Q5 Factors Influence Recovery
Konstantinou 2018 - Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort. - Results
- Longer leg pain duration OR 0.41 - High identity score OR 0.70 - Pt's belief problem will last a long time OR 0.27 strongest independent prognostic factors negatively associated with improvement. The last two factors were similarly negatively associated with improvement in the sciatica subgroup. Factors associated with improvement in disability: - Shorter pain duration - Lower leg pain intensity - Fewer other sx associated with the back and leg pain (lower identity score) - Pt's belief problem will be short-lived, and initially having myotomal weakness.
Rastogi 2022 - Exploring indicators of extremity pain of spinal source as identified by Mechanical Diagnosis and Therapy (MDT): a secondary analysis of a prospective cohort study - Results Odds Ratio
1) History: Presence of Paresthesia OR 1.984 2) History: Change in sx with sitting/neck or trunk flexion/turning neck/when still OR 2.642 3) Physical Exam: Change in sx with posture change OR 3.956 (STRONGEST indicator) 4) Physical Exam: Restriction in spinal mvmt OR 2.633 5) Physical Exam: No restriction in extremity mvmt OR 2.241
May 2018 - Centralization and directional preference: An updated systematic review with synthesis of previous evidence: Limitations
1. Certain studies did not include assessment or treatment based on classification, CEN or DP. 2. There were also studies included that used systems other than the MDT methods: Unfortunately, enough errors and dogmatic statements call into question the quality of this review as a whole. This SR's "split-date" procedures likely explain discrepancies regarding interrater reliability and prevalence rates reported for DP. The review may include more recent studies, but the 2012 SR is of higher quality and based on more established and accepted research strategies.
Werneke 2018 - Directional preference and functional outcomes among subjects classified at high psychosocial risk using STarT - Limitations
Incomplete data collection required that the study results be interpreted cautiously, although the completion rate noted was comparable with previous studies of similar design. The use of a convenience sample limited the generalizability of findings. Likewise, it does not imply cause and effect. The authors suggested a stronger research design for validation. An additional constraint of observational research included the potential impact of unmeasured variables on study results.
George 2011 - Depressive symptoms, anatomical region, and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain. - Objective
Investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions.
Kuhnow 2021 - The McKenzie Method and its association with psychosocial outcomes in low back pain: a systematic review - Results Psychological Distress / Disturbance
It appears the hallmark features of MDT, DP and CEN, impacts psychological distress (PD) as participants who are non-DP were 2.59 time more likely to have PD (Apeldoorn 2012) and that non-CEN was associated with a 1.16 greater risk for mental distress. Risk stratification on the front end using the classic STarT back risk form saw significant reduction in that outcome measure at discharge when using MDT principles (Werneke 2018).
Gupta 2020 - Does Size Matter? An Analysis of the Effect of Lumbar Disc Herniation Size on the Success of Nonoperative Treatment. - Results
It was found that the size of the herniation and the percentage of the canal occupied had no predictive value concerning the failure of conservative management, generating an odds ratio for surgery of 1.00.
Green 2018 - Clinical course and prognostic factors across different musculoskeletal pain sites: A secondary analysis of individual patient data from randomised clinical trials - Results
Knee Pain due to OA has poor long-term outcomes compared to LBP Increasing age, manual work, longer pain duration, widespread pain, and increasing anxiety/depression are associated with poor outcomes regardless of the pain site.
