Talk:McKenzie method/Archive 1

Untitled
References Whoever is criticising the references of this article hasn't really recognized the reference list. Almost 100 % of the quoted articles were published in peer reviewed journals like Spine, The Spine Journal, Manual Therapy,....

So there is absolutely no need to edit this aspect of the article.--Blueeye1967 (talk) 14:19, 23 October 2010 (UTC)

Efficacy seems overstated in a subtle way
I came from this article from low back pain, where its efficacy was summarized with the same wording used here: "Clinical research also shows that MDT treatment is as effective as other commonly used methods". Most methods are not very effective, so this says that, but in a vague and ambiguous way. MacHado et al 2006 summarizes the evidence in this manner:"There is some evidence that the McKenzie method is more effective than passive therapy for acute LBP; however, the magnitude of the difference suggests the absence of clinically worthwhile effects. There is limited evidence for the use of McKenzie method in chronic LBP. The effectiveness of classification-based McKenzie is yet to be established." It is notable that "When McKenzie was compared with advice to stay active, a reduction in disability favored advice (WMD on a 0- to 100-point scale, 3.85 points; 95% confidence interval, 0.30 to 7.39) at 12 weeks of follow-up". II | (t - c) 04:49, 18 January 2011 (UTC) Regarding systematic reviews this judgement may be reasonable. But in contrast to many other methods in the field of musculosceletal medicine the McKenzie Method shows good reliability and the diagnostic findings have prognostic value. Former research on the method didn't take into account the need for subgrouping. If patients are subgrouped MDT-treatment seems to be superior Browder et al 2007Long et al 2004--Blueeye1967 (talk) 20:15, 25 February 2011 (UTC)

External links modified (January 2018)
Hello fellow Wikipedians,

I have just modified one external link on McKenzie method. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:
 * Added archive https://web.archive.org/web/20130516033957/http://www.mckenziemdt.org/robin.cfm to http://www.mckenziemdt.org/robin.cfm
 * Added tag to http://www.ptjournal.org/cgi/pmidlookup?view=long&pmid=14984296

When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.

Cheers.— InternetArchiveBot  (Report bug) 15:58, 23 January 2018 (UTC)

SPA and Fringe or non quality medical information.
I'm suggesting a move back to this version. There seems to be some questionable information that has been added to this article that may be fringe. -- VViking Talk Edits 13:49, 30 April 2020 (UTC) McKenzie Method Wikipedia response

Thank you for reviewing and questioning this material presented in this article. We appreciate attempts at making sure articles posted are accurate and based on evidence-based literature. So the reason for all the edits is because I’m in the medical field and one of numerous physical therapists that specialize in Mechanical Diagnosis and Therapy or the “McKenzie Method”. I’m sorry this is my first time at doing something like this so I’m trying to figure out how to do per Wikipedia guidelines. This project was originated by the International Director of Education for the McKenzie Institute International and a well-known physical therapy researcher, and a team of other physical therapists as we have been working on updating this on and off for almost a year now and finally tried editing the source material. And this is all volunteer work, as the McKenzie Institute does not employ me.

The purpose of this was to update and revamp the information on here as much of it is outdated, there is a lot more recent research out there, and some of the information on the original article is actually inaccurate. For instance your notation regarding “(Changes such as removing references to having at most, limited benefit for helping alleviate acute back pain to "system encompassing assessment (evaluation), diagnosis, treatment, and prevention for the spine and the extremities.")” was one of many things that needed updated. First that statement on the initial part of the article your were referring to: “Research has found that the McKenzie method has, at most, limited benefit for helping alleviate acute back pain. It is of no benefit for chronic back pain.” is number one, not referenced, and two, inaccurate. That statement, which was not referenced, appears to be referring to the first sentence under “Effectiveness” section which states: “According to a meta-analysis of clinical trials in 2006, treatment using the McKenzie method is somewhat effective for acute low back pain, but the evidence suggests that it is not effective for chronic low-back pain”. There have been numerous issues brought up about this research article already, reference number 8 by Machado et al 2006, which was also discussed by another wiki username Blueeye1967 (see https://en.wikipedia.org/wiki/Talk:McKenzie_method - Section “Efficacy seems overstated in a subtle way).

