When clinicians bring up the phrase "Mechanical Diagnosis And Therapy" (MDT), they will often mention things like diagnostic classification, centralization, and directional preference. You might even hear mention of self treatment.
I would suggest that we can add one more phrase to the mix: public health.
MDT clinicians are uniquely qualified to contribute favorably to a public health initiative. Though that may sound like a pretty significant value proposition for the future of health care, it comes with some substantial rationale to support it. There are a number of reasons why MDT can provide the foundation for a public health initiative that could truly be a game-changer.
Health care has done a stunning job over the past few decades of creating an environment of patient dependency, almost to the point of codependency. It starts with paternalistic behaviors and builds from there. The traditional "hands-on" care that has been a cornerstone of our health care system is not only costly, but it is also highly dependent upon assessment techniques shown to have poor inter-rater reliability and treatment interventions with questionable outcomes. Clinicians perpetuate the myth that "hands-on" care is, in effect, better care. Most importantly, it also promotes an external locus of control even if the clinician is ultra-focused on "patient education" and "independence".
This traditional approach in health care runs counter to a sound long-term public health strategy.
The Association of Schools of Public Health defines "public health" as
"... the science of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention."
There is a distinction made between public health professionals and clinical professionals:
"Public health professionals try to prevent problems from happening or re-occurring through implementing educational programs, developing policies, administering services, regulating health systems and some health professions, and conducting research, in contrast to clinical professionals, such as doctors and nurses, who focus primarily on treating individuals after they become sick or injured."
Unless, of course, you are an MDT clinician.
MDT clinicians are uniquely qualified to contribute favorably to a public health initiative because the primary themes of MDT are central to a community-based program. MDT is more than just a clinical assessment or treatment approach. It is, in essence, cognitive-behavioral in nature. MDT has a primary focus on self care and self treatment strategies which promotes an internal locus of control. MDT also naturally progresses from clinical care when injured to a prevention-centered approach for the long-term health benefits of the patient.
These themes - that are the bedrock of MDT - are the foundations for public health strategy in musculoskeletal health. And let's face the music - musculoskeletal conditions such as spinal pain (both acute and chronic) are, without a doubt, a public health issue.
There is hope, but it will require a shift in thinking. Public health strategies must foster an internal locus of control, something that can change a patient's perception of their self efficacy. This goes far beyond just "being taught the right exercises". It is more than just "having the clinician crack my back" every time an episode recurs. And it is beyond "exercise adherence".
For the long-term health of our communities, can we afford to promote dependence any longer? Public health will require a game changer - and MDT may provide one such solution.
Photo credits: Kathy Harrison
"Running Injuries: Etiology And Recovery- Based Treatment" (co-author Bridget Clark, PT) appears in the recently released third edition of "
" by S. Brent Brotzman, MD and Robert C. Manske, PT.