Hider 2015 - Pain location matters: the impact of leg pain on health care use, work disability and quality of life in patients with low back pain - Results
LBP+BK compared to LBP only more likely to be unemployed, take time off work, consult their doctor, receive PT or be referred to another HCP. Statistically significant decrements in EQ-5D for LBP+AK compared to LBP only, and for LBP+BK compared to LBP+AK (p < 0.05)
Kuhnow 2021 - The McKenzie Method and its association with psychosocial outcomes in low back pain: a systematic review - Relevance to MDT
MDT is not explicitly a solutions-finding approach but imbedded in the approach are the tripartite elements of subgroup classification, directional preference, and centralization. These elements, based on the evidence cited above, can "guide the clinician to focus on psychosocial issues." Both DP and CEN influence the comorbidity drives (psychological distress), cognitive, emotional drivers (FABQ), and contextual drives (RTW expectation)
Kilpikoski 2023 - Comparison of magnetic resonance imaging findings among sciatica patients classified as centralizers or non-centralizers: Results
Non-CEN had significantly more intense back pain and were more disabled compared to the CEN. The CEN had more severe degenerative findings on MRI than the Non-CEN: vertebral end-plate changes were 63% and 43%;
May 2012 - Centralization and directional preference: a systematic review: Non-CEN Negative Predictor
Non-centralization was generally a negative predictor of outcome and was more likely to be associated with psychosocial issues. Specifically, non-centralization had OR 9, 13, 2, and 3 for non-organic signs, pain behaviors, somatization, and fear of work, respectively.
Neeley 2022 - Four Variables Were Sufficient for Low Back Pain: Determining Which Patient-Reported Tools Pain and Disability Improvement - OSPRO-YF vs. SBST
OSPRO-YF performed slightly better in some models, no clear advantage over SBST. If risk stratification and matched treatment is the goal, use SBST. If interested in the number of YF across domains to support subsequent clinical action, use OSPRO-YF.
Beneciuk 2018 - Prediction of Persistent Musculoskeletal Pain at 12 Months: A Secondary Analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Validation Cohort Study. - Results
Participants with persistent pain at 12 months (n = 101; 36.2%) had more comorbidities, higher NPRS, and higher OSPRO-ROS and OSPRO-YF tool scores at baseline than those without persistent pain, and the findings were independent of the anatomical region.
May 2012 - Centralization and directional preference: a systematic review: CEN Positive Predictor - Neck
Patients with neck pain who demonstrated centralization in one session were more likely to show overall improvement across sessions. OR for improvement was 9.2, compared to 21.3 for a change in rotation movement and 4.5 for a change in pain intensity. However, a re-analysis found that centralization in one session, and other changes, only predicted overall change in that particular outcome, and not in other impairments.
May 2012 - Centralization and directional preference: a systematic review: CEN Positive Predictor
Patients with sciatica who centralized at baseline had significant improvements in pain and disability both short and long-term. Significantly less likely to undergo lumbar surgery in the following year Surgery OR Non-CEN group was 6.
de Raaij 2018 - The Association of Illness Perception and Prognosis for Pain and Physical Function in Patients With Noncancer Musculoskeletal Pain: A Systematic Literature Review - Results on Function
Physical Function moderate evidence that dimensions of consequences, timeline, control beliefs and identity are prognostic factors at time interval < 6 months. Moderate evidence that illness perception dimensions of consequences, control beliefs (personal), and identity are prognostic factors at time interval > 12 months.
Rastogi 2022 - Exploring indicators of extremity pain of spinal source as identified by Mechanical Diagnosis and Therapy (MDT): a secondary analysis of a prospective cohort study. - Overview
Potential indicators of a spinal source of extremity pain were explored from a prospective cohort study. Five indicators were found to be predictive and can be used by clinicians to aid in spinal/extremity decision-making
Definition of Yellow Flags
Psychosocial risk factors for the development of persistent pain. They can include such domains as fear-avoidance behaviors, incorrect beliefs regarding one's condition, pain catastrophizing, hypervigilance, depression, and social withdrawal.
Beneciuk 2018 - Prediction of Persistent Musculoskeletal Pain at 12 Months: A Secondary Analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Validation Cohort Study - Limitations
Recruitment of participants relied on convenience sampling, which could have introduced selection bias Second, the 63.4% follow-up rate at 12 months was lower than anticipated; therefore, selection bias could influence the generalizability of results
Rastogi 2022 - Exploring indicators of extremity pain of spinal source as identified by Mechanical Diagnosis and Therapy (MDT): a secondary analysis of a prospective cohort study - Limitations
Results of the current study would need to undergo a validation study in another sample to confirm findings. The original study by Rosedale et al. 2019) was done by MDT-trained clinicians, so it may not apply to clinicians utilizing other treatment approaches. However, as noted by the authors, many clinicians should be able to easily incorporate some of these clinical indicators into everyday practice with little formal MDT training (especially the history-related questions). No formal reference standard was utilized (no injections to confirm possible anatomical sources of symptoms).