The article’s actual conclusion however was much different then what was stated on the Wikipedia article (see below):

https://www.ncbi.nlm.nih.gov/pubmed/16641766 Machado et al 2006 - “Conclusion: There is some evidence that the McKenzie method is more effective than passive therapy for acute LBP; however, the magnitude of the difference suggests the absence of clinically worthwhile effects. There is limited evidence for the use of McKenzie method in chronic LBP. The effectiveness of classification-based McKenzie is yet to be established.”

Again, this report being inaccurate is one of the many reasons for the initiative to update this information. If you read on to our updated Effectiveness” section, there have been several recent studies done which have found much different conclusions (see below):

From our attempted update/edit: A 2012 systematic review looking at directional preference showed mixed results, with some evidence found supporting the effectiveness of directional preference when applied to participants with a directional preference upon a repeated end range movement assessment, particularly at short-term and intermediate-term follow-ups.[43]

More recently, another systematic review[44]  found that there was moderate to high quality evidence that MDT is not superior to other rehabilitation interventions for acute low back pain but is superior for chronic low back in reducing pain and disability. These findings conflict with another review.[45]  However, the authors[44]    reported limitations with intention to treat analyses not met in all the studies, some studies only looking at specific MDT subgroups, and no studies were included which compared MDT to other classification approaches.[44]   Also, several of the studies[46][47][48[[49]   included clinicians with minimal levels of training (not certified) even though they reported, “trained therapists are more reliable in classifying patients than are therapists who are not certified”.[44]

Finally, one additional systematic review[50] looked at the difference between pain and disability in patients with low back pain managed with the “core principles” of MDT versus treatment using “some or none” of the MDT principles. They found that trials following the “core principles” of MDT had greater treatment effects versus the other trials which did not follow the principles as closely.[50]  They concluded that better outcomes utilizing the MDT system could be accomplished by following the core principles of MDT[50]  such as matching the treatment to the specific classification. This appears to re-enforce some of the shortcomings of some the previously mentioned reviews.[44][45]

Again our attempt at all the updates/edits is to provide consumers/patients, health-care providers (doctors, therapists, chiropractors, etc.), researchers, and any others the most updated and accurate information about the McKenzie Method. We also attempted to present the information in an un-biased way to discuss the literature that was out there, specifically focusing on the systematic reviews, which did include reviews which discussed findings that were both positive and negative. No physical therapy system is perfect, and being honest about findings is important so that we can learn from them as well, but also be honest and discuss why there may be limitations to certain studies. To do an exhaustive review of the literature would be too much for the readers. We would appreciate allowing our edit back up the way it was and of course we can make some further changes to as needed. This has been a very long project with a lot of time spent on it, and again all voluntary time. Hopefully this information was helpful and I apologize for the length of it. If there were specific suggestions that you have, then let me know. Thank you.Spcarp83 (talk) 18:47, 1 May 2020 (UTC)

References: 8. MacHado, Luciana Andrade Carneiro; De Souza, Marcelo von Sperling; Ferreira, Paulo Henrique; Ferreira, Manuela Loureiro (2006). "The McKenzie Method for Low Back Pain". Spine. 31 (9): E254–62. doi:10.1097/01.brs.0000214884.18502.93. PMID 16641766.

43. Surkitt LD., Ford JJ., Hahne AJ., Pizzari T., McMeeken JM. (2012).Efficacy of directional preference management for low back pain: a systematic review. Phys Ther. 2012 May; 92(5):652-65. doi: 10.2522/ptj.20100251..

