Derek,
Did you read the Long 2004 article?
I’m not sure what would “sufficiently refute” the utility of the method for myself. Nothing that has been posted here has met that criteria though. I spent the first 2 years of my career searching for guidance in my clinical decision making. Eventually I decided that MDT was worth investigating further. I also continue to search, hence the reason I visit Barbell Medicine. I have also read all the articles on The Logic of Rehab.
This mechanical obstruction is determined by a clinical observation of obstructed movement. There is not a pathoanatomical obstruction included in the definition, only a clinical presentation. A clinical presentation associated with mechanical obstruction is based on the patient’s history and clinical examination findings. I again refer all to the reference list on the McKenzie Institute site to check the reliability and validity studies.
Maybe there is some influence related to clinical equipoise in the Long paper. The authors address the reasoning for having all treatment groups treated by the MDT clinician. Maybe the results of clinicians without clinical equipoise are affected because the clinicians are more trained in the techniques that they believe in and therefore perform them more effectively. For example the study you included involved 2 PTs and a chiropractor. I think most of us would agree that both of those professions typically involve more training with joint based interventions versus constant touch (whatever that is). Not to mention that the study had fake back pain and fake interventions. There was not a clinician that had a preference for constant touch. There was better improvement with joint based intervention over constant touch overall. My statistics knowledge is poor but I would not be surprised if those facts influence the statistics reported in that study.
With the evidence I have provided (there are hundreds of articles posted on the McKenzie Institute reference list) I do not understand the harm in my recommendations which were:
In this thread: “PTs have to have Continuing Education credits of some sort (many other professions do too), so I recommend courses A-D for anyone interested in learning more about MDT.”
In my original post in the intro thread: “I would recommend the textbooks written by Robin McKenzie for all young clinicians and students as personal reading material for great information on reliability of tests/measures, epidemiology, and natural history of musculoskeletal conditions.”
Your comment towards my recommendation in the intro forum was: “I would not recommend the textbooks of Robin McKenzie as the overall bolus of literature does not state that it is superior to any other method and my understanding of the reading is it has a propensity for a structuralist approach to explanation.”
As I have read the books, I do feel qualified to make the recommendation based on my further understanding of their content and the method. I understand you are working from a different background, however regarding the full scope of literature I do not believe it is responsible to dismiss something that has not been sufficiently explored. And one cannot justify a lack of understanding with hearsay.