The Appropriateness of Spinal Manipulation for Low-Back Pain

Indications and Ratings by a Multidisciplinary 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 contains the indications and ratings for appropriateness for spinal manipulation that reflect the findings of a nine-member panel of back-pain experts. The panel members rated the appropriateness of indications twice, using a nine-point scale. The initial ratings of appropriateness were done individually and without group discussion. The second-round ratings used a structured method based on consensus procedures. The results showed that these physicians were able to formulate detailed lists of indications for spinal manipulation for low-back pain and rate their appropriateness. There was an increase in agreement and a decrease in disagreement between the initial round and the final round. The final round rated 1,550 indications, and there was agreement on 36 percent and disagreement on 12 percent of the indications. The level of disagreement was somewhat less than in previous ratings of medical procedures by all-medical panels.

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