Inter-rater Reliability of the McKenzie Method of Mechanical Diagnosis and Therapy for the Provisional Classification of Low Back Pain in Adolescents and Young Adults

Objective: To investigate the inter-rater reliability of Mechanical Diagnosis and Therapy (MDT)-trained Diplomats in classifying adolescents and young adults with lumbar pain.

Methods: Forty-three participants (mean age 15 ± 2 years) with lumbar pain, with or without lower extremity symptoms, were assessed simultaneously by three MDT Diploma holders and classified into one of three groups: 1) Derangement, 2) Dysfunction, 3) Postural/OTHER. Inter-rater reliability was calculated using the Fleiss kappa statistics with 95% confidence intervals (CI). Analyses were repeated with the younger (11 to 15 years old) and older (16 to 21 years old) age groups.

Results: There was moderate reliability (Fleiss kappa = 0.50, 95% CI = 0.45 to 0.54) for the entire sample, which was statistically significant (p < 0.001). There was good reliability in older participants (Fleiss kappa = 0.63, 95% CI = 0.57 to 0.70), but poor reliability in younger participants (Fleiss kappa = 0.33, 95% CI = 0.27 to 0.39). There was 100% agreement in classifications among assessors for 70% of participants.

Discussion: The MDT system has moderate reliability when classifying lumbar pain in adolescents and young adults. Future reliability studies may include a balanced group for classifications or a second session.