44. Lam OT., Strenger DM., Chan-Fee M., Pham PT., Preuss RA., Robbins SM. (2018). “Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis.” J Orthop Sports Phys Ther. Jun;48(6):476-490. doi: 10.2519/jospt.2018.7562.

45.	^ Machado, LA., De Souza M., Ferreira PH., Ferreira ML. (2006). The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine 2006; 31(9): E254-E262. [PubMed]. doi:10.1097/01.brs.0000214884.18502.93. PMID 16641766.

46.	Garcia AN., Costa LC., da Silva TM., Gondo FL., Cyrillo FN., Costa RA., Costa LO. (2013) Ef¬fectiveness of back school versus McKenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2013;93:729-747. https://doi.org/10.2522/ ptj.20120414

47.	Garcia AN., Costa LC., Hancock MJ., Souza FS., Gomes GVFO., Almeida MO., Costa LOP. (2018) McKen¬zie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain: a randomised pla¬cebo controlled trial with short and longer term follow-up. Br J Sports Med. 2018;52:594-600. https://doi.org/10.1136/bjsports-2016-097327

48.	Moncelon S., Otero J. (2015) The McKenzie Method of Mechanical Diagnosis and Therapy in chronic low back pain with directional preference. Kinésithér Rev. 2015;15:31-37. https://doi.org/10.1016/j. kine.2014.11.086

49.	Murtezani A., Govori V., Meka VS., Ibraimi Z., Rrecaj S., Gashi S. (2015) A comparison of McKenzie therapy with electrophysical agents for the treatment of work re¬lated low back pain: a randomized controlled trial. J Back Musculoskelet Rehabil. 2015; 28:247-253. https://doi.org/10.3233/BMR-140511

50.	Halliday MH., Garcia AN., Amorim AB., Machado GC., Hayden JA., Pappas E., Ferreira PH., Hancock MJ. (2019). Treatment Effect Sizes of Mechanical Diagnosis and Therapy for Pain and Disability in Patients With Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther. Apr;49(4):219-229. doi: 10.2519/jospt.2019.8734.

Very outdated information here. Suggestions on how to proceed.
I’m a Physiotherapist with 18 years of experience, I currently work at Whipps Cross University Hospital in London. I’m trained in the McKenzie Method, and when I found this Wikipedia page I was shocked at how outdated it was, nearly every reference is from more than a decade ago. And there’s some outright misinformation with statements such as "research has found that the McKenzie method has, at most, limited benefit for helping alleviate acute back pain. It is of no benefit for chronic back pain" which is just plainly untrue, and doesn’t even have a reference. How is this allowed?

There’s been loads of recent research in scientific publications that should be included in this article. Looking at the Edit History it seems like someone associated with the McKenzie Institute has been trying to update the information on the article, using scholarly sources, but they keep being reverted without much explanation. I imagine the problem might be their wording is coming across as somewhat promotional. But all the back and forth editing and reverting is counterproductive, so I would suggest an editor with appropriate credentials points out the problematic phrases specifically, so the person trying to update with recent research and citations is able to include this new information without constantly being reverted.

If this is not possible, please make other suggestions, because favouring outdated information over recent and properly-cited research is not what I expected from Wikipedia. SantiagoRamosPhysio (talk) 10:39, 28 May 2020 (UTC)
 * It's properly cited in the body text in the Effectiveness section, as Policy wp:P&G dictates. With regards to the "loads of research in scientific publications that should be included in this article.", great, read WP:MEDRS and provide them here. If you aren't confident updating article text, there are many experienced editers who will help you. -Roxy the elfin dog . wooF 11:17, 28 May 2020 (UTC)

SantiagoRamosPhysio - thank you for the support. I attempted to update the source material as you have read to no avail and I also have significant experience and training in MDT, but not as familiar with wiki so I'm trying to learn how to go about this correctly but this has been extremely frustrating experience.

