Although approximately 30% to 70% of people with neck pain improve spontaneously over time,1, 15 and 16 neck pain can be a persistent or a recurrent disorder.1 and 17 Thus, it is important to investigate if MDT provides additional benefit in comparison to natural resolution of neck pain and other therapeutic approaches. The approach of MDT emphasises patient education throughout the treatment so that patients can obtain

skills to both manage their current episode of neck pain and prevent or self-treat future recurrences independently. Therefore, it is also important to investigate long-term effects in addition to short-term effects. A systematic review with meta-analysis of randomised selleck screening library trials is required to synthesise the evidence about the effectiveness of MDT on pain intensity and disability in the short, intermediate and long term in comparison to wait-and-see control and to other therapeutic approaches. In 2004, a systematic selleck inhibitor review was conducted to try to synthesise randomised trials of MDT for spinal pain compared to other therapeutic

approaches.18 However, only one randomised trial of MDT for neck pain was included in that review, so findings were inconclusive. In 2006, the MDT textbook for neck pain, including whiplash-associated disorders,14 was updated considerably.19 Research on MDT has been increasing over the past decade. Therefore, this systematic review was deemed necessary to estimate the effectiveness of MDT on neck pain and disability from unbiased evidence. The research questions were: 1. In people with neck pain, does MDT reduce pain and disability more than a wait-and-see control? A systematic search was performed in PubMed, SCOPUS, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and the Cochrane library, from inception to May 2013. The refined key search terms included: McKenzie therapy, McKenzie method, McKenzie approach, McKenzie

treatment or mechanical diagnosis, and neck or cervical. In addition, the reference list of the McKenzie Institute website and the International Clinical Trials Registry Platform Search Portal were manually searched. Cross-referencing was undertaken through communications with experts in this field and relevant reviews. Inclusion criteria Etomidate are presented in Box 2. Two assessors (HT and RN) independently inspected studies to be included. Full text was inspected after exclusion of studies by screening the title and abstract. Disagreements were resolved by consensus. Design • Randomised controlled trials Participants • People with neck pain Intervention • Mechanical Diagnosis and Therapy (MDT) without other treatment modalities Outcome measures • Neck pain intensity Comparisons • MDT versus ‘wait and see’, act as usual, or placebo Methodological quality was assessed using the 10-point PEDro scale, excluding Item 1 (eligibility), as recommended because of its relevance to external not internal validity.