Takasaki Hiroshi, Ueno Takahiro
Department of Physical Therapy, Saitama Prefectural University, Koshigaya, JPN.
Department of Rehabilitation, Koshigaya Rehabilitation Care Center, Koshigaya, JPN.
Cureus. 2024 Oct 1;16(10):e70652. doi: 10.7759/cureus.70652. eCollection 2024 Oct.
Background The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) has long been misunderstood as a biomedical approach. In fact, it is a biopsychosocial approach with an up-to-date evidence-based educational curriculum. Recently, it has become possible to partially measure competence in clinical decision-making based on contemporary pain understanding and confidence in pain management using the Pain Understanding and Confidence Questionnaire (PUnCQ). The primary aim of this study was to compare the following outcomes between physical therapists with and without credential license in MDT (Cred.MDT) and the PUnCQ as well as attitudes toward the biopsychosocial perspective, adherence to evidence-based management for low back pain (LBP), and knowledge of modern pain science. The secondary aim was to explore relevant factors in the PUnCQ. Methodology Clinical physical therapists who were managing patients with pain were recruited from two associations (the Japanese Society of Allied Health and Rehabilitation and the Japan Branch of the International McKenzie Institute, who had all acquired at least the Cred.MDT). The following outcomes were measured: (1) the PUnCQ-1 for partial competence in evidence-based clinical decision-making for pain management; (2) part 2 scores of the PUnCQ for confidence in pain management; (3) the Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT) biopsychosocial/biomedical ratio for treatment perspectives; (4) the Knowledge and Attitudes of Pain (KNAP) for knowledge of modern pain science; and (5) a questionnaire for adherence to LBP practice guidelines. Two group comparisons were conducted for the primary aim and a multiple regression analysis for the independent variable of the PUnCQ-1 was conducted for the secondary aim. Results Data from 122 physical therapists (63 and 59 participants with and without the Cred.MDT, respectively) were analyzed. Statistically significantly higher scores were detected for physical therapists with Cred.MDT compared to those without (all p<0.05) for all of the above outcomes. The multiple regression analysis demonstrated that statistically significant contributors to the PUnCQ-1 were part 2 scores of the PUnCQ for the pain management factor (p = 0.016) and acquisition of the Cred.MDT (p = 0.038) (R = 0.12). Conclusion Competence and confidence in pain management, attitudes toward biopsychosocial approaches, knowledge of modern pain science and guideline adherence are higher in physical therapists with the Cred.MDT than those without it. Confidence in pain management and acquisition of the Cred.MDT contributed to competence in evidence-based clinical decision-making for pain management.
背景 麦肯齐机械诊断与治疗方法（MDT）长期以来一直被误解为一种生物医学方法。事实上，它是一种生物心理社会方法，拥有最新的循证教育课程。最近，使用疼痛理解与信心问卷（PUnCQ），基于当代疼痛理解和疼痛管理信心，部分测量临床决策能力已成为可能。本研究的主要目的是比较拥有和未拥有MDT认证执照（Cred.MDT）的物理治疗师在PUnCQ方面的以下结果，以及对生物心理社会观点的态度、对腰痛（LBP）循证管理的依从性和现代疼痛科学知识。次要目的是探索PUnCQ中的相关因素。
方法 从两个协会（日本联合健康与康复协会和国际麦肯齐研究所日本分会，他们都至少获得了Cred.MDT）招募管理疼痛患者的临床物理治疗师。测量以下结果：（1）用于疼痛管理循证临床决策部分能力的PUnCQ - 1；（2）PUnCQ第2部分中疼痛管理信心得分；（3）物理治疗师疼痛态度与信念量表（PABS - PT）治疗观点的生物心理社会/生物医学比率；（4）现代疼痛科学知识的疼痛知识与态度（KNAP）；（5）一份关于LBP实践指南依从性的问卷。针对主要目的进行两组比较，针对次要目的对PUnCQ - 1的自变量进行多元回归分析。
结果 分析了122名物理治疗师的数据（分别有63名和59名拥有和未拥有Cred.MDT的参与者）。对于上述所有结果，与未拥有Cred.MDT的物理治疗师相比，拥有Cred.MDT的物理治疗师在统计学上的得分显著更高（所有p < 0.05）。多元回归分析表明，对PUnCQ - 1有统计学显著贡献的因素是PUnCQ第2部分中疼痛管理因素的得分（p = 0.016）和获得Cred.MDT（p = 0.038）（R = 0.12）。
结论 拥有Cred.MDT的物理治疗师在疼痛管理能力和信心、对生物心理社会方法的态度、现代疼痛科学知识以及指南依从性方面高于未拥有者。疼痛管理信心和获得Cred.MDT有助于疼痛管理循证临床决策能力。