Kilpikoski 2023 - Comparison of magnetic resonance imaging findings among sciatica patients classified as centralizers or non-centralizers: Conclusion
Sciatica pt's non-centralizers had significantly more severe back pain, and were significantly more disabled than centralizers, who instead had more severe degenerative findings on MRI. Thus, classification to non-centralizers by MDT does not predict a higher incidence of degenerative findings on MRI than centralizers.
Rethorn 2019 - Social Determinants of Health: If You Aren't Measuring Them, You Aren't Seeing the Big Picture. - SDH Definition
Social determinants of health (SDH) directly contribute to well-being and health outcomes. SDH influences individuals' health behaviors and lifestyle choices by making it more accessible, more challenging, and more or less desirable to choose healthier behaviors over less healthy behaviors. SDH = Economic stability, education, health and health care, neighborhood and built environment, and social and community context
Ibrahim 2020 - Big Five Personality Traits and Disabling Chronic Low Back Pain: Association with Fear-Avoidance, Anxious and Depressive Moods - Definition Neuroticism
The Neuroticism dimension of the Five-Factor Model assesses the individual's tendency to experience negative emotions and interpret ordinary situations as threatening and minor frustrations as hopelessly difficult.
Yarznbowicz 2020 -A prospective study of patients with shoulder pain and Mechanical Diagnosis and Therapy (MDT) - OTHER subgroups
The OTHER subgroups had the highest pain and disability outcomes at discharge of any of the classifications. They may represent a spectrum of problems more resistant to physical therapy intervention. This may help determine prognosis and guide appropriate care.
Tsuge 2020 - Does the Keele STarT Back Screening Tool Contribute to Effectiveness in Treatment and Cost and Loss of Follow-Up of the Mechanical Diagnosis and Therapy for Patients with Low Back Pain? Relevance to MDT
The SBST does not influence the effectiveness of MDT. This appeared to correlate with previous literature reporting that the functional status at discharge was not predicted by the patient's psychological status (Werneke 2016) Directional preference and/or centralization that this finding will many times demonstrate improvements in all outcome measures, including the psychosocial impairments as well. While lack of directional preference or centralization can contribute to poorer prognosis and increased risk of chronic disability (Werneke 2001)
Rastogi 2022 - Exploring indicators of extremity pain of spinal source as identified by Mechanical Diagnosis and Therapy (MDT): a secondary analysis of a prospective cohort study - Relevance to MDT
The author's note this is one of the first studies to provide a combination of clinical indicators to predict a spinal source for isolated extremity pain. These clinical indicators need to be validated in subsequent studies. This provides good clinical utility, allowing clinicians to use these indicators to determine the likelihood of a spinal source for extremity pain.
Steenstra 2017 - Systematic Review of Prognostic Factors for Return to Work in Workers with Sub Acute and Chronic Low Back Pain. - Results
The impact of pain, functional status, and radiating pain seems to change with the duration of work disability. Workers' recovery expectations remain important after six weeks. Modified duties are rarely studied in later phases of work disability. Depression/mental health did not appear to be an important factor in later phases. Workplace physical factors remain important.
Beneciuk 2018 - Prediction of Persistent Musculoskeletal Pain at 12 Months: A Secondary Analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Validation Cohort Study - Results Comorbidities
The number of comorbidities (odds ratio [OR] range = 0.30-0.46) Compared to pt's with ≥ 2 comorbidities; those with no comorbidities less likely to have persistent MSK pain at 12 months
Kuhnow 2021 - The McKenzie Method and its association with psychosocial outcomes in low back pain: a systematic review - Objective & Methods
The objective of this recent systematic review "is to understand if there is an association between MDT and various psychological outcomes in adults with LBP." The authors identified from their search strategy (MDT/lumbar pain/ psychosocial factors) 16 studies (5 RCT n = 11 Observational n = 11) totaling 4,005 individuals with LBP. The authors identified seven (7) items to be investigated for analysis: fear-avoidance scale, kinesiophobia scales, depression measures, RTW outcomes, psychosocial distress, overall psychological wellness measures, and health care utilization.
