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 updating * Corresponding author. H. Takasaki et al. 174 information 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.
Objective: The purpose of this study was to investigate attitudes towards Mechanical Diagnosis and Therapy (MDT) for extremity problems and inter-examiner reliability of classifying extremity problems into MDT subgroups by credentialed practitioners in MDT (Cred.MDT) in Japan. Methods: A cross-sectional survey was used and all 120 Cred.MDT practitioners registered in the McKenzie Institute International Japan branch were asked about their attitude towards MDT for extremity problems and were asked to select the most appropriate MDT subgroup for each of the 25 extremity patient vignettes. Model classifications were used to investigate accuracy of classification. Percent agreement and Kappa analyses were examined. Results: Sixty practitioners (50%) participated in this study. For the management of patients with extremity problems, the majority did not use MDT most of the time (53%) due to a lack of confidence in using MDT in the extremities (78%). The overall accuracy for their MDT classification for extremity problems was 87% (Fleiss's κ = 0.78). Conclusions: The majority of the Cred.MDT practitioners in Japan did not use MDT frequently and were not confident to use MDT with extremity patients. However, accuracy and inter-examiner agreement of their MDT classification from the information on the assessment sheet was good.
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