Roxy - I posted some of this above: First that statement on the initial part of the article you were referring to: “Research has found that the McKenzie method has, at most, limited benefit for helping alleviate acute back pain. It is of no benefit for chronic back pain.” is number one, not referenced, and two, inaccurate. That statement, which was not referenced, appears to be referring to the first sentence under “Effectiveness” section which states: “According to a meta-analysis of clinical trials in 2006, treatment using the McKenzie method is somewhat effective for acute low back pain, but the evidence suggests that it is not effective for chronic low-back pain”. There have been numerous issues brought up about this research article already, reference number 8 by Machado et al 2006, which was also discussed by another wiki username Blueeye1967 (see https://en.wikipedia.org/wiki/Talk:McKenzie_method - Section “Efficacy seems overstated in a subtle way).

The article’s actual conclusion however was much different then what was stated on the Wikipedia article (see below):

https://www.ncbi.nlm.nih.gov/pubmed/16641766 Machado et al 2006 - “Conclusion: There is some evidence that the McKenzie method is more effective than passive therapy for acute LBP; however, the magnitude of the difference suggests the absence of clinically worthwhile effects. There is limited evidence for the use of McKenzie method in chronic LBP. The effectiveness of classification-based McKenzie is yet to be established.” And this is not discussed correctly in the "Effectiveness" section either as you can read.

From our attempted edit, some of the much more recent literature that SantiagoRamosPhysio was referring to I believe: More recently, another systematic review[44] found that there was moderate to high quality evidence that MDT is not superior to other rehabilitation interventions for acute low back pain but is superior for chronic low back in reducing pain and disability. These findings conflict with another review.[45] However, the authors[44] reported limitations with intention to treat analyses not met in all the studies, some studies only looking at specific MDT subgroups, and no studies were included which compared MDT to other classification approaches.[44] Also, several of the studies[46][47][48[[49] included clinicians with minimal levels of training (not certified) even though they reported, “trained therapists are more reliable in classifying patients than are therapists who are not certified”.[44]

Finally, one additional systematic review[50] looked at the difference between pain and disability in patients with low back pain managed with the “core principles” of MDT versus treatment using “some or none” of the MDT principles. They found that trials following the “core principles” of MDT had greater treatment effects versus the other trials which did not follow the principles as closely.[50] They concluded that better outcomes utilizing the MDT system could be accomplished by following the core principles of MDT[50] such as matching the treatment to the specific classification. This appears to re-enforce some of the shortcomings of some the previously mentioned reviews.[44][45]More recently, another systematic review[44] found that there was moderate to high quality evidence that MDT is not superior to other rehabilitation interventions for acute low back pain but is superior for chronic low back in reducing pain and disability. These findings conflict with another review.[45] However, the authors[44] reported limitations with intention to treat analyses not met in all the studies, some studies only looking at specific MDT subgroups, and no studies were included which compared MDT to other classification approaches.[44] Also, several of the studies[46][47][48[[49] included clinicians with minimal levels of training (not certified) even though they reported, “trained therapists are more reliable in classifying patients than are therapists who are not certified”.[44]

References from our attempted previous edits for above 44. Lam OT., Strenger DM., Chan-Fee M., Pham PT., Preuss RA., Robbins SM. (2018). “Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain: Literature Review With Meta-analysis.” J Orthop Sports Phys Ther. Jun;48(6):476-490. doi: 10.2519/jospt.2018.7562.

45.	^ Machado, LA., De Souza M., Ferreira PH., Ferreira ML. (2006). The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine 2006; 31(9): E254-E262. [PubMed]. doi:10.1097/01.brs.0000214884.18502.93. PMID 16641766.

46.	Garcia AN., Costa LC., da Silva TM., Gondo FL., Cyrillo FN., Costa RA., Costa LO. (2013) Ef¬fectiveness of back school versus McKenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2013;93:729-747. https://doi.org/10.2522/ ptj.20120414

47.	Garcia AN., Costa LC., Hancock MJ., Souza FS., Gomes GVFO., Almeida MO., Costa LOP. (2018) McKen¬zie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain: a randomised pla¬cebo controlled trial with short and longer term follow-up. Br J Sports Med. 2018;52:594-600. https://doi.org/10.1136/bjsports-2016-097327

48.	Moncelon S., Otero J. (2015) The McKenzie Method of Mechanical Diagnosis and Therapy in chronic low back pain with directional preference. Kinésithér Rev. 2015;15:31-37. https://doi.org/10.1016/j. kine.2014.11.086

49.	Murtezani A., Govori V., Meka VS., Ibraimi Z., Rrecaj S., Gashi S. (2015) A comparison of McKenzie therapy with electrophysical agents for the treatment of work re¬lated low back pain: a randomized controlled trial. J Back Musculoskelet Rehabil. 2015; 28:247-253. https://doi.org/10.3233/BMR-140511

50.	Halliday MH., Garcia AN., Amorim AB., Machado GC., Hayden JA., Pappas E., Ferreira PH., Hancock MJ. (2019). Treatment Effect Sizes of Mechanical Diagnosis and Therapy for Pain and Disability in Patients With Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther. Apr;49(4):219-229. doi: 10.2519/jospt.2019.8734. — Preceding unsigned comment added by Spcarp83 (talk • contribs) 17:02, 1 June 2020 (UTC) Spcarp83 (talk) 18:03, 1 June 2020 (UTC)

Redaction section "Effectiveness"
Created a variant of the updated section "Effectiveness". I ask experienced editors to rate it here.

What is changed:
 * sorted sources in chronological order
 * added information from one new source
 * combined information from sources [8] and [11] (as indicated in the article) since they refer to the same thing
 * deleted information without source
 * detailed the previous text in accordance with the information provided in the sources (for example, the source [10] refers to the 2004 literature review, and the article states that it was 2006, or [8] says that there is not enough information to evaluate the effect of the method on patients with chronic back pain, and in the text “it is not effective for chronic low-back pain ", and these are completely different things).

All sources comply with the WP:MEDRS

NDenPT (talk) 18:51, 7 June 2020 (UTC)
 * MEDRS recommends not using sources > 5 years old when newer are available. Alexbrn (talk) 18:57, 7 June 2020 (UTC)

I think so that it is necessary to clarify the interpretation of the systematic review information in the chapter "Effectiveness". This review examined the effectiveness of the Mackenzie method compared to other rehabilitation methods: manual therapy, educations and exercise. The latter are a proven method for treating lower back pain, which is have in the guidelines for doctors in most developed countries. And, by the way, Mackenzie method is also based on exercises. Nowhere in the source does it say that it has "little benefit for treating acute pain and disability", it is indicated there that it is "not superior to other rehabilitation interventions" and given that it was compared with conventional methods, I think it is more logical to write “Research evaluates it as effectively as other common methods,” as writes this German-language Wikipedia article.

Regarding "evidence is of insufficient quality" and "only weak evidence": the quality of this literature review is 1a, i.e. highest. And it says that "To treat patients with LBP, MDT may be used, although other intervention methods might offer a similar benefit." And I think this wording is suitable, as well as the example from the German-language Wikipedia. NDenPT (talk) 18:49, 8 June 2020 (UTC)
 * There is much discussion of the problematic nature of the evidence, and the concluding words of the article are "Although statistically significant, clinical significance of MDT needs to be determined as the effect sizes found were small to moderate" which colours everything. The German Wikipedia has its own distinct flavour and is not a reliable source. Their recasting of "not superior" to "as effectively as [sic]" is an obvious editorial spin, since not superior means something is at best equivalent to, and otherwise worse. Alexbrn (talk) 20:04, 8 June 2020 (UTC)

Of course there can be a discussion, but it does not change the fact that the level of evidence is the highest. What is written at the very end of this article, in the chapter "Caution", as for me, is of not great importance. First, that at the very beginning, in the preamble, this is not said. Secondly, it says that "clinical significance of MDT effects needs to be determined", it does not say that it does not exist, but only that it remains to be evaluated. As for the German Wikipedia, I thought that it was guided by the same principles and rules as the English-language. Is that not so? Regarding "not superior": at the beginning of the chapter "Discussion" it says "In patients with acute LBP MDT yielded statistically and clinically significant better improvements in pain intensity compared to manual therapy plus exercise", therefore the statement "at best equivalent to, and otherwise worse" is false.