Kuhnow 2021 - The McKenzie Method and its association with psychosocial outcomes in low back pain: a systematic review - Results Return to Work
The observational studies display impressive results with the hallmark feature of CEN and RTW. Those who display CEN have a 31% greater chance of RTW (68.4% CEN vs 52.2% non-CEN Long 1995). In another study, non-CEN has a 9.4 more likely not to RTW at 12 months (Werneke and Hart 2001). CEN were 2.25 and 9.99 times more likely to work full time at 9 months and 12 months respectively (Edmond 2010). Finally, CEN RTW more frequently than non-CEN (Kara 1997).
Rastogi 2022 - Exploring indicators of extremity pain of spinal source as identified by Mechanical Diagnosis and Therapy (MDT): a secondary analysis of a prospective cohort study - Results Sens/Spec
The optimal number of indicators for classification was two (sens = 0.638, spec= 0.807). Post-test probability 73% 4 indicators, sens = 0.1, spec = 0.99 , Post-test probability 88.5%
Neeley 2022 - Four Variables Were Sufficient for Low Back Pain: Determining Which Patient-Reported Tools Pain and Disability Improvements. - Results
The parsimonious "best model" for the prediction of the 180-day MDQ change included three predictors (Admit MDQ, NIH-CP, and OSPRO ROS+) because it had the lowest penalized goodness-of-fit statistic (BIC = −35.21) The parsimonious "best model" for 180-day NPRS change included 2 variables (Admit NPRS and OSPRO-ROS+)
George 2011 - Depressive symptoms, anatomical region, and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain - Results Prevalence
The prevalence of severe depression was higher in women, in industrial and pain clinics, and in patients who reported chronic pain or prior surgery. Lower prevalence rates were found in patients > 65 y/o and those who had UE or LE pain.
May 2012 - Centralization and directional preference: a systematic review: Overview
The review included 54 studies relating to centralization and 8 relating to directional preference exercises. The prevalence on centralization was 44% in back and neck pain, with higher prevalence in acute (74%) than sub-acute or chronic symptoms (42%). Twenty-one of 23 studies supported the prognostic validity of centralization, whereas 2 did not. Centralization and directional preference appear to be useful treatment effect modifiers in 7 of 8 studies. Levels of reliability were very varied (kappa 0.15-0.9).
George 2011 - Depressive symptoms, anatomical region, and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain - Methods Depression
The severity of depressive symptoms was assessed with the SCL-90-R depression scale.
Werneke 2018 - Directional preference and functional outcomes among subjects classified at high psychosocial risk using STarT - Overview
This cohort study examined 138 patients classified as High STarT (high psychosocial risk) evaluated and treated using MDT. Those with a Directional Preference (65% of the cohort) demonstrated greater improvements in function than those with no Directional Preference. MDT management may be an alternative for STarT high-risk patients.
Yarznbowicz 2020 -A prospective study of patients with shoulder pain and Mechanical Diagnosis and Therapy (MDT). - Overview
This prospective cohort study looked at the prevalence of MDT classifications in the shoulder and examined these classifications in relation to the outcomes. It concluded that shoulder Derangements and Dysfunctions were common, and their outcomes conformed to the classifications predicted prognosis
Yarznbowicz 2018 - Pain pattern classification and directional preference are associated with clinical outcomes for patients with low back pain - Overview
This prospective cohort study, with 639 patients with complete data, examined the association between pain pattern classification, directional preference, and outcomes. Both centralizers and those with directional preference had better pain and functional outcomes
Tsuge 2020 - Does the Keele STarT Back Screening Tool Contribute to Effectiveness in Treatment and Cost and Loss of Follow-Up of the Mechanical Diagnosis and Therapy for Patients with Low Back Pain? - Overview
This retrospective chart study of MDT practice investigated whether medium-high risk in the STarT Back Screening Tool contributes to time and sessions until discharge and to loss of follow-up before identifying a promising management strategy. It did not impact time or sessions until discharge for 89 participants. Those with medium-high risk in the Mechanically Inconclusive subgroup were 4.61 times more likely to be lost to follow-up by the fifth session than the low-risk group.
