{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T15:53:10Z","timestamp":1790437990482,"version":"4.1.0"},"reference-count":38,"publisher":"Journal of Orthopaedic & Sports Physical Therapy (JOSPT)","issue":"12","content-domain":{"domain":["www.jospt.org"],"crossmark-restriction":true},"short-container-title":["Journal of Orthopaedic &amp; Sports Physical Therapy"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p> An updated summary of the evidence for the reliability of the Mechanical Diagnosis and Therapy (MDT) system in patients with spinal pain is needed. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p> To investigate the evidence on the intrarater and interrater reliability of MDT in patients with spinal pain. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> Searches in MEDLINE, CINAHL, Embase, PEDro, and Scopus were conducted for this systematic review. We included any study design as long as reliability of the MDT method was tested in patients with spinal pain. We collected data on the reliability of MDT to identify main and subsyndromes, directional preference, the centralization phenomenon, and lateral shift. The methodological quality of studies was assessed using the Quality Appraisal of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement Studies checklists. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Twelve studies were included (8 studies on back pain, pooled n = 2160 patients; 3 studies on neck pain, pooled n = 45 patients; and 3 studies recruited mixed spinal conditions, pooled n = 389 patients). Studies investigating patients with back pain reported kappa estimates ranging from 0.26 to 1.00 (main and subsyndromes), 0.27 to 0.90 (directional preference), and 0.11 to 0.70 (centralization phenomenon). Kappa estimates for studies investigating neck pain ranged from 0.47 to 0.84 (main and subsyndromes) and 0.46 (directional preference). In mixed populations, kappa estimates ranged from 0.56 to 0.96 (main and subsyndromes). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> The MDT system appears to have acceptable interrater reliability for classifying patients with back pain into main and subsyndromes when applied by therapists who have completed the credentialing examination, but unacceptable reliability in other therapists. We found conflicting evidence regarding the reliability of the MDT system in patients with neck pain or mixed pain locations. J Orthop Sports Phys Ther 2018;48(12):923\u2013933. Epub 22 Jun 2018. doi:10.2519\/jospt.2018.7876 <\/jats:p><\/jats:sec>","DOI":"10.2519\/jospt.2018.7876","type":"journal-article","created":{"date-parts":[[2018,6,22]],"date-time":"2018-06-22T23:38:16Z","timestamp":1529710696000},"page":"923-933","update-policy":"https:\/\/doi.org\/10.2519\/jospt.crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Reliability of the Mechanical Diagnosis and Therapy System in Patients With Spinal Pain: A Systematic Review"],"prefix":"10.2519","volume":"48","author":[{"given":"Alessandra Narciso","family":"Garcia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00edola da Cunha Menezes","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabr\u00edcio Soares","family":"de Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matheus Oliveira","family":"de Almeida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda Costa","family":"Araujo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hancock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Oliveira Pena","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1394","reference":[{"key":"bib1","doi-asserted-by":"publisher","DOI":"10.1097\/00001416-200707000-00007"},{"key":"bib2","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-4754(03)00104-0"},{"key":"bib3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmpt.2005.01.003"},{"key":"bib4","doi-asserted-by":"publisher","DOI":"10.1016\/j.physio.2004.05.001"},{"key":"bib5","doi-asserted-by":"publisher","DOI":"10.1016\/S0004-9514(14)60110-0"},{"key":"bib6","doi-asserted-by":"publisher","DOI":"10.1016\/j.physio.2005.12.003"},{"key":"bib7","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/76.7.706"},{"key":"bib8","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31822ef72c"},{"key":"bib9","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20120414"},{"key":"bib10","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20140208"},{"key":"bib11","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-097327"},{"key":"bib12","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins JPT","year":"2011"},{"key":"bib13","doi-asserted-by":"publisher","DOI":"10.1016\/S0031-9406(10)63053-2"},{"key":"bib14","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200204150-00016"},{"key":"bib15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.03.002"},{"key":"bib16","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"bib17","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-13-111"},{"key":"bib18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.10.002"},{"key":"bib19","doi-asserted-by":"publisher","DOI":"10.1016\/j.math.2012.05.003"},{"key":"bib20","doi-asserted-by":"publisher","DOI":"10.1016\/S0004-9514(06)70044-7"},{"key":"bib21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmpt.2009.08.007"},{"key":"bib22","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2012.031"},{"key":"bib24","volume-title":"The Lumbar Spine: Mechanical Diagnosis and Therapy","author":"McKenzie R","year":"1981"},{"key":"bib25","volume-title":"The Human Extremities: Mechanical Diagnosis and Therapy","author":"McKenzie R","year":"2000"},{"key":"bib26","volume-title":"The Lumbar Spine: Mechanical Diagnosis and Therapy Volume One","author":"McKenzie R","year":"2003","edition":"2"},{"key":"bib27","volume-title":"The Lumbar Spine: Mechanical Diagnosis and Therapy Volume Two","author":"McKenzie R","year":"2003","edition":"2"},{"key":"bib28","volume-title":"The Cervical and Thoracic Spine. Mechanical Diagnosis and Treatment","author":"McKenzie RA","year":"1990"},{"key":"bib29","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-010-9606-8"},{"key":"bib30","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-094913"},{"key":"bib31","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2000.30.7.368"},{"key":"bib32","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199308000-00013"},{"key":"bib33","doi-asserted-by":"publisher","DOI":"10.1179\/106698102790819193"},{"key":"bib34","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198528470.001.0001","volume-title":"Health Measurement Scales: A Practical Guide to Their Development and Use","author":"Streiner DL","year":"2003","edition":"3"},{"key":"bib35","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20150640"},{"key":"bib36","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2016.12.016"},{"key":"bib37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2006.03.012"},{"key":"bib38","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199904010-00012"},{"key":"bib39","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000117"}],"container-title":["Journal of Orthopaedic &amp; Sports Physical Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jospt.org\/doi\/pdf\/10.2519\/jospt.2018.7876","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T13:48:43Z","timestamp":1724680123000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jospt.org\/doi\/10.2519\/jospt.2018.7876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12]]},"references-count":38,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.2519\/jospt.2018.7876"],"URL":"https:\/\/doi.org\/10.2519\/jospt.2018.7876","relation":{},"ISSN":["0190-6011","1938-1344"],"issn-type":[{"value":"0190-6011","type":"print"},{"value":"1938-1344","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12]]},"assertion":[{"value":"2018-11-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}