Therefore, based on evidence, I believe that the most appropriate wording for the chapter "Effectiveness" is: "Research rate its effectiveness as comparable to other common methods." NDenPT (talk) 10:36, 9 June 2020 (UTC)
 * , this is a very common theme with fringe therapies. Weak evidence, poor studies, low effect sizes, most studies conducted by advocates. All this adds up to: it doesn't work (or at least that any effect is not due to the specifics of the intervention). Like chiropractic. It's as effective as NSAIDs for lower back pain, which is to say, not very, according to studies conducted by True Believers. And sometimes it kills people. Guy (help!) 11:02, 9 June 2020 (UTC)

Regarding the editing of this article, I formulate my opinion in accordance with the rules of Wikipedia, bringing the corresponding arguments. And I would be glad to see counter-arguments that will be also based on relevant WP:MEDRS sources. It will be especially interesting to see a reliable source under the phrase "And sometimes it kills people".

Regarding "Weak evidence, poor studies" already wrote above.

Therefore, my opinion remains the same, the most appropriate wording for the chapter "Effectiveness" is: "Research rate its effectiveness as comparable to other common methods."NDenPT (talk) 06:58, 10 June 2020 (UTC)

I can’t find information in the source that research into the effectiveness of the McKenzie Method has been of poor quality. Tell me where did you find her there? NDenPT (talk) 10:09, 11 June 2020 (UTC)
 * It is in the conclusion. -Roxy the elfin dog . wooF 10:18, 11 June 2020 (UTC)

Thank you! This review focuses on the efficacy of the Mackenzie method compared to ONLY manual therapy for the treatment of chronic lower back pain. My opinion: it is not correct to extrapolate information only from this systematic review to "In general". For example, this source does not have such information. Therefore, I think it’s more correct to say "One reliable source said that the research is devoted to the study of the effectiveness of the Mackenzie method in comparison with manual therapy for the treatment of chronic lower back pain of generally low quality"NDenPT (talk) 10:54, 11 June 2020 (UTC)


 * I think the conclusion gives its comments a wider context, referring to "this area" and "this field", and also in the Introduction we learn of the Mckenzie Mehod, that "it would seem the evidence relating to its efficiency is dubious". Alexbrn (talk) 11:05, 11 June 2020 (UTC)

here the phrases "this area" and "this field" can be interpreted in two ways. But the statement "McKenzie method has been recognized as one of effective methods for treating LBP. This has become the most popular, particularly among physiotherapists, clinically approved treatment for LBP", which have in the same source, leaves no room for ambiguities. There is also, with respect to the McKenzie method, "it is recommended by NICE" (National Institute for Health and Care Excellence). I think that this information should also be indicated in Wikipedia article.NDenPT (talk) 22:30, 12 June 2020 (UTC)
 * That's fair, since the whole thrust of the article is that its popularity may not be justified by the evidence. I have added something to reflect this. Alexbrn (talk) 04:57, 13 June 2020 (UTC)

I think the authors wanted to say that the method successfully applied in clinical practice, therefore it is so popular among specialists and as a result approved at the state level and more studies need to be conducted to evaluate the effectiveness in more detail. This source also indicated the strengths of the available researchs and why some details may be omitted, taking into account the specifics of this field of activity (for example, blinding patients). NDenPT (talk) 12:31, 13 June 2020 (UTC)