Yarznbowicz 2018 - Pain pattern classification and directional preference are associated with clinical outcomes for patients with low back pain - Prevalence
This study did support that Directional Preference (DP) is common in clinical practice and occurs more often than Centralization (CEN). DP 84.5% vs CEN 19.6% prevalence.
Kilpikoski 2023 - Comparison of magnetic resonance imaging findings among sciatica patients classified as centralizers or non-centralizers: Overview
This study examined the relationship between MRI findings and CEN vs NON-CEN. CEN had significantly more degenerative change, end plate damage and spondylosis than NON-CEN, but no differences in other MRI findings.
Yarznbowicz 2018 - Pain pattern classification and directional preference are associated with clinical outcomes for patients with low back pain - Relevance to MDT
This study supports the (+) trend of eliciting DP CEN on the initial visit as a predictor of greater functional gains and greater pain reduction following a course of intervention. The classification of DP CEN had 3.43 greater points on the RMDQ, indicating improved function compared to the Non-DP Non-CEN. DP CEN also has 1.99 greater points of reduction in pain compared to the Non-DP Non-CEN.
May 2018 - Centralization and directional preference: An updated systematic review with synthesis of previous evidence: Overview
This systematic review found 43 additional articles from the previous review. Prevalence of Centralisation was 40% and Directional Preference was 66%, and they were both confirmed as key prognostic factors in patients with low back pain with limited evidence for the cervical spine.
Kuhnow 2021 - The McKenzie Method and its association with psychosocial outcomes in low back pain: a systematic review. - Overview
This systematic review looked at the association between MDT intervention and psychosocial outcomes. It found that there was an association with improving fear-avoidance beliefs, pain self-efficacy, depression, and psychological distress.
Naye 2023 - Six Externally Validated Prognostic Models Have Potential Clinical Value to Predict Patient Health Outcomes in the Rehabilitation of Musculoskeletal Conditions: A Systematic Review. - Results
We found 6 externally validated models with adequate measures, which could be deemed clinically valuable (1) STart Back Screening Tool (2) Wallis Occupational Rehabilitation RisK model (3) Da Silva model (4) PICKUP model (5) Schellingerhout rule (6) Keene model Despite having a high risk of bias, which is mostly explained by the very conservative properties of the PROBAST tool, the 6 models remain clinically relevant.
May 2012 - Centralization and directional preference: a systematic review: Prognosis of CEN vs psychosocial
When centralization was present, fear beliefs did not need to be addressed, whereas if non-centralization was present fear beliefs should be addressed. The presence of centralization also confounded the association between depression and somatization and had an impact on chronic pain and disability. Centralization was a more significant predictor than fear-avoidance, bothersomeness and depression, work satisfaction, Waddell signs, pain behaviors, depression, somatization, fear-avoidance, and referral of symptoms.
Werneke 2018 - Directional preference and functional outcomes among subjects classified at high psychosocial risk using STarT - Results MDT DP
When patients classified as SBST high-risk demonstrated DP, a significant and clinically important increase in functional status score was identified. Functional status outcomes changed by an average of 30.8 points over 7.5 visits. MDT clinicians, despite a lack of formal cognitive behavioral training, demonstrated successful intervention. This implies that the latter might not be required to achieve favorable results as previously described within the literature.
May 2012 - Centralization and directional preference: a systematic review: Prognosis of DP
Whereas directional preference accompanied by centralization predicted a good outcome in terms of pain and function, directional preference by itself was not a useful predictor of function.
Kuhnow 2021 - The McKenzie Method and its association with psychosocial outcomes in low back pain: a systematic review - Results Fear Avoidance
In the 3 RCT investigating FABQ and kinisiophobia, the results displayed improvements in FABQ-PA and work in the short term (Mbada 2015), improvements in kinesiophobia at 6 months (Moffet 2016) and kinesiophobia in the long term (Garcia 2018). The observational studies demonstrated similar improvement in FABQ-PA in the short term (Al-Obaidi 2011). The second observation study revealed the sub-group CEN to have favorable FABQ-PA in the short term.
