The Appropriateness of Spinal Manipulation for Low-Back Pain

Indications and Ratings by an All-Chiropractic Expert Panel

by Paul G. Shekelle, Alan H. Adams, Mark R. Chassin, Eric Hurwitz, Rolla Edward Park, Reed B. Phillips, Robert H. Brook


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This report presents results from the third stage of the RAND Appropriateness of Spinal Manipulation for Low-Back Pain Study. The study is designed to ascertain the clinical criteria for the appropriate use of spinal manipulation for low-back pain from chiropractors and medical specialists, and then to investigate the use of chiropractic services in a random sample of practicing chiropractors. The third stage describes the methods used for assessing the appropriateness of spinal manipulation by a panel of expert chiropractors and presents the panel's actual ratings of 1570 indications for the use of spinal manipulation for low-back pain. The panel members rated the appropriateness of indications twice, using a nine-point scale. Results showed that these chiropractic physicians were able to formulate detailed lists of indications for spinal manipulation for low-back pain and rate their appropriateness for spinal manipulation.

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