Pontifícia Universidade Católica de Minas Gerais

OBJECTIVE: This systematic review was designed and conducted in an effort to evaluate the evidence currently available for the many suggested risk factors for work-related musculoskeletal disorders. METHODS: To identify pertinent literature we searched four electronic databases (Cinahl, Embase, Medline, and The Cochrane Library). The search strategies combined terms for musculoskeletal disorders, work, and risk factors. Only case-control or cohort studies were included. RESULTS: A total of 1,761 non-duplicated articles were identified and screened, and 63 studies were reviewed and integrated in this article. The risk factors identified for the development of work-related musculoskeletal disorders were divided and organized according to the affected body part, type of risk factor (biomechanical, psychosocial, or individual) and level of evidence (strong, reasonable, or insufficient evidence). CONCLUSIONS: Risk factors with at least reasonable evidence of a causal relationship for the development of work-related musculoskeletal disorders include: heavy physical work, smoking, high body mass index, high psychosocial work demands, and the presence of co-morbidities. The most commonly reported biomechanical risk factors with at least reasonable evidence for causing WMSD include excessive repetition, awkward postures, and heavy lifting. Additional high methodological quality studies are needed to further understand and provide stronger evidence of the causal relationship between risk factors and work-related musculoskeletal disorders. The information provided in this article may be useful to healthcare providers, researchers, and ergonomists interested on risk identification and design of interventions to reduce the rates of work-related musculoskeletal disorders.

AIM: To determine the incidence of peri-implantitis in individuals with mucositis in a 5-year follow-up study. MATERIAL AND METHODS: A sample of 212 partially edentulous individuals, rehabilitated with dental implants, underwent periodontal and peri-implant clinical examinations in 2005 (baseline). Five years later, 80 individuals who had been diagnosed with mucositis in the baseline examination were re-examined. These individuals were divided into two groups: one group with preventive maintenance during the study period (GTP; n = 39), and another group without preventive maintenance (GNTP; n = 41). The following parameters were clinically evaluated: plaque index, bleeding on periodontal and peri-implant probing, periodontal and peri-implant probing depth, suppuration and peri-implant bone loss. The influence of biological and behavioural risk variables associated with the occurrence of peri-implantitis was analysed using univariate and multivariate logistic regression analyses. RESULTS: The incidence of peri-implantitis in the global sample was 31.2% (GNTP = 43.9% and GTP = 18.0%). CONCLUSION: The absence of preventive maintenance in individuals with pre-existing peri-implant mucositis was associated with a high incidence of peri-implantitis. Clinical parameters, such as bleeding on peri-implant probing, periodontal probing depth and the presence of periodontitis were associated with a higher risk of developing peri-implantitis.

This paper presents a comprehensive review of the industrial applications of artificial neural networks (ANNs), in the last 12 years. Common questions that arise to practitioners and control engineers while deciding how to use NNs for specific industrial tasks are answered. Workable issues regarding implementation details, training and performance evaluation of such algorithms are also discussed, based on a judiciously chronological organization of topologies and training methods effectively used in the past years. The most popular ANN topologies and training methods are listed and briefly discussed, as a reference to the application engineer. Finally, ANN industrial applications are grouped and tabulated by their main functions and what they actually performed on the referenced papers. The authors prepared this paper bearing in mind that an organized and normalized review would be suitable to help industrial managing and operational personnel decide which kind of ANN topology and training method would be adequate for their specific problems.

Practice guidelines recommend various types of exercise and manipulative therapy for chronic back pain but there have been few head-to-head comparisons of these interventions. We conducted a randomized controlled trial to compare effects of general exercise, motor control exercise and manipulative therapy on function and perceived effect of intervention in patients with chronic back pain. Two hundred and forty adults with non-specific low back pain 3months were allocated to groups that received 8weeks of general exercise, motor control exercise or spinal manipulative therapy. General exercise included strengthening, stretching and aerobic exercises. Motor control exercise involved retraining specific trunk muscles using ultrasound feedback. Spinal manipulative therapy included joint mobilization and manipulation. Primary outcomes were patient-specific function (PSFS, 3-30) and global perceived effect (GPE, -5 to 5) at 8weeks. These outcomes were also measured at 6 and 12months. Follow-up was 93% at 8weeks and 88% at 6 and 12months. The motor control exercise group had slightly better outcomes than the general exercise group at 8weeks (between-group difference: PSFS 2.9, 95% CI: 0.9-4.8; GPE 1.7, 95% CI: 0.9-2.4), as did the spinal manipulative therapy group (PSFS 2.3, 95% CI: 0.4-4.2; GPE 1.2, 95% CI: 0.4-2.0). The groups had similar outcomes at 6 and 12months. Motor control exercise and spinal manipulative therapy produce slightly better short-term function and perceptions of effect than general exercise, but not better medium or long-term effects, in patients with chronic non-specific back pain.

