An overview of the RAND appropriateness method is provided along with a summary of key results of the recent multidisciplinary expert consensus panel assessing the appropriateness of manipulation and mobilization in the cervical spine. Appropriate use of such results is discussed. The RAND appropriateness method was used which involved a synthesis of literature, creation of a clinical indications list based on the literature, and input from informed sources. An expert multidisciplinary panel of clinicians was selected and a Delphi rating round for appropriateness of cervical spine manipulation and mobilization was performed. Results were tabulated and the panel was convened for second round of appropriateness ratings. Over 1400 clinical scenarios (indications) were rated. The panel demonstrated clear agreement on 40% of the indications and clear disagreement on 2% of them.
Regarding the appropriateness of cervical manipulation or mobilization for the indications 43% of the indications were rated inappropriate for the intervention with 41% ranking as uncertain and 16% considered appropriate. The level of panel disagreement was higher with manipulation compared to mobilization. The utility of the results of this appropriateness panel is discussed relative to practicing chiropractors, non-physicians, and the chiropractic profession as a whole.
Originally published in: