The McKenzie Method Compared With

The McKenzie Method Compared With
Manipulation When Used Adjunctive to
Information and Advice in Low Back Pain Patients
Presenting With Centralization or Peripheralization
A Randomized Controlled Trial
Tom Petersen, PT, PhD , Kristian Larsen , PT, PhD , Jan Nordsteen , DC, MPH , Steen Olsen , PT ,
Gilles Fournier, MD, DC, BSc , and Soren Jacobsen , MD, DrMsci
Study Design.
Randomized controlled trial.
Objective.
To compare the effects of the McKenzie method performed by certified therapists with spinal manipulation performed by chiropractors when used adjunctive to information and advice. Summary of Background Data. Recent guidelines recommend a structured exercise program tailored to the individual patient as well as manual therapy for the treatment of persistent low back pain. There is presently insufficient evidence to recommend the use of specific decision methods tailoring specific c therapies to clinical subgroups of patients in primary care.
Methods.
A total of 350 patients suffering from low back pain with duration of more than 6 weeks who presented with centralization or peripheralization of symptoms with or without signs of nerve root involvement, were enrolled in the trial. Main outcome was number of patients with treatment success defined as a reduction of at least 5 points or an absolute score below 5 points on the Roland Morris Questionnaire. Secondary outcomes were reduction in disability and pain, global perceived effect, general health, mental health, lost work time, and medical care utilization.
Treatment Allocation and Treatment
The McKenzie treatment was planned individually after the therapist’s pretreatment physical assessment. 21 Manual vertebral mobilization techniques including high velocity thrust were not allowed. An educational booklet describing self care 22 or a “lumbar roll” for correction of the seated position was sometimes provided to the patient at the discretion of the therapist. All three therapists performing the treatment had passed a credential examination in the McKenzie method. In the spinal manipulation treatment, all types of manual techniques including vertebral mobilization and high velocity thrust as well as myofascial trigger-point massage were used. The choice of technique, or combination of techniques, was at the discretion of the chiropractor dependent of the results of their pretreatment physical assessment. General mobilizing exercises, that is, self-manipulation, alternating lumbar flexion/extension movements, and stretching, were allowed but not specific exercises in the directional preference. An inclined wedged pillow for correction of the seated position was available to the patients if the chiropractor believed this to be indicated. Patients were encouraged not to seek any other kind of treatment for the 2 months period of self-administered exercises.
Outcome Measures
The main outcome measure was proportion of patients reporting success at 2 months follow-up. Treatment success was defined as a reduction of at least 5 points or an absolute score below 5 points on the 23-item modified Roland Morris Disability Questionnaire (RMDQ). Secondary outcome measures were treatment success at other follow-ups as well as measures of changes in RMDQ at all follow-ups. Other outcome measures were changes in pain, global perceived effect, quality of life, days with reduced activity, return-to-work, satisfaction with treatment, and use of health care after the completion of treatment. Follow-up assessment was carried out by a secretary blinded to treatment allocation at the end of treatment, after 2 months, and 1-year post-treatment.
DISCUSSION
In both the McKenzie and the manipulation group, long-term improvements were observed. Although between-group differences were not particularly large at all follow-ups, the McKenzie method appeared to be the more favorable method of treatment.
Results.
Both treatment groups showed clinically meaningful improvements in this study. At 2 months follow-up, the McKenzie treatment was superior to manipulation with respect to the number of patients who reported success after treatment (71% and 59%, respectively) (odds ratio 0.58, 95% confidence interval [CI] 0.36 to
0.91, P = 0.018). The number needed to treat with the McKenzie method was 7 (95% CI 4 to 47). The McKenzie group showed improvement in level of disability compared to the manipulation group reaching a statistical significance at 2 and 12 months follow up (mean difference 1.5, 95% CI 0.2 to 2.8, P = 0.022 and 1.5, 95% CI 0.2 to 2.9, P = 0.030, respectively). There was also a significant difference of 13% in number of patients reporting global perceived effect at end of treatment (P = 0.016). None of the other secondary outcomes showed statistically significant differences.
Conclusion.
In patients with low back pain for more than 6 weeks presenting with centralization or peripheralization of symptoms, we found the McKenzie method to be slightly more effective than manipulation when used adjunctive to information and advice