STUDY DESIGN: Ultrasound and electromyographic (EMG) measures of trunk muscle activity were compared between low back pain (LBP) and control subjects in a cross-sectional study. OBJECTIVES: To compare the recruitment of the abdominal muscles (measured as a change in thickness with ultrasound imaging) between people with and without low back pain and to compare these measurements with EMG recordings made with intramuscular electrodes. SUMMARY OF BACKGROUND DATA: Although ultrasonography has been advocated as a noninvasive measure of abdominal muscle activity, it is not known whether it can provide a valid measure of changes in motor control of the abdominal muscles in LBP. METHODS: Ten subjects with recurrent LBP and 10 matched controls were tested during isometric low load tasks with their limbs suspended. Changes in thickness from resting baseline values were obtained for transversus abdominis (TrA), obliquus internus (OI), and obliquus externus (OE) using ultrasonography. Fine wire EMG was measured concurrently. RESULTS: Study participants with LBP had a significantly smaller increase in TrA thickness with isometric leg tasks compared with controls. No difference was found between groups for OI or OE. Similar results were found for EMG. People with LBP had less TrA EMG activity with leg tasks, and there was no difference between groups for EMG activity for OI or OE. CONCLUSIONS: This study reinforces evidence for changes in automatic control of TrA in people with LBP. Furthermore, the data establish a new test of recruitment of the abdominal muscles in people with LBP. This test presents a feasible noninvasive test of automatic recruitment of the abdominal muscles.

In Brief Study Design. Translation, cross-cultural adaptation, and clinimetric testing of self-report outcome measures. Objective. The aims of this investigation were to perform the translation and cross-cultural adaptation of the Patient-Specific Functional Scale (PSFS) into Brazilian-Portuguese and to perform a head-to-head comparison of the clinimetric properties of the Brazilian-Portuguese versions of the PSFS, the Roland-Morris Disability Questionnaire (RMDQ) and the Functional Rating Index (FRI). Summary of Background Data. To date, there is no Brazilian-Portuguese version of the PSFS available and no head-to-head comparison of the Brazilian-Portuguese versions of the PSFS, RMDQ, and FRI has been undertaken. Methods. The PSFS was translated and adapted into Brazilian-Portuguese. The PSFS, the RMDQ, and the FRI were administered to 99 patients with low back pain to evaluate internal consistency, reproducibility, ceiling and floor effects, construct validity, internal and external responsiveness. To fully test the construct validity and external responsiveness of these measures, it was necessary to cross-culturally adapt the Pain Numerical Rating Scale and the Global Perceived Effect Scale. Results. All measures demonstrated high levels of internal consistency (Cronbach's α range = 0.88–0.90) and reproducibility (Intraclass Correlation Coefficient2,1 range = 0.85–0.94). High correlations among the disability-related measures were observed (Pearson's r ranging from 0.51 to 0.71). No ceiling or floor effects were detected. The PSFS was consistently more responsive than the other measures in both the internal responsiveness and external responsiveness analyses. Conclusion. The results from this study demonstrate that the Brazilian-Portuguese versions of the RMDQ, the FRI and the PSFS have similar clinimetric properties to each other and to the original English versions. Of allthe measures tested in this study the PSFS seems the most responsive. These measures will enable international comparisons to be performed, and encourage researchers to include Portuguese speakers in their clinical trials. The aims of this study were to cross-culturally adapt the Patient-Specific Functional Scale to Brazilian-Portuguese and to perform a head-to-head comparison of its clinimetric properties with those of the Roland-Morris Disability Questionnaire and the Functional Rating Index. The 3 measures were shown to have similar clinimetric properties however, the Patient-Specific Functional Scale was the most responsive.

