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J Man Manip Ther. 2017 May;25(2):83-90. doi: 10.1080/10669817.2016.1229396. Epub 2016 Sep 7.

Inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy in the examination of the knee.

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Department of Physiotherapy, London Health Sciences Centre, University Hospital, London, Canada.
School of Physical and Occupational Therapy, Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation Centre, McGill University, Montreal, Canada.



The McKenzie System of Mechanical Diagnosis and Therapy (MDT) is a widely used method of classification and management of musculoskeletal problems. Although MDT has been investigated for its reliability and efficacy in the management of spinal pain, few studies have evaluated the system when applying it to musculoskeletal problems in the extremities, in particular the knee. The purpose of this study was to investigate the inter-rater reliability of MDT when classifying clinical vignettes describing patients with musculoskeletal knee pain.


This study was divided into two phases. First, 10 clinicians experienced in the use of MDT were recruited to write a total of 60 clinical vignettes based upon the initial assessment of their past patients with knee pain. Second, six different MDT raters were recruited to rate 53 selected vignettes and reliability was determined using Fleiss Kappa.


There was 'substantial agreement' among six MDT raters classifying the clinical vignettes into one of four categories (κ = 0.72). There was no statistically significant difference between therapists with different levels of training.


MDT demonstrated acceptable reliability among trained raters to classify clinical vignettes describing patients with musculoskeletal knee pain. To generalize the use of the system to more users, future research should continue to investigate the reliability of MDT using raters with lower levels of training and experience and assess reliability in real patients.




McKenzie System; Mechanical Diagnosis and Therapy; knee; reliability; vignette

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