I got the impression that the Wikipedia administrators in the text of the article intentionally underestimate the effectiveness of the Mackenzie method. At this rate, this is a violation of one of the fundamental principles of Wikipedia - neutral point of view. I think, that administrators first of all should monitor the implementation of this principle and ensure that it is not violated. As for me, information about the Mackenzie method from the indicated sources is presented one-sidedly with the aim of convincing that it is not effective. I agree that there are certain questions about the method, but this does not mean that you need to be silent about its strengths, which are also indicated in the sources, but are almost absent in the Wikipedia article. I would like the information regarding its effectiveness to be presented in a balanced manner, observing Neutral point of view. NDenPT (talk) 13:17, 13 June 2020 (UTC)
 * For a more "positive" presentation we would need more positive sources. When what we have says the "clinical significance of MDT needs to be determined" and that "the evidence relating to its efficiency is dubious", then Wikipedia faithfully reflects that. We don't say it is "not effective". Alexbrn (talk) 14:01, 13 June 2020 (UTC)
 * Sources is have, the problem is how the information from them is interpreted and presented here. For example, "Compared to other treatments, the McKenzie Method is of little benefit for treating acute pain and disability for people with lower back pain" can be formed as "For treating acute pain and disability for people with lower back pain, the effectiveness of the McKenzie Method was similar to others treatments ". Essentially nothing will change. NDenPT (talk) 08:40, 14 June 2020 (UTC)
 * That would not be an honest summary, as I have already written. Alexbrn (talk) 11:03, 14 June 2020 (UTC)
 * I think this is an honest summary. The arguments are written above. In my opinion, here violated Neutral point of view. NDenPT (talk) 14:22, 14 June 2020 (UTC)
 * Do you have a WP:COI to declare? Alexbrn (talk) 14:32, 14 June 2020 (UTC)
 * Sometimes I use the Mackenzie method in my profession. Therefore, I know how it works. I have no financial interest in editing this article. NDenPT (talk) 11:26, 16 June 2020 (UTC)
 * According to source 8 and 9 the method is effective. I have therefore edited the article to show clear NPOV writing and have gone as far as to take what was literally said from the article. Since you insist that we use valid sources a review and subsequent update of what was found in the sources you yourself have advocated for should be in order. I do not know how you came to your conclusion upon reading source 8 and 9 but I have read through both of them and found both of them to be objective and straightforward as well as in support of the effectiveness of the McKenzie Method. It is however a gross miss-attribute to say that the method is ineffective based on the findings of the studies which has been the opposite. MarqReg (talk) 17:22, 25 June 2020 (UTC)
 * Wikipedia does not say "the method is ineffective". It's more nuanced than that. Also be aware of the WP:SOCKing policy. Alexbrn (talk) 17:26, 25 June 2020 (UTC)
 * , as noted before, for lower back pain, "works as well as standard of care" equals "does not work". Guy (help!) 18:00, 25 June 2020 (UTC)
 * This account is not a sockpuppet, every time anyone comes forwards and questions the validity of the statements made in this article you three argue with two main points: A) YOU ARE VIOLATING THE NPOV / represent an organization, etc. B) Same effectivity means does not work. These two arguments have no validity because firstly A: You three are clearly violating the NPOV yourself and have shown on your own pages that some of you have friendly relationships with each other and are helping each other further your own agenda. You even have a manifesto on your page declaring your plain bias for and against things. B: A treatment recommended by the National Institute for Health and Care Excellence should plainly show to you that this method is effective. Can you also explain why you twist the words found in reference 8 and 9? Those two articles clearly show support for the effectiveness of the article. I will conclude this statement by saying that immediately when anyone comes forward in support of the method you cry like children about the NPOV and ask people if they have a WP:COI to declare. I would say this is projection and that you three should look at yourself and realize that you clearly need to declare your own WP:COI . As a frequent user of Wikipedia on mundane and work related topics seeing this gross misuse of power and clear propaganda thriving here is disgusting. MarqReg (talk) 19:22, 25 June 2020 (UTC)
 * Your edits are bad and not even in understandable English. WP:CIR. Sorry, but Wikipedia needs to be in understandable English summarizing sources accurately. We are not a brochure for this product. Alexbrn (talk) 22:14, 25 June 2020 (UTC)
 * Are you implying that the reliable source is in unintelligible thus making it an invalid source? "Conclusion
 * There is moderate- to high-quality evidence that MDT is not superior to other rehabilitation interventions for reducing pain and disability in patients with acute LBP. In patients with chronic LBP, there is moderate- to
 * high-quality evidence that MDT is superior to other rehabilitation interventions for reducing pain and disability; however, this depends on the type of intervention being compared to MDT." Taken directly from the
 * source. Are you saying that the source is written so poorly that you cannot understand it? Then why list it as a source? I would retort that your edits aren't just bad but plain wrong. Your ego is the size of Mount Everest. Also nice of you do abuse the Edit system to prevent a undo, real smart there. MarqReg (talk) 22:51, 25 June 2020 (UTC)