BACKGROUND: Recent evidence indicates a potential therapeutic role of fluvoxamine for COVID-19. In the TOGETHER trial for acutely symptomatic patients with COVID-19, we aimed to assess the efficacy of fluvoxamine versus placebo in preventing hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to a tertiary hospital due to COVID-19. METHODS: This placebo-controlled, randomised, adaptive platform trial done among high-risk symptomatic Brazilian adults confirmed positive for SARS-CoV-2 included eligible patients from 11 clinical sites in Brazil with a known risk factor for progression to severe disease. Patients were randomly assigned (1:1) to either fluvoxamine (100 mg twice daily for 10 days) or placebo (or other treatment groups not reported here). The trial team, site staff, and patients were masked to treatment allocation. Our primary outcome was a composite endpoint of hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to tertiary hospital due to COVID-19 up to 28 days post-random assignment on the basis of intention to treat. Modified intention to treat explored patients receiving at least 24 h of treatment before a primary outcome event and per-protocol analysis explored patients with a high level adherence (>80%). We used a Bayesian analytic framework to establish the effects along with probability of success of intervention compared with placebo. The trial is registered at ClinicalTrials.gov (NCT04727424) and is ongoing. FINDINGS: The study team screened 9803 potential participants for this trial. The trial was initiated on June 2, 2020, with the current protocol reporting randomisation to fluvoxamine from Jan 20 to Aug 5, 2021, when the trial arms were stopped for superiority. 741 patients were allocated to fluvoxamine and 756 to placebo. The average age of participants was 50 years (range 18-102 years); 58% were female. The proportion of patients observed in a COVID-19 emergency setting for more than 6 h or transferred to a teritary hospital due to COVID-19 was lower for the fluvoxamine group compared with placebo (79 [11%] of 741 vs 119 [16%] of 756); relative risk [RR] 0·68; 95% Bayesian credible interval [95% BCI]: 0·52-0·88), with a probability of superiority of 99·8% surpassing the prespecified superiority threshold of 97·6% (risk difference 5·0%). Of the composite primary outcome events, 87% were hospitalisations. Findings for the primary outcome were similar for the modified intention-to-treat analysis (RR 0·69, 95% BCI 0·53-0·90) and larger in the per-protocol analysis (RR 0·34, 95% BCI, 0·21-0·54). There were 17 deaths in the fluvoxamine group and 25 deaths in the placebo group in the primary intention-to-treat analysis (odds ratio [OR] 0·68, 95% CI: 0·36-1·27). There was one death in the fluvoxamine group and 12 in the placebo group for the per-protocol population (OR 0·09; 95% CI 0·01-0·47). We found no significant differences in number of treatment emergent adverse events among patients in the fluvoxamine and placebo groups. INTERPRETATION: Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalisation defined as retention in a COVID-19 emergency setting or transfer to a tertiary hospital. FUNDING: FastGrants and The Rainwater Charitable Foundation. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

We review the ecological and socio-economic impacts of the catastrophic dam failure in Mariana, Brazil. Tailing management practices by Samarco mining company ultimately caused a dam breach that abruptly discharged between 55 and 62 million m3 of tailings into the Doce River watershed. On November 5th, 2015, a tsunami of slurry engulfed the small district of Bento Rodrigues, loading the Doce River and its estuary with toxic tailings along a 663.2 km trajectory, extending impacts to the Atlantic coast. Acute ecological impacts will adversely affect livelihoods of more than 1 million people in 41 riparian municipalities by reducing local access to fisheries resources, clean water, crop production sites, hydroelectric power generation and raw materials. The threats to riverine human communities are particularly critical for the disadvantaged populations from remote areas that rely on subsistence agriculture and fisheries, and are uniquely vulnerable to long-term heavy metal exposure. At the landscape scale, we predict multiple negative impacts, ranging from alterations of the genetic diversity of fish populations to long-term vegetation loss and poor regeneration in contaminated areas. Consequently, compromised soil stability and runoff control will increase the risk of further geomorphologic disturbance, including landslides, bank failure and mass movements. We propose spatially explicit long-term monitoring frameworks and priority mitigation measures to cope with acute and chronic risks. We posit that, from a national perspective, disastrous impacts like that of Doce River may become more frequent, given the recent regulatory changes that undermine both institutional governance structures and enforcement of environmental regulation.

