McKenzie Therapists Adhere More to Evidence-Based Guidelines and Have a More Biopsychosocial Perspective on the Management of Patients with Low Back Pain than General Physical Therapists in Japan


Design: Cross-sectional. Objective: Aim 1 was to preliminarily explore the contributions of the following factors to adherence to LBP practice guidelines using regression modeling: 1) the credential qualification of Mechanical Diagnosis and Therapy (MDT); 2) balance of biomedical and behavioral (i.e. biopsychosocial) oriented approach for low back pain (LBP); 3) demographics; 4) academic degree and 5) the attitude towards updating information for evidence-based clinical practice. Aim 2 was to investigate whether therapists credentialed in MDT (Cred.MDT) were more behavioral oriented and less biomedical oriented than general physical therapists. Summary of Background Data: LBP practice guidelines are not adhered to by every physical therapist. MDT is a behavioral modification approach. Thus, it was hypothesized that the Cred.MDT therapist was more behavioral oriented and more adherent to LBP practice guidelines compared with general physical therapists. Methods: One-hundred-twenty Cred.MDT therapists and 2000 general physical therapists in Japan were contacted. For regression modeling, the dependent variable was adherent to guidelines using a questionnaire with a vignette. Independent variables included balance of biomedical and behavioral perspectives for LBP using the Pain Attitudes and Beliefs Scale for Physiotherapist (PABS-PT), demographics, academic degree and the attitude towards updatinginformation for evidence-based clinical practice. The ratio of the two mean scores of the biomedical and behavioral subscales in the PABS-PT was compared between the Cred.MDT therapist group and the general physical therapists group. Results: Data of 46 general physical therapists and 44 Cred.MDT therapists were available. The Cred.MDT therapist group was significantly (P < 0.05) more behavioral oriented and more adherent to LBP practice guidelines compared with the general physical therapist group. The regression indicated significance of the two predictors of adherence to guidelines, Cred.MDT (β = 0.58, P < 0.001) and academic degree (β = 0.19, P = 0.03). Conclusions: Cred.MDT therapists are more guideline-consistent and have a more biopsychosocial treatment orientation than general physical therapists in Japan.

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Takasaki, H. , Saiki, T. and Iwasada, Y. (2014) McKenzie Therapists Adhere More to Evidence-Based Guidelines and Have a More Biopsychosocial Perspective on the Management of Patients with Low Back Pain than General Physical Therapists in Japan. Open Journal of Therapy and Rehabilitation, 2, 173-181. doi: 10.4236/ojtr.2014.24023.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Feuerstein, M., Hartzell, M., Rogers, H.L., et al. (2006) Evidence-Based Practice for Acute Low Back Pain in Primary Care: Patient Outcomes and Cost of Care. Pain, 124, 140-149.
[2] Fritz, J.M., Cleland, J.A. and Brennan, G.P. (2007) Does Adherence to the Guideline Recommendation for Active Treatments Improve the Quality of Care for Patients with Acute Low Back Pain Delivered by Physical Therapists? Medical Care, 45, 973-980.
[3] Rutten, G.M., Degen, S., Hendriks, E.J., et al. (2010) Adherence to Clinical Practice Guidelines for Low Back Pain in Physical Therapy: Do Patients Benefit? Physical Therapy, 90, 1111-1122.
[4] Koes, B.W., van Tulder, M., Lin, C.W., et al. (2010) An Updated Overview of Clinical Guidelines for the Management of Non-Specific Low Back Pain in Primary Care. European Spine Journal, 19, 2075-2094.
[5] Hendrick, P., Mani, R., Bishop, A., et al. (2013) Therapist Knowledge, Adherence and Use of Low Back Pain Guidelines to Inform Clinical Decisions—A National Survey of Manipulative and Sports Physiotherapists in New Zealand. Manual Therapy, 18, 136-142.
[6] Learman, K.E., Ellis, A.R., Goode, A.P., et al. (2014) Physical Therapists’ Clinical Knowledge of Multidisciplinary Low Back Pain Treatment Guidelines. Physical Therapy, 94, 934-946.
[7] Battie, M.C., Cherkin, D.C., Dunn, R., et al. (1994) Managing Low Back Pain: Attitudes and Treatment Preferences of Physical Therapists. Physical Therapy, 74, 219-226.
[8] Foster, N.E., Thompson, K.A., Baxter, G.D., et al. (1999) Management of Nonspecific Low Back Pain by Physiotherapists in Britain and Ireland. A Descriptive Questionnaire of Current Clinical Practice. Spine, 24, 1332-1342.
[9] Hurley, D.A., Dusoir, T.E., McDonough, S.M., et al. (2000) Biopsychosocial Screening Questionnaire for Patients with Low Back Pain: Preliminary Report of Utility in Physiotherapy Practice in Northern Ireland. Clinical Journal of Pain, 16, 214-228.
[10] McKenzie, R. and May, S. (2003) The Lumbar Spine: Mechanical Diagnosis and Therapy. 2nd Edition, Spinal Publications New Zealand Ltd., Waikenae.
[11] Green, S.B. (1991) How Many Subjects Does It Take to Do a Regression Analysis? Multivariate Behavioral Research, 26, 499-510.
[12] Maxwell, S.E. (2000) Sample Size and Multiple Regression Analysis. Psychological Methods, 5, 434-458.
[13] Evans, D.W., Breen, A.C., Pincus, T., et al. (2010) The Effectiveness of a Posted Information Package on the Beliefs and Behavior of Musculoskeletal Practitioners: The UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain Management (Complement) Randomized Trial. Spine, 35, 858-866.
[14] Evans, D.W., Foster, N.E., Underwood, M., et al. (2005) Testing the Effectiveness of an Innovative Information Package on Practitioner Reported Behaviour and Beliefs: The UK Chiropractors, Osteopaths and Musculoskeletal Physiotherapists Low Back Pain Management (Complement) Trial. BMC Musculoskeletal Disorders, 6, 41.
[15] Beaton, D.E., Bombardier, C., Guillemin, F., et al. (2000) Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine, 25, 3186-3191.
[16] Ostelo, R.W.J.G., Stomp-van den Berg, S.G.M., Vlaeyen, J.W.S., et al. (2003) Health Care Provider’s Attitudes and Beliefs towards Chronic Low Back Pain: The Development of a Questionnaire. Manual Therapy, 8, 214-222.
[17] Houben, R.M., Ostelo, R.W., Vlaeyen, J.W., et al. (2005) Health Care Providers’ Orientations Towards Common Low Back Pain Predict Perceived Harmfulness of Physical Activities and Recommendations Regarding Return to Normal Activity. European Journal of Pain, 9, 173-183.
[18] Campos, T.F., Beckenkamp, P.R. and Moseley, A.M. (2013) Usage Evaluation of a Resource to Support Evidence- Based Physiotherapy: The Physiotherapy Evidence Database (PEDro). Physiotherapy, 99, 252-257.
[19] Faul, F., Erdfelder, E., Lang, A.G., et al. (2007) G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences. Behavior Research Methods, 39, 175-191.

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