In 2018, the Communication Evaluation in Rehabilitation Tool (CERT) was developed to evaluate a physical therapist's communication skill in increasing patient autonomy. The developers of CERT reported an intraclass correlation coefficient (ICC) of 0.76 for the total CERT score. The purpose of this study was to investigate the inter-examiner reliability of non-CERT developers. Two novice examiners independently evaluated voice data in the initial physical therapy sessions of 16 patients with low back pain who were treated by 4 physical therapists (4 patients each). The examiners viewed the CERT training materials (audio of 3 cases and CERT reference values) equivalent to 4 hours, and then scored according to the CERT coding manual. For the inter-examiner reliability, ICC was calculated for each of the 18 items of CERT and the total score, and scores of 0.4 or less were interpreted as weak. The ICC of the total score was 0.85, but 6 items had scores of 0.4 or less. This study found that the total score of CERT has inter-examiner reliability even for non-CERT developers. However, it will be necessary to improve the coding manual and investigate whether inter-examiner reliability is guaranteed for each item of the CERT.

[Purpose] This study aimed to report the improvement effect of Fascial Manipulation (FM) on refractory painful external tibia. [Subject] We report the case of painful external tibia of Veitch classification type II, for which surgical treatment was considered. [Method] We evaluated pain assessment, ankle and hindfoot criteria, and walking ability. Furthermore, we measured the foot arch ratio and spread ratio as morphometric measurements of the foot. We performed FM as a physical therapy. [Results] No change was observed in the morphology of the foot; however, walking ability improved, and pain reduction was observed. [Conclusion] FM as manual therapy was suggested to be useful for painful external tibia.

The McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) is a system of classification and management based on clinical responses induced by specific mechanical loadings. This system can be applied to any musculoskeletal problem: e.g. low back pain, neck pain, and extremity symptoms. The MDT classification system comprises four major categories (Derangement Syndrome, Dysfunction Syndrome, Postural Syndrome, OTHER) and each category leads to a specific management strategy. This paper introduces: 1) the evaluation process leading to each category, 2) the criteria of the four categories and rate of each category, and 3) the significance of the MDT classification system. Some research findings are also presented to support its validity.

Low back pain (LBP) is often referred to as a national disease, and only about 15% of it can be identified as the cause of the disease. As a method for solving problems of LBP, the idea of determining management based on the patterns of symptomic change when mechanical load is applied may be useful. In this case, we report the improvement utilising Mechanical Diagnosis & Therapy (MDT) evaluation and intervention in a patient with LBP and an acute kyphosis. A female aged 40 presented with acute lumbar kyphosis due to pain, and came to the clinic with her family. Careful observation of changes in symptoms and findings while applying a mechanical load following MDT principles the patient made a remarkable improvement.

Mechanical Diagnosis and Therapy (MDT, McKenzie method) is a system for classifying patients’ symptoms. Once the symptoms change, due to a specific loading, that loading is adopted for the patients’ self-exercise. Patients can then self-manage their problems following this procedure. This is a single case study of demonstrating successful MDT procedures for a patient suffering anterior shoulder pain when pitching. The patient’s symptoms were diagnosed as periarthritis of the shoulder and rotator cuff injury. Regarding self-management, the patient was able to maintain and manage his condition with regular exercise. Following the procedures of MDT as a classification methodology, the patient’s history was taken in detail and his movement was assessed mechanically. Pain and restriction during throwing and the results of a ROM test on the shoulder were noted as baselines. Active, repeated, end-range extensions of the cervical and thoracic spine were performed as the screening test, then overpressure at the end range of the spinal movement into extension was added in order to clarify whether the spine was the source of the shoulder pain. Since there were no baseline differences, the therapist added overpressure and extension mobilization progressively to the force self-applied by the patient. However, the base line symptoms did not change significantly despite the loading on the spine. Next, a loading test was conducted on the shoulder. Active extension in the neutral position with and without overpressure was self-tested by the patient. The outcome of this test movement was significant in this session. The symptom was classified as shoulder Derangement and the Directional Preference (DP) was extension. The improvement from the patient’s exercise lasted, and he returned to his leisure activities, including pitching without any concerns. The patient was required to perform the exercise regularly while checking and re-checking the baseline.