The most common classification in the mechanical diagnosis and therapy for patients with a primary complaint of non-acute knee pain was Spinal Derangement: a retrospective chart review

ABSTRACT

Objectives: To preliminarily investigate in patients with a primary complaint of non-acute knee pain for ≥ 1 month: 1) the proportion of patients with non-acute knee pain classified by Mechanical Diagnosis and Therapy (MDT) as Spinal Derangements, 2) the number of sessions taken to identify the concluding classification, and 3) the ability of MDT classifications, demographics, and symptomatic baselines to predict pain reduction at 1-month follow-up.Methods: This study reviewed data from outpatients managed with MDT. For modeling knee pain reduction at the 1-month follow-up, 3 MDT provisional or concluding classifications (Spinal Derangement, Knee Derangement, and Non-Derangement) and the following variables were included: 1) gender, 2) symptom duration, 3) presence of low back pain (LBP), 4) the Japanese Knee Osteoarthritis Measure, 5) average pain intensity at the initial session using a 0–10 numerical rating scale, and 6) the Kellgren–Lawrence grade.Results: Data from 101 patients were extracted. The percentage of patients with the concluding classification 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 classification was determined by the fourth session in 80% of patients. Multiple regression modeling demonstrated that only the concluding classification significantly predicted the knee pain reduction at the 1-month follow-up.Discussion: These findings suggest the importance of careful screening assessments of the lumbar spine and the importance of detecting Derangements throughout the follow-up sessions for patients with a primary complaint of knee pain.

KEYWORDS:

• Classification
• cohort studies
• knee
• lumbar spine
• McKenzie
• musculoskeletal pain
• physical therapy specialty
• self-care

Acknowledgments

The authors wish to acknowledge Mr Richard Rosedale for peer-reviewing this paper prior to submission.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Sanshiro Hashimoto

Sanshiro Hashimoto is an orthopedic surgeon specialized in the knee, who is also credentialed in Mechanical Diagnosis and Therapy (MDT). He has received many international awards. He is a director of Minami Shinjuku Orthopedic Clinic, which is a certified McKenzie clinic in Japan.

Masatsugu Hirokado

Masatsugu Hirokado is a physiotherapist, who is credentialed in MDT. He has presented MDT studies at national and international conferences.

Hiroshi Takasaki

Hiroshi Takasaki is a physiotherapist and an associate professor in the Department of Physical Therapy at The Saitama Prefectural University, Japan. He is credentialed in MDT, who also completed MDT diploma clinical training. He has many MDT publications in international journals and has presented many studies at international conferences. He is one of seven research advisory committee members in the McKenzie Institute International.