Another possible limitation is omission of relevant studies – in particular non-English studies – although the review was made as inclusive as possible. In conclusion: in people with neck pain, in the short, intermediate or long term, currently available high-quality studies provide GSK1120212 consistent evidence that any additional benefit of MDT compared with a

wait-and-see approach or other therapeutic approaches may not be clinically important in terms of pain intensity, and is not clinically important in terms of disability. However, there was no study where MDT was only performed by therapists with an MDT Diploma. In addition, certain subgroups may have better effects from MDT than others. Therefore, future trials of MDT should only use therapists with an MDT Diploma and analyse each MDT subgroup separately. What is already known on this topic: Neck pain is common and disabling. Mechanical Diagnosis and Therapy (MDT, also known as the McKenzie approach) classifies the patient’s symptoms into subgroups and recommends different Vemurafenib treatments for these

subgroups. What this study adds: MDT may have a better effect on pain than ‘wait and see’ or other treatment approaches, but the difference in effect may not be clinically important. MDT does not have a greater effect on disability than ‘wait and see’ or other treatment approaches. Existing evidence has not examined the effect of MDT when administered by physiotherapists with the highest MDT training. eAddenda: Table 2, Figure 3 and Figure 5 can be found online at doi:10.1016/j.jphys.2014.05.006 Ethics approval: Not applicable. Competing interests: There is no conflict of interest. Source(s) of support: There was no funding in relation to this study. Acknowledgements: The authors wish to acknowledge: Ms Rie Namaeda for her assistance in searching studies; Ms Xiaoqi Chen for her assistance in extracting data as an independent assessor; Mr Chris Chase for peer-reviewing before paper submission; and Dr Grażyna Guzy and Dr Alice Kongsted

for providing unpublished data for this study. Correspondence: Hiroshi Takasaki, Division of Physical Therapy, Sitaxentan Saitama Prefectural University, Japan. Email: [email protected] “
“The Australian Institute of Health and Welfare has found that 65-year-old Australians have increasing life expectancy, both of years lived with disability and years lived without disability.1 With the percentage of Australians aged 85 years and older expected to increase from 2% in 2013 to 3.5% in 2033,2 the costs of disability in older Australians can be expected to substantially increase unless disability can be prevented and treated more efficiently. Falls are a major contributor to injury with subsequent disability in the elderly, and poor balance is associated with increased risk of injurious falls.