A comparison of the mckenzie method and a first-line educational intervention for patients with acute non-specific low back pain: a meta-analysis of pain and function

Context: Currently, the standard medical practice for treatment of acute non-specific low back pain (NSLBP) is through conservative education by a first line health care professional. With physical therapists (PT) joining first-line health care through direct access and a multitude of physical therapeutic interventions currently available for acute NSLBP, it is vital to identify the most efficacious and cost effective first-line health care professional. The McKenzie Method is a physical therapy intervention specifically designed to address the issues associated with acute NSLBP, however there is no study comparing first-line health care profession with a specific proven therapeutic intervention. Objective: The purpose of this meta-analysis is to compare the specific evaluation, treatment, and patient adherence of the repeated movement and patient education principles of the McKenzie Method and a conventional educational session by a first-line health care professional in treatment of NSLBP by comparing the outcome measures of pain and physical function. Data Sources: Search procedures followed PRISMA guidelines using the databases PubMed, CINAHL, and PEDro. A manual search of previous systematic reviews and the McKenzie International Institute reference list was also conducted. The search was limited to randomized control trials published in peer reviewed articles from 1984 to 2015 in the English language. Study Selection: Four studies were included in this meta-analysis. Studies were included based on the following criteria: adults ages 18-80 years, acute too sub-acute NSLBP with or without radiating symptoms, duration of symptoms greater than 2 days and less than 12 weeks, McKenzie Method treatment, a single education session with or without a provided booklet by a first-line health care professional, and a follow-up within 12 months of treatment. Pain was measured using the visual analog scale (VAS). The functional outcome measures used were the Short Form 36, physical function section (SF 36 PF), the Patient Specific Functional Scale (PSFS), and the Multidimensional Task Ability Profile (MTAP). Data Extraction: Titles, abstracts, full text articles, and reference lists were screened by 1 reviewer from May 2015 to October 2015. Results: The McKenzie Method intervention proved to be far superior statistically and clinically to a first-line educational intervention for reducing pain and improving function. The McKenzie Method outperformed first-line education for short and long-term pain improvement, moderate effect 0.48 (95% Confidence Interval (CI) = -0.68, -0.28) p = 0.43, Q = 1.66]; (95% CI) = -0.50 ( -0.70, -0.30) p= 0.000048, Q = 19.86]. Results again favored McKenzie in regards to improved physical function, short-term and long-term showing strong effect 0.74, (95% CI =0.49, 0.98) p = 0.000087, Q = 18.69], and moderate effect 0.52; (95% CI = 0.26,0.79) p = 0.021, Q = 5.26]. Conclusion: Based on the results of this meta-analysis, patients suffering from acute NSLBP should utilize direct access and consult a physical therapist for treatment instead of consulting a first-line health care professional.