Abstract Aim The knowledge of biodiversity facets such as species composition, distribution and ecological niche is fundamental for the construction of biogeographic hypotheses and conservation strategies. However, the knowledge on these facets is affected by major shortfalls, which are even more pronounced in the tropics. This study aims to evaluate the effect of sampling bias and variation in collection effort on Linnean, Wallacean and Hutchinsonian shortfalls and diversity measures as species richness, endemism and beta‐diversity. Location Brazil. Methods We have built a database with over 1.5 million records of arthropods, vertebrates and angiosperms of Brazil, based on specimens deposited in scientific collections and on the taxonomic literature. We used null models to test the collection bias regarding the proximity to access routes. We also tested the influence of sampling effort on diversity measures by regression models. To investigate the Wallacean shortfall, we modelled the geographic distribution of over 4000 species and compared their observed distribution with models. To quantify the Hutchinsonian shortfall, we used environmental Euclidean distance of the records to identify regions with poorly sampled environmental conditions. To estimate the Linnean shortfall, we measured the similarity of species composition between regions close to and far from access routes. Results We demonstrated that despite the differences in sampling effort, the strong collection bias affects all taxonomic groups equally, generating a pattern of spatially biased sampling effort. This collection pattern contributes greatly to the biodiversity knowledge shortfalls, which directly affects the knowledge on the distribution patterns of diversity. Main conclusions The knowledge on species richness, species composition and endemism in the Brazilian biodiversity is strongly biased spatially. Despite differences in sampling effort for each taxonomic group, roadside bias affected them equally. Species composition similarity decreased with the distance from access routes, suggesting collection surveys at sites far from roads could increase the probability of sampling new geographic records or new species.

S ince the 1990s, the English School of International Relations has re-emerged as a research program. The work of its classical authors has been taken up again and new theoretical investments have projected it onto the centre of the debates on transformations in the international order after the Cold War. The English School has thus gained a renewed momentum. In spite of the remark by Tim Dunne (1998) as to the alleged development of two streams within this tradition -classical theorists of international society and critical theorists of international society -what one has been able to observe is the theoretical-analytical dispersion around and based on the main concepts inherited from classical authors -Butterfield, Wight, Manning, Bull, Watson and Vincent, among others. However, such dispersion denotes not fragility but the vitality of a theoretical architecture that has plasticity as its central characteristic. Such plasticity has allowed contemporary authors to recover the concept of "international society" -a distinctive element of the English School of International Relations -and to place it, in the first instance, within a dialogue with the main theoretical debates of the field, and, secondly, at the service of an understanding of the problem of international order (see Weaver 1992Weaver , 1998Weaver , 1999)). Such dispersion allows one to understand the recent writings of Linklater and Suganami (2002), on the one hand, and of Barry Both seek to confront one problem: how to deal with the growing density of international society in the light of the concepts inherited from the tradition and, in particular, in the light of the debate between pluralist and solidarist perspectives that marked the intellectual

BACKGROUND: Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health apps. OBJECTIVE: The aim of our study was to evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist DM patients in treatment. METHODS: We conducted searches in the electronic databases MEDLINE (Pubmed), Cochrane Register of Controlled Trials (CENTRAL), and LILACS (Latin American and Caribbean Health Sciences Literature), including manual search in references of publications that included systematic reviews, specialized journals, and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, patients with DM, and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager software version 5.3. RESULTS: The literature search identified 1236 publications. Of these, 13 studies were included that evaluated 1263 patients. In 6 RCTs, there were a statistical significant reduction (P<.05) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (mean difference, MD -0.44; CI: -0.59 to -0.29; P<.001; I²=32%).The evaluation favored the treatment in patients who used apps without significant heterogeneity. CONCLUSIONS: The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care by contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly by reducing their fear of not knowing how to deal with potential hypoglycemic episodes that may occur.

