Chiba Hiroki, Handa Yusuke, Kikkawa Kazuki, Takasaki Hiroshi
Health and Social Services, Saitama Prefectural University, Koshigaya, JPN.
Physical Therapy, Saitama Prefectural University, Koshigaya, JPN.
Cureus. 2024 Jun 16;16(6):e62492. doi: 10.7759/cureus.62492. eCollection 2024 Jun.
Introduction Mechanical diagnosis and therapy (MDT) is the most researched approach in musculoskeletal physical therapy and involves classifying patients into sub-groups based on their response to loading strategies. MDT diploma therapists (Dip-MDTs) fully recognize the value of MDT in musculoskeletal physical therapy. MDT is updating its system based on the latest research, but the system has not yet been fully established. Therefore, more research is required to increase the comprehensibility of the system. Thus, we aimed to identify future research priorities of MDT. Methods We conducted a modified Delphi study with three rounds. The Research Advisory Committee (RAC) members (n=7) of the McKenzie Institute International were invited to participate in the initial idea generation round. In the subsequent two consensus rounds, Dip-MDTs (n=299) were asked to indicate their level of agreement with the results of the idea generation round using a five-point Likert scale. The criteria for consensus were mean score ≥4.0, coefficient of variation ≤30%, percent agreement ≥75%, and quartile deviation ≤1. A post-hoc analysis of the consensus was conducted when the number of participants from a certain country exceeded one-third of the total number of participants. Results The participation rates for each round were 57.1%, 52.2%, and 49.8%. The USA accounted for 43.6% and 44.3% of all participants at the two consensus rounds, respectively. Finally, nine items reached consensus in the second consensus round. After the post-hoc analysis, eight items reached consensus: (1) cost-effectiveness, (2) cervical and thoracic spine, (3) extremity classifications, (4) filtered randomized controlled trials (RCTs), (5) spinal source classification, (6) centralization and directional preferences, (7) predictive factors for recurrence, and (8) patient education. Conclusion In this study, we identified the research priorities of MDT that would enhance the completion of the MDT system.
引言 机械诊断与治疗（MDT）是肌肉骨骼物理治疗领域研究最多的方法，涉及根据患者对负荷策略的反应将其分为不同亚组。MDT文凭治疗师（Dip-MDTs）充分认识到MDT在肌肉骨骼物理治疗中的价值。MDT正在根据最新研究更新其系统，但该系统尚未完全建立。因此，需要更多研究来提高该系统的可理解性。因此，我们旨在确定MDT未来的研究重点。方法 我们进行了三轮改进的德尔菲研究。邀请国际麦肯齐研究所的研究咨询委员会（RAC）成员（n = 7）参加初始想法生成轮。在随后的两轮共识轮中，要求Dip-MDTs（n = 299）使用五点李克特量表表明他们对想法生成轮结果的同意程度。共识标准为平均得分≥4.0、变异系数≤30%、同意百分比≥75%和四分位数偏差≤1。当某个国家/地区的参与者数量超过参与者总数的三分之一时，对共识进行事后分析。结果 每轮的参与率分别为57.1%、52.2%和49.8%。美国在两轮共识轮中分别占所有参与者的43.6%和44.3%。最后，九个项目在第二轮共识轮中达成共识。经过事后分析，八个项目达成共识：（1）成本效益，（2）颈椎和胸椎，（3）肢体分类，（4）过滤随机对照试验（RCTs），（5）脊柱源性分类，（6）中心化和方向偏好，（7）复发的预测因素，以及（8）患者教育。结论 在本研究中，我们确定了MDT的研究重点，这将有助于完善MDT系统。
