The participants had centralisation, which is a feature of reducible Derangement Syndrome. In the study, MDT was compared to a rehabilitation program including infrared irradiation, massage and exercises for the neck and shoulder. The outcome measures included pain intensity at the head, neck, shoulders, upper extremities, and overall. Pain intensity on a scale of 0 to 100 favoured MDT, with mean differences (95% CI) of 28 (17 to 39) at the head, 29 (20 to 38) at the
neck, 31 (21 to 41) at the shoulders, 40 (31 to 48) at the upper extremities, and 40 (32 to 48) overall. Except at the head, these confidence intervals had lower limits that were higher MK-8776 supplier than 20 on a scale of 0 to 100. A recent systematic review40 concluded that centralisation
was generally a good prognostic factor and a treatment-effect modifier. The present review included studies of any participants with neck pain, not specific subgroups such as those with centralisation. The estimate of the effect of MDT may therefore have been influenced by the inclusion of less-responsive subgroups such as irreducible Derangement Syndrome, Dysfunction Syndrome, Posture Syndrome and Other. Among people with neck pain, the prevalence of irreducible Derangement Syndrome, Dysfunction Syndrome, Posture learn more Syndrome and Other is 0.9%, 8.1%, 2.7% and 7.2%, respectively.41 In particular, it may be difficult for non-Diploma MDT therapists to guide patients in the irreducible Derangement Syndrome and Other subgroups appropriately because the treatment for these subgroups requires a biopsychosocial approach, which is introduced in the Diploma MDT education program, rather than a simple-mechanical approach, which is introduced in the general MDT
workshops. This present review accepted all measures of disability. The Neck Disability Index42 was used by two trials: the Northwick Park Neck Pain Questionnaire43 by one trial, and the 15-item Copenhagen Neck Functional Disability Scale44 by the other trial. These questionnaires are spine-specific questionnaires and therefore may not accurately reflect the most troublesome construct for each patient. The Neck Disability Index and those the Copenhagen Neck Functional Disability Scale have lower responsiveness than the Patient Specific Functional Scale45 in people with chronic whiplash-associated disorders.46 The Neck Disability Index was also inferior to the Patient Specific Functional Scale in people with cervical radiculopathy in terms of test-retest reliability, construct validity, and responsiveness.47 Therefore, it may be appropriate for future research to include a patient-centered questionnaire for the assessment of disability and functional performance, as well as a spine-specific disability measure.