Wireless sensor networks (WSNs) are becoming an increasingly important technology that will be used in a variety of applications such as environmental monitoring, infrastructure management, public safety, medical, home and office security, transportation, and military. WSNs will also play a key role in pervasive computing where computing devices and people are connected to the Internet. Until now, WSNs and their applications have been developed without considering a management solution. This is a critical problem since networks comprising tens of thousands of nodes are expected to be used in some of the applications above. This article proposes the MANNA management architecture for WSNs. In particular, it presents the functional, information, and physical management architectures that take into account specific characteristics of this type of network. Some of them are restrict physical resources such as energy and computing power, frequent reconfiguration and adaptation, and faults caused by nodes unavailable. The MANNA architecture considers three management dimensions: functional areas, management levels, and WSN functionalities. These dimensions are specified to the management of a WSN and are the basis for a list of management functions. The article also proposes WSN models to guide the management activities and the use of correlation in the WSN management. This is a first step into a largely unexplored research area.

Several studies demonstrate the benefits of low-power light therapy on wound healing. However, the use of LED as a therapeutic resource remains controversial. There are questions regarding the equality or not of biological effects promoted by LED and LASER. One objective of this review was to determine the biological effects that support the use of LED on wound healing. Another objective was to identify LED´s parameters for the treatment of wounds. The biological effects and parameters of LED will be compared to those of LASER. Literature was obtained from online databases such as Medline, PubMed, Science Direct and Scielo. The search was restricted to studies published in English and Portuguese from 1992 to 2012. Sixty-eight studies in vitro and in animals were analyzed. LED and LASER promote similar biological effects, such as decrease of inflammatory cells, increased fibroblast proliferation, stimulation of angiogenesis, granulation tissue formation and increased synthesis of collagen. The irradiation parameters are also similar between LED and LASER. The biological effects are dependent on irradiation parameters, mainly wavelength and dose. This review elucidates the importance of defining parameters for the use of light devices.

Studying the interaction between a system's components and the temporal evolution of the system are two common ways to uncover and characterize its internal workings. Recently, several maps from a time series to a network have been proposed with the intent of using network metrics to characterize time series. Although these maps demonstrate that different time series result in networks with distinct topological properties, it remains unclear how these topological properties relate to the original time series. Here, we propose a map from a time series to a network with an approximate inverse operation, making it possible to use network statistics to characterize time series and time series statistics to characterize networks. As a proof of concept, we generate an ensemble of time series ranging from periodic to random and confirm that application of the proposed map retains much of the information encoded in the original time series (or networks) after application of the map (or its inverse). Our results suggest that network analysis can be used to distinguish different dynamic regimes in time series and, perhaps more importantly, time series analysis can provide a powerful set of tools that augment the traditional network analysis toolkit to quantify networks in new and useful ways.

The very last wireless network technology, created to increase the speed and the connections responsiveness, the Fifth-Generation Network (5G) can transmit a great volume of data. It uses wireless broadband connections to support specific end-users and businesses services. It is specifically useful for the Internet of Vehicles (IoV), guaranteeing fast connections and security. The 5G network technology can be used to support Vehicle-to-Everything (V2X) communications and applications on autonomous vehicles. It can enable information exchanges between vehicles and other infrastructures and people. It can also provide a more comfortable and safer environment and accurate traffic knowledge. The traffic ?ow can be improved, reducing pollution and accident rates. The cellular network can be associated with V2X as a communicating base to offer enhanced road safety and autonomous driving, and also to offer the IoV connections. This survey presents the 5G technology evolution, standards, and infrastructure associated with V2X ecosystem by IoV. In other words, it presents the IoV supported by 5G V2X communications, considering its architecture, applications and also the V2X features and protocols, as well as the modes, the evaluation and the technological support in such combination. The contribution of this paper is a systematized study about the interaction among these three contents: IoV, 5G, and V2X. Eighty four works were selected to present concepts, standards and to identify the ways to overcome challenges. This survey aims to guide the development of new 5G-V2X services and technologies dedicated to vehicle communications, and also to indicate future directions.

