct its treatment. No study known to the authors has determined the link between MDT diagnosis and treatment for neck pain. The objective of the current study was to determine inter-rater agreement on the link between MDT diagnosis and treatment for neck pain. Setting Outpatient physical therapy clinics. Participants Fifty-four clinician raters, 20 patients with neck pain. Design Clinicians, MDT-trained for neck pain, viewed videotaped examinations of adult patients with neck pain and rated diagnosis and initial treatment. Main outcomes measures Inter-rater agreement on the MDT diagnosis-treatment link and derangement-directional preference link. Results Inter-rater agreement on the diagnosis-treatment link of derangement-directional preference and not derangement-no directional preference of treatment was with moderate clinical and statistical significance ( κ = 0.46, 95% confidence interval 0.45–0.47; P < 0.001; 86% agreement). There was moderate agreement on derangement-directional preference for the ‘derangement-extension’ link ( κ = 0.40, 95% confidence interval 0.38–0.41; P < 0.001) and ‘derangement-lateral’ link ( κ = 0.45, 95% confidence interval 0.44–0.46; P < 0.001), but with poor agreement for the ‘derangement-flexion’ link ( κ = 0.04, 95% confidence interval 0.02–0.05; P < 0.001). Conclusions Clinicians trained in MDT for neck pain link diagnosis to initial treatment of patients with neck pain with moderate reliability, specifically using extension or laterally directed preference for treatment. The current study contributes towards validation of the diagnosis-treatment link of the MDT patient care model for neck pain.