Grant Approvals

2009 Approvals - 1 January 2010 Projects

Derangement syndrome in OA knees: An RCT of McKenzie therapy
Principal Investigator: Richard Rosedale, PT, Dip. MDT

Abstract
The Mechanical Diagnosis and Therapy (MDT) approach has been extensively used to manage patients with spinal pain. Studies have shown this approach to be valid and reliable. Although the approach is used for extremity joints, there is no research on using this approach to classify individuals presenting with knee osteoarthritis (OA). The diagnosis of "OA knee" offers no indication as to the potential response to intervention. An assessment procedure that could potentially identify a subgroup of patients who might experience rapid improvement to conservative care would be valuable.

The aims of the study are:

1. Classify individuals presenting with knee OA as responders (derangements) or non-responders to intervention using the MDT evaluation.
   
   
2. Quantify the individual's pain and functional abilities pre and post-physiotherapy treatment using self-report and performance based measures and compare to no intervention.
   
   
3. Report on the efficacy of the MDT classification and treatment of derangements in OA knees compared to evidence based physiotherapy and no intervention.

Patients with a diagnosis of "OA knee" will be recruited from the waiting list of surgeons. Patients who consent to participate will be randomized to an intervention group or control group. Baseline self-report measures and a physical performance measure will be collected. The intervention group will be assessed by an MDT credentialed therapist over three sessions and then classified as having a "derangement" or not. Those classified as a derangement will have two to three further sessions over two weeks and will be given direction specific exercises. Those patients who were not classified as derangements will also have two to three sessions of evidenced based treatment consisting of strengthening and aerobic exercise. The control group will continue with the usual standard of care while queuing for a follow up consultation with their orthopaedic surgeon. The usual standard of care involves no intervention from the surgeon and continued adherence to any directives from the family physician's pre-referral management plan. At two weeks, both groups will have baseline measures reassessed and will be discharged. Follow up by telephone at six months and one year to reassess functional and pain measures.

Ultrasound imaging of lumbar spine flexion and extension
Principal Investigator: Gary Chleboun, PT, PhD

Abstract
The outcomes of Mechanical Diagnosis and Therapy (MDT) are not only centralization of pain, but also increased lumbar spine range of motion. However, the exact nature of the relationship between decreased pain and increased motion is not clear because previous studies assessed gross clinical measurements of lumbar range of motion, rather than specific segmental lumbar motion. We have recently developed a novel method for measurement of segmental lumbar flexion and extension using ultrasound imaging to determine the distance between spinous processes.

Specific Aims
The specific aims are to:

1. complete validation experiments of ultraound assessment of motion in the lumbar spine,
   
   
2. determine if segmental lumbar spinal motion changes occur during MDT examination in asymptomatic subjects, and
   
   
3. determine if segmental lumbar spinal motion changes occur after MDT examination and treatment in patients with low back pain.

Specific aim 1 compares the measurement of lumbar segmental spinal motion between ultrasound imaging and MRI. Flexion and extension motion is determined by measuring the distance between the spinous processes. Images will be obtained from ultrasound and MRI of 10 asymptomatic subjects in three standardized lumbar positions: neutral spine in supine, lumbar flexion and lumbar extension.

Specifc aim 2 determines the effect of repeated flexion and extension motions on the distance between spinous processes of lumbar segments in subjects with no history of back pain. Lumbar segmental motion will be measured prior to movement and then after the first and tenth repetition of a standard MDT examination of repeated flexion and extension.

Specific aim 3 determines the effect of MDT (both examination and treatment ) on segmental lumbar spinal motion in patients who have low back pain and centralizing symptoms. Lumbar segmental motion will be measured as was done in specific aim 2, however, measurements will be made after both the examination and treatment on the initial visit and then one week later.

Since clinical evidence suggest that decreased low back pain and increased lumbar motion occur together in response to MDT, a clinically useful tool for assessment of segmental lumbar spine motion is needed to substantiate this relationship between decreased pain and increased motion.

2007 Approval - 1 January 2008 Projects

The effectiveness of MDT in patients who meet the clinical prediction rule for spinal manipulation

Principal Investigator: Ronald J. Schenk, PT, PhD, OCS, FAAOMPT, Cert. MDT
Organization and Department: Daemen College, Department of Physical Therapy

Abstract
Background/Problem: A clinical prediction rule (CPR) for spinal manipulation has been validated for specific patients with low back pain (LBP). Patient-specific exercise within Mechanical Diagnosis and Therapy (MDT) intervention has been validated in patients with mechanical LBP. The effectiveness of MDT rendered to these same specific patients has not been compared to use of spinal manipulation.

Specific Aims: To determine if patients who receive MDT have more favorable outcomes than patients who receive spinal manipulation. Outcomes will be assessed according to changes in Modified Oswestry Disability Index Score (ODI); Fear Avoidance Beliefs Questionnaire Score (FABQ), visual analog scale (pain) score (VAD), trunk flexion range of motion, patient satisfaction in 2 weeks of treatment (Study 1) and (Study 2) ODI score, FABQ score, VAS score, and use of medication, physician consults, and rehabilitation interventions over the course of 6 months and 12 months in patients who satisfy selection criteria for the CPR for spinal manipulation.

Clinicians: Licensed physical therapists credentialed/diplomaed in MDT and trained in spinal manipulation.

Patient Subjects: Two hundred adults diagnosed with LBP.

Research Design and Methods for Achieving the Aims: Randomized controlled study with pre-test, post-test, multivariate measures (Study 1) and repeated, multivariate measures (Study 2). Two hundred consecutively selected, formally consenting adult patients diagnosed with LBP will be randomized to either a MDT group or spinal manipulation group and will receive the respective intervention. Outcome measures will be taken at 2 weeks, at 6 months, at 12 months on both groups and compared between groups and per individual over time.

Clinical Relevance of the Proposed Project: Patients who respond more favourably to MDT as compared to spinal manipulation on a short-term basis, may also demonstrate positive long-term results. This is hypothesized due to the fact that MDT teaches learned self-management of the condition. This may play a role in reducing recurrence and decreasing health care costs related to the management of low back pain.