Although highly diverse (Fonseca et al . 1996), the Atlantic forest mammal fauna is still poorly known, with very few sites exhaustively inventoried or subjected to long-term studies (Passamani et al . 2000). Although the first surveys using camera traps were carried out in the 1920s (e.g. Chapman 1927), most studies are rather recent (Karanth &amp; Nichols 1998). This is not different in Brazil, where few studies have been published (Marques &amp; Ramos 2001, Santos-Filho &amp; Silva 2002, Silveira et al . 2003, Trolle 2003, Trolle &amp; Kéry 2003). Given this, the objective of this paper is to assess the efficiency of camera trapping as an inventory technique for Neotropical forests in general and Atlantic forest in particular. The study was conducted at the Santa Lúcia Biological Station (SLBS), a biologically rich Atlantic Forest preserve located in south-eastern Brazil (Mendes &amp; Padovan 2000) where mammals have been intensively live-trapped, observed from line-transects or had indirect evidence of their presence (faeces, footprints, scratches, etc.) recorded in earlier years (Passamani et al . 2000).

The problem of robust H/spl infin/ filtering for continuous-time uncertain linear systems with multiple time-varying delays in the state variables is investigated. The uncertain parameters are supposed to belong to a given convex bounded polyhedral domain. The aim is to design a stable linear filter assuring asymptotic stability and a prescribed H/spl infin/ performance level for the filtering error system, irrespective of the uncertainties and the time delays. Sufficient conditions for the existence of such a filter are established in terms of linear matrix inequalities, which can be efficiently solved by means of powerful convex programming tools with global convergence assured. An example illustrates the proposed methodology.

Americanae nace como un proyecto conjunto que surge dentro de la Red Europea de Información y Documentación sobre América Latina (REDIAL), y que ha afrontado la Biblioteca de la Agencia Española de Cooperación Internacional para el Desarrollo (AECID). Esta nueva biblioteca virtual hace más accesibles los libros digitales de tema americanista a los investigadores y usuarios interesados de cualquier parte del mundo.

COVID-19 has had negative repercussions on the entire global population. Despite there being a common goal that should have unified resources and efforts, there have been an overwhelmingly large number of clinical trials that have been registered that are of questionable methodological quality. As the final paper of this Series, we discuss how the medical research community has responded to COVID-19. We recognise the incredible pressure that this pandemic has put on researchers, regulators, and policy makers, all of whom were doing their best to move quickly but safely in a time of tremendous uncertainty. However, the research community's response to the COVID-19 pandemic has prominently highlighted many fundamental issues that exist in clinical trial research under the current system and its incentive structures. The COVID-19 pandemic has not only re-emphasised the importance of well designed randomised clinical trials but also highlighted the need for large-scale clinical trials structured according to a master protocol in a coordinated and collaborative manner. There is also a need for structures and incentives to enable faster data sharing of anonymised datasets, and a need to provide similar opportunities to those in high-income countries for clinical trial research in low-resource regions where clinical trial research receives considerably less research funding.

In Brief Study Design and Objectives. Meta-analysis of randomized controlled trials to evaluate the effectiveness of the McKenzie method for low back pain (LBP). Summary of Background Data. The McKenzie method is a popular classification-based treatment for LBP. The faulty equation of McKenzie to extension exercises (generic McKenzie) is common in randomized trials. Methods. MEDLINE, EMBASE, PEDro, and LILACS were searched up to August 2003. Two independent reviewers extracted the data and assessed methodologic quality. Pooled effects were calculated among homogeneous trials using the random effects model. A sensitivity analysis excluded trials reporting on generic McKenzie. Results. Eleven trials of mostly high quality were included. McKenzie reduced pain (weighted mean difference [WMD] on a 0- to 100-point scale, −4.16 points; 95% confidence interval, −7.12 to −1.20) and disability (WMD on a 0- to 100-point scale, −5.22 points; 95% confidence interval, −8.28 to −2.16) at 1 week follow-up when compared with passive therapy for acute LBP. 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. Heterogeneity prevented pooling of studies on chronic LBP as well as pooling of studies included in the sensitivity analysis. Conclusions. 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. There is some evidence that the McKenzie method is more effective than passive therapy for acute low back pain; however, the magnitude of the effect may not be clinically worthwhile. There is limited evidence for the use of the McKenzie method in chronic low back pain. The effectiveness of classification-based McKenzie is yet to be established.