Research quality
has been edit-warring to remove mention of the research quality in this area, offering various reasons: that such an assessment is like appraising a painting, and latterly that they can't find this material in the source. Yet the source contains much discussion of the quality of research, and in its conclusion has:

I propose we restore a mention of the problem with research quality and reverse Brakkar's edit, which misses this important aspect and thus overstates the efficacy of this treatment in a way the sources cannot support. Also, less seriously, we don't include text like "a systematic review found ..." in medical articles as it's bad style. Alexbrn (talk) 14:02, 27 June 2020 (UTC)
 * The source does not say that research into the McKenzie method is of poor quality. It says quite the opposite in fact. It scores the five included studies on a scale of 1-11 where higher scores are better; four of the studies score 8, the other 6. The score concerns experiment design, not research quality; blinding is difficult to achieve in an experiment evaluating the McKenzie method, but this does not imply that the research that results is of poor quality.
 * The main result of the review is that the method has short term benefits in pain reduction, and long term benefits in back function. It does not find that most research into the method is of poor quality. What was in the article before was clearly an egregious misrepresentation of what the source said.
 * As for the supposed bad style of saying that a result comes from a systematic review: if there has been a discussion where this has been decided, please post the link. Brakkar (talk) 14:46, 27 June 2020 (UTC)
 * Read the conclusion I quoted. What we had was a nice summary. We don't confuse readers with unnecessary gubbins about "a meta-analysis ..." (or whatever) except when necessary. Feel free to check at WT:MED or browse some featured medical articles to see how it's done. Alexbrn (talk) 14:52, 27 June 2020 (UTC)
 * What was there was not a nice summary. It was a misrepresentation. The main result of the review was that benefits were found to the method. They noted that there are very few randomised controlled trials available; that does not remotely equate to "research is generally poor quality in this area", which was the claim you were making. Ok if you don't want to confuse readers with the words "meta-analysis", but what does that have to do with my edit? Brakkar (talk) 15:03, 27 June 2020 (UTC)
 * I disagree: the poor quality of the evidence is a major strand of the review. Basic reading comprehension is necessary to summarize sources faithfully. Your shifting justifications suggests you wanted to revert the text all along, and are scrabbling around trying to retro-fit some justification. Edit-warring is not the way to proceed in any case. Alexbrn (talk) 15:09, 27 June 2020 (UTC)
 * Withdraw your personal attack please. Brakkar (talk) 16:01, 27 June 2020 (UTC)
 * Accusing somebody of a personal attack when there is no such thing is a personal attack. Read WP:NPA, and withdraw your personal attack please, thanks. - ALSO, stop edit warring. consider this your Final Warning. Thanks. -Roxy the elfin dog . wooF 16:17, 27 June 2020 (UTC)