STUDY DESIGN: Literature review with meta-analysis. BACKGROUND: The McKenzie method of mechanical diagnosis and therapy (MDT), a classification-based system, was designed to classify patients into homogeneous subgroups to direct treatment. OBJECTIVES: To examine the effectiveness of MDT for improving pain and disability in patients with either acute (less than 12 weeks in duration) or chronic (greater than 12 weeks in duration) low back pain (LBP). METHODS: Randomized controlled trials examining MDT in patients with LBP were identified from 6 databases. Independent investigators assessed the studies for exclusion, extracted data, and assessed risk of bias. The standardized mean difference (SMD) and 95% confidence interval were calculated to compare the effects of MDT to those of other interventions in patients with acute or chronic LBP. RESULTS: Of the 17 studies that met the inclusion criteria, 11 yielded valid data for analysis. In patients with acute LBP, there was no significant difference in pain resolution (p = 0.11) and disability (p = 0.61) between MDT and other interventions. In patients with chronic LBP, there was a significant difference in disability (SMD -0.45), with results favoring MDT compared to exercise alone. There were no significant differences between MDT and manual therapy plus exercise (p > 0.05) for pain and disability outcomes. CONCLUSION: There is moderate- to high-quality evidence that MDT is not superior to other rehabilitation interventions for reducing pain and disability in patients with acute LBP. In patients with chronic LBP, there is moderate- to high-quality evidence that MDT is superior to other rehabilitation interventions for reducing pain and disability; however, this depends on the type of intervention being compared to MDT. LEVEL OF EVIDENCE: Therapy, level 1a.

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