Congruence Between Decisions to Initiate Chiropractic Spinal Manipulation for Low Back Pain and Appropriateness Criteria in North America

Published in: Annals of Internal Medicine, v. 129, no. 1, July 1, 1998, p. 9-17

Posted on RAND.org on December 31, 1997

by Paul G. Shekelle, Ian D. Coulter, Eric Hurwitz, Barbara Genovese, Alan H. Adams, Silvano A. Mior, Robert H. Brook

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This study set out to determine the appropriateness of chiropractors' decisions to use spinal manipulation for patients with low back pain. The study used retrospective review of chiropractic office records against preset criteria for appropriateness that were developed from a systematic review of the literature and a nine-member panel of chiropractic and medical specialists. Appropriateness criteria reflect the expected balance between risk and benefit. The report concludes that the proportion of chiropractic spinal manipulation judged to be congruent with appropriateness criteria is similar to proportions previously described for medical procedures; thus, the findings provide some reassurance about the appropriate application of chiropractic care. However, more than one quarter of patients were treated for indications that were judged inappropriate. The number of inappropriate decisions to use chiropractic spinal manipulation should be decreased.

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