Beneciuk 2018 - Prediction of Persistent Musculoskeletal Pain at 12 Months: A Secondary Analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Validation Cohort Study - Methods
Comorbidities: with Charlson Comorbidity Index and Functional Comorbidity Index OSPRO-ROS, identify systemic involvement of cardiovascular, gastrointestinal, endocrine, nervous, integumentary, pulmonary, and musculoskeletal. The OSPRO-YF tool was administered at baseline, 4 weeks, and 6 and 12 months later. Includes items from pain vulnerability (negative affect and fear avoidance) and pain resilience domains (positive affect and self-efficacy) to assist with the identification of psychological distress.
George 2011 - Depressive symptoms, anatomical region, and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain - Results Effect Size
Depressive symptoms had a moderate to large effect on pain ratings (Cohen d 0.55-0.87) and a small to large effect on functional status (Cohen d 0.28-0.95). In multivariate analysis, depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations, except for discharge values for the cervical region.
Naye 2023 - Six Externally Validated Prognostic Models Have Potential Clinical Value to Predict Patient Health Outcomes in the Rehabilitation of Musculoskeletal Conditions: A Systematic Review. - Definition of Discrimination
Discrimination refers to the model's ability to distinguish between the absence and presence of the outcome correctly. Discrimination performance measure must be between 0.61 and 0.75 to be possibly helpful and> 0.75 to be clearly helpful for clinicians
Ibrahim 2020 - Big Five Personality Traits and Disabling Chronic Low Back Pain: Association with Fear-Avoidance, Anxious and Depressive Moods. - Conclusion
Clinicians would benefit from assessing patients' personality traits to address protective and risk factors for psychological distress, particularly in difficult-to-treat, highly disabled low back pain patients.
Beneciuk 2018 - Prediction of Persistent Musculoskeletal Pain at 12 Months: A Secondary Analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Validation Cohort Study - Purpose
Identify patient factors predictive of persistent MSK pain 12 months after PT
Naye 2023 - Six Externally Validated Prognostic Models Have Potential Clinical Value to Predict Patient Health Outcomes in the Rehabilitation of Musculoskeletal Conditions: A Systematic Review. - Results Discrimination value
1. Forsbrand et al for their prediction of health-related quality of life (discrimination =0.73) and work ability (discrimination =0.68) at an endpoint between 11 and 27 months for people with acute/subacute low back or neck pain. 2. Luthi et al for their prediction of return-to-work (dis- crimination =0.73) at 24 months for people with orthopedic trauma. 3. Da Silva et al for their prediction of number of days to pain recovery (discrimination = 0.71) at 1 month for people with acute low back pain. 4. Traeger et al for their prediction of chronicity (discrimi- nation = 0.66) at 3 months for people with low back pain. 5. Schellingerhout et al for their prediction of global per- ceived recovery (discrimination =0.66) at 6 months for people with neck pain. 6.Keene et al for their prediction of poor outcome (ie,severe persistent pain and/or severe functional difficulty and/or sig- nificant lack of confidence in the ankle and/or recurrent sprain) (discrimination = 0.64) at 9 months for
de Raaij 2018 - The Association of Illness Perception and Prognosis for Pain and Physical Function in Patients With Noncancer Musculoskeletal Pain: A Systematic Literature Review - Definition
1. Identity: label given to condition by patients and symptoms perceived to go with it 2. Timeline-chronic: how long the patient believes the illness will last 3. Consequences: how strong the impact of the patient's illness is on pain or function 4. Casual beliefs: patient's beliefs about what causes the illness 5. Control beliefs: patient's beliefs about how to control or recover from the illness.
Neeley 2022 - Four Variables Were Sufficient for Low Back Pain: Determining Which Patient-Reported Tools Pain and Disability Improvements - Implications
A model consisting of baseline pain and disability ratings, NIH task force definition of chronic LBP, OSPRO-YF, and Review of Systems + tools was suggested as a standard model to consider for clinical implementation.
Rethorn 2019 - Social Determinants of Health: If You Aren't Measuring Them, You Aren't Seeing the Big Picture. - Overview
A recent viewpoint discussed how social determinants of health (economic stability, education, neighborhood, built environment) play a large role in overall health and recovery. About 20% of recovery can be attributed to the actual health care provided. Whereas the remaining 80% is attributed to the remaining social determinants. Social and economic factors: 40% Environmental factors: 10% Behavioral patterns: 30%.
Werneke 2018 - Directional preference and functional outcomes among subjects classified at high psychosocial risk using STarT - Methods
A total of 138 patients experiencing non-specific low back pain were evaluated. Patients were included if identified as high psychological risk using the SBST and age 17 or older. Following the principles and practices of MDT, patients were classified into a DP or No-DP category at initial assessment. If present, treatment was guided by DP. Alternatively, an individualized rehabilitation program was created at the discretion of the treating PT. Regardless of classification however, all patients received the same educational component in which self-efficacy and locus of control was promoted within the rehabilitation process.
Kuhnow 2021 - The McKenzie Method and its association with psychosocial outcomes in low back pain: a systematic review - Results Depression
Achieving a DP based on LBP presentation promoted lower Beck Depression scores per Long 2004 and having non-CEN saw the odd ratio (OR) 1.23 time more likely than CEN for depression (Christiansen 2009).
de Raaij 2018 - The Association of Illness Perception and Prognosis for Pain and Physical Function in Patients With Noncancer Musculoskeletal Pain: A Systematic Literature Review. - Results
Across 15 cross-sectional studies on 9 different musculoskeletal conditions, the researchers found limited to moderate evidence for a consistent direction of the relationship of illness perceptions with pain intensity and physical function. Higher maladaptive illness perceptions imply stronger pain intensity and more limitation in physical function. Evidence in longitudinal studies is lacking, especially on pain.
Ibrahim 2020 - Big Five Personality Traits and Disabling Chronic Low Back Pain: Association with Fear-Avoidance, Anxious and Depressive Moods. - Results
After adjusting for covariates, Neuroticism was associated with higher fear avoidance, depression, and anxiety scores. Conversely, Extraversion and Openness to experience negatively correlated with depression scores.
Petersen 2015 - Predicting a clinically important outcome in patients with low back pain following McKenzie therapy or spinal manipulation: a stratified analysis in a randomized controlled trial:
An analysis of a previous RCT with 350 patients looked at any factors that predicted the outcome. There were no predictors. However, MDT was superior to manipulation across all subgroups. The two strongest predictors of success with MDT were nerve root involvement and peripheralization.
Yarznbowicz 2020 -A prospective study of patients with shoulder pain and Mechanical Diagnosis and Therapy (MDT) - Relevance to MDT
Average time to discharge varies based on classification Derangement (28.4 days) Dysfunction (63.7 days) OTHER subgroups (56.7 days)
Hayward 2021 - Self-efficacy as a prognostic factor and treatment moderator in chronic musculoskeletal pain patients attending pain management programmes: A systematic review. - Conclusion
Baseline self-efficacy may affect physical function outcomes in Chronic MSK Pain patients attending a Pain Management Program. Higher quality evidence is needed to determine the influence of self-efficacy on outcomes in this setting.
Yarznbowicz 2020 -A prospective study of patients with shoulder pain and Mechanical Diagnosis and Therapy (MDT) - Results on Classification
Classification broke down as follows; Derangement (44.3%) Dysfunction (40%) Postural (0%) OTHER (15.6%). These percentages generally reflect and support prior work by May & Rosedale and by Heidar Abady et al.
Yarznbowicz 2020 -A prospective study of patients with shoulder pain and Mechanical Diagnosis and Therapy (MDT) - Methods
Classification was limited to Derangement, Dysfunction (Contractile and Articular), and OTHER. Data was collected on 261 consecutive patients who met inclusion criteria. Care was taken to exclude any patients who had cervical spine involvement as determined by MDT evaluation or who had shoulder surgery within the preceding 12 months.
