Mechanical diagnosis and therapy enhances attitude toward self-management in people with musculoskeletal disorders: A preliminary evidence with a before-after design.

Objectives: Mechanical diagnosis and therapy is one of the most common approaches for the management of low back pain. In mechanical diagnosis and therapy, a great emphasis is placed on patient education so that patients can manage their problems by themselves. However, there has been no evidence that mechanical diagnosis and therapy actually enhances patient's self-management skills. This study aimed to preliminarily investigate whether self-reported skills of self-management for musculoskeletal problems are enhanced through the course of mechanical diagnosis and therapy.

Method: Outpatients with musculoskeletal disorders in a local orthopedic clinic were included. The primary outcome measures were the "Self-monitoring and Insight" and "Skill and Technique Acquisition" scores of the Health Education Impact Questionnaire, where higher scores indicate greater self-management skills. Mechanical diagnosis and therapy was undertaken up to a maximum of twice per week for 1 month. The Self-monitoring and Insight and Skill and Technique Acquisition scores before and 1 month after the mechanical diagnosis and therapy interventions were compared. Proportions of patients who exceed the threshold for "reliable change" in the Health Education Impact Questionnaire scores (% >positive "reliable change") and proportions of patients with the net positive "reliable change" (% net positive "reliable change") were investigated.

Results: Forty-five patients participated and 97.8% completed the 1-month follow-up. The Self-monitoring and Insight and Skill and Technique Acquisition scores significantly increased at the follow-up (Self-monitoring and Insight, p  = 0.002; Skill and Technique Acquisition, p  < 0.001. The % >positive "reliable change" (Self-monitoring and Insight = 22.2%, Skill and Technique Acquisition = 48.9%) and % net positive "reliable change" (Self-monitoring and Insight = 13.3%, Skill and Technique Acquisition = 46.7%) in this study were comparative to or greater than self-management programs in previous studies (%> positive "reliable change': Self-monitoring and Insight = 20.5%, Skill and Technique Acquisition = 30.7%; % net positive "reliable change": Self-monitoring and Insight = 14.1%, Skill and Technique Acquisition = 23.0%).

Conclusion: This study provides a preliminary evidence that mechanical diagnosis and therapy enhances patient's self-management skills, particularly in the self-monitoring skills for symptoms/functions and the self-management skill for symptoms/problems.