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Chiropractic C‑class Low‑importance

This article is within the scope of WikiProject Chiropractic, a collaborative effort to improve the coverage of Chiropractic on Misplaced Pages. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.ChiropracticWikipedia:WikiProject ChiropracticTemplate:WikiProject ChiropracticChiropractic C This article has been rated as C-class on Misplaced Pages's content assessment scale. Low This article has been rated as Low-importance on the project's importance scale.

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References Whoever is criticising the references of this article hasn't really recognized the reference list. Almost 100 % of the quoted articles were published in peer reviewed journals like Spine, The Spine Journal, Manual Therapy,....

So there is absolutely no need to edit this aspect of the article.--Blueeye1967 (talk) 14:19, 23 October 2010 (UTC)

Efficacy seems overstated in a subtle way

I came from this article from low back pain, where its efficacy was summarized with the same wording used here: "Clinical research also shows that MDT treatment is as effective as other commonly used methods". Most methods are not very effective, so this says that, but in a vague and ambiguous way. MacHado et al 2006 summarizes the evidence in this manner:

There is some evidence that the McKenzie method is more effective than passive therapy for acute LBP; however, the magnitude of the difference suggests the absence of clinically worthwhile effects. There is limited evidence for the use of McKenzie method in chronic LBP. The effectiveness of classification-based McKenzie is yet to be established.

It is notable that "When McKenzie was compared with advice to stay active, a reduction in disability favored advice (WMD on a 0- to 100-point scale, 3.85 points; 95% confidence interval, 0.30 to 7.39) at 12 weeks of follow-up". II | (t - c) 04:49, 18 January 2011 (UTC)

Regarding systematic reviews this judgement may be reasonable. But in contrast to many other methods in the field of musculosceletal medicine the McKenzie Method shows good reliability and the diagnostic findings have prognostic value. Former research on the method didn't take into account the need for subgrouping. If patients are subgrouped MDT-treatment seems to be superior Browder et al 2007Long et al 2004--Blueeye1967 (talk) 20:15, 25 February 2011 (UTC)

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SPA and Fringe or non quality medical information.

I'm suggesting a move back to this version. There seems to be some questionable information that has been added to this article that may be fringe. --VViking_TalkEdits 13:49, 30 April 2020 (UTC) McKenzie Method Misplaced Pages response

Thank you for reviewing and questioning this material presented in this article. We appreciate attempts at making sure articles posted are accurate and based on evidence-based literature. So the reason for all the edits is because I’m in the medical field and one of numerous physical therapists that specialize in Mechanical Diagnosis and Therapy or the “McKenzie Method”. I’m sorry this is my first time at doing something like this so I’m trying to figure out how to do per Misplaced Pages guidelines. This project was originated by the International Director of Education for the McKenzie Institute International and a well-known physical therapy researcher, and a team of other physical therapists as we have been working on updating this on and off for almost a year now and finally tried editing the source material. And this is all volunteer work, as the McKenzie Institute does not employ me.

The purpose of this was to update and revamp the information on here as much of it is outdated, there is a lot more recent research out there, and some of the information on the original article is actually inaccurate. For instance your notation regarding “(Changes such as removing references to having at most, limited benefit for helping alleviate acute back pain to "system encompassing assessment (evaluation), diagnosis, treatment, and prevention for the spine and the extremities.")” was one of many things that needed updated. First that statement on the initial part of the article your were referring to: “Research has found that the McKenzie method has, at most, limited benefit for helping alleviate acute back pain. It is of no benefit for chronic back pain.” is number one, not referenced, and two, inaccurate. That statement, which was not referenced, appears to be referring to the first sentence under “Effectiveness” section which states: “According to a meta-analysis of clinical trials in 2006, treatment using the McKenzie method is somewhat effective for acute low back pain, but the evidence suggests that it is not effective for chronic low-back pain”. There have been numerous issues brought up about this research article already, reference number 8 by Machado et al 2006, which was also discussed by another wiki username Blueeye1967 (see https://en.wikipedia.org/Talk:McKenzie_method - Section “Efficacy seems overstated in a subtle way).

The article’s actual conclusion however was much different then what was stated on the Misplaced Pages article (see below):

https://www.ncbi.nlm.nih.gov/pubmed/16641766 Machado et al 2006 - “Conclusion: There is some evidence that the McKenzie method is more effective than passive therapy for acute LBP; however, the magnitude of the difference suggests the absence of clinically worthwhile effects. There is limited evidence for the use of McKenzie method in chronic LBP. The effectiveness of classification-based McKenzie is yet to be established.”

Again, this report being inaccurate is one of the many reasons for the initiative to update this information. If you read on to our updated Effectiveness” section, there have been several recent studies done which have found much different conclusions (see below):

From our attempted update/edit: A 2012 systematic review looking at directional preference showed mixed results, with some evidence found supporting the effectiveness of directional preference when applied to participants with a directional preference upon a repeated end range movement assessment, particularly at short-term and intermediate-term follow-ups.

More recently, another systematic review found that there was moderate to high quality evidence that MDT is not superior to other rehabilitation interventions for acute low back pain but is superior for chronic low back in reducing pain and disability. These findings conflict with another review. However, the authors reported limitations with intention to treat analyses not met in all the studies, some studies only looking at specific MDT subgroups, and no studies were included which compared MDT to other classification approaches. Also, several of the studies included clinicians with minimal levels of training (not certified) even though they reported, “trained therapists are more reliable in classifying patients than are therapists who are not certified”.

Finally, one additional systematic review looked at the difference between pain and disability in patients with low back pain managed with the “core principles” of MDT versus treatment using “some or none” of the MDT principles. They found that trials following the “core principles” of MDT had greater treatment effects versus the other trials which did not follow the principles as closely. They concluded that better outcomes utilizing the MDT system could be accomplished by following the core principles of MDT such as matching the treatment to the specific classification. This appears to re-enforce some of the shortcomings of some the previously mentioned reviews.

Again our attempt at all the updates/edits is to provide consumers/patients, health-care providers (doctors, therapists, chiropractors, etc.), researchers, and any others the most updated and accurate information about the McKenzie Method. We also attempted to present the information in an un-biased way to discuss the literature that was out there, specifically focusing on the systematic reviews, which did include reviews which discussed findings that were both positive and negative. No physical therapy system is perfect, and being honest about findings is important so that we can learn from them as well, but also be honest and discuss why there may be limitations to certain studies. To do an exhaustive review of the literature would be too much for the readers. We would appreciate allowing our edit back up the way it was and of course we can make some further changes to as needed. This has been a very long project with a lot of time spent on it, and again all voluntary time. Hopefully this information was helpful and I apologize for the length of it. If there were specific suggestions that you have, then let me know. Thank you.~~Spcarp83 (talk) 18:47, 1 May 2020 (UTC)

References: 8. MacHado, Luciana Andrade Carneiro; De Souza, Marcelo von Sperling; Ferreira, Paulo Henrique; Ferreira, Manuela Loureiro (2006). "The McKenzie Method for Low Back Pain". Spine. 31 (9): E254–62. doi:10.1097/01.brs.0000214884.18502.93. PMID 16641766.

43. Surkitt LD., Ford JJ., Hahne AJ., Pizzari T., McMeeken JM. (2012).Efficacy of directional preference management for low back pain: a systematic review. Phys Ther. 2012 May; 92(5):652-65. doi: 10.2522/ptj.20100251..

44. Lam OT., Strenger DM., Chan-Fee M., Pham PT., Preuss RA., Robbins SM. (2018). “Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis.” J Orthop Sports Phys Ther. Jun;48(6):476-490. doi: 10.2519/jospt.2018.7562.

45. ^ Machado, LA., De Souza M., Ferreira PH., Ferreira ML. (2006). The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine 2006; 31(9): E254-E262. . doi:10.1097/01.brs.0000214884.18502.93. PMID 16641766.

46. Garcia AN., Costa LC., da Silva TM., Gondo FL., Cyrillo FN., Costa RA., Costa LO. (2013) Ef¬fectiveness of back school versus McKenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2013;93:729-747. https://doi.org/10.2522/ ptj.20120414

47. Garcia AN., Costa LC., Hancock MJ., Souza FS., Gomes GVFO., Almeida MO., Costa LOP. (2018) McKen¬zie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain: a randomised pla¬cebo controlled trial with short and longer term follow-up. Br J Sports Med. 2018;52:594-600. https://doi.org/10.1136/bjsports-2016-097327

48. Moncelon S., Otero J. (2015) The McKenzie Method of Mechanical Diagnosis and Therapy in chronic low back pain with directional preference. Kinésithér Rev. 2015;15:31-37. https://doi.org/10.1016/j. kine.2014.11.086

49. Murtezani A., Govori V., Meka VS., Ibraimi Z., Rrecaj S., Gashi S. (2015) A comparison of McKenzie therapy with electrophysical agents for the treatment of work re¬lated low back pain: a randomized controlled trial. J Back Musculoskelet Rehabil. 2015; 28:247-253. https://doi.org/10.3233/BMR-140511

50. Halliday MH., Garcia AN., Amorim AB., Machado GC., Hayden JA., Pappas E., Ferreira PH., Hancock MJ. (2019). Treatment Effect Sizes of Mechanical Diagnosis and Therapy for Pain and Disability in Patients With Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther. Apr;49(4):219-229. doi: 10.2519/jospt.2019.8734.

Very outdated information here. Suggestions on how to proceed.

I’m a Physiotherapist with 18 years of experience, I currently work at Whipps Cross University Hospital in London. I’m trained in the McKenzie Method, and when I found this Misplaced Pages page I was shocked at how outdated it was, nearly every reference is from more than a decade ago. And there’s some outright misinformation with statements such as "research has found that the McKenzie method has, at most, limited benefit for helping alleviate acute back pain. It is of no benefit for chronic back pain" which is just plainly untrue, and doesn’t even have a reference. How is this allowed?

There’s been loads of recent research in scientific publications that should be included in this article. Looking at the Edit History it seems like someone associated with the McKenzie Institute has been trying to update the information on the article, using scholarly sources, but they keep being reverted without much explanation. I imagine the problem might be their wording is coming across as somewhat promotional. But all the back and forth editing and reverting is counterproductive, so I would suggest an editor with appropriate credentials points out the problematic phrases specifically, so the person trying to update with recent research and citations is able to include this new information without constantly being reverted.

If this is not possible, please make other suggestions, because favouring outdated information over recent and properly-cited research is not what I expected from Misplaced Pages. SantiagoRamosPhysio (talk) 10:39, 28 May 2020 (UTC)

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