Mechanical diagnosis and therapy has similar effects on pain and disability as ‘wait and see’ and other approaches in people with neck pain: a systematic review

Questions: In people with neck pain, does Mechanical Diagnosis and Therapy (MDT) reduce pain and disability more than 'wait and see'? Does MDT reduce pain and disability more than other interventions? Are any differences in effect clinically important? Design: Systematic review of randomised trials with meta-analysis. Participants: People with neck pain. Intervention: MDT. Outcome measures: Pain intensity and disability due to neck pain in the short (< 3 months), intermediate (< 1 year) and long term (>= 1 year). Results: Five trials were included. Most comparisons demonstrated mean differences in effect that favoured MDT over wait-and-see controls or other interventions, although most were statistically non-significant. For pain, all comparisons had a 95% confidence interval (CI) with lower limits that were less than 20 on a scale of 0 to 100, which suggests that the difference may not be clinically important. For disability, even the upper limits of the 95% CI were below this threshold, confirming that the differences are not clinically important. In all of the trials, some or all of the treating therapists did not have the highest level of MDT training. Conclusion: The additional benefit of MDT compared with the wait-and-see approach or other therapeutic approaches may not be clinically important in terms of pain intensity and is not clinically important in terms of disability. However, these estimates of the effect of MDT may reflect suboptimal training of the treating therapists. Further research could improve the precision of the estimates and assess whether the extent of training in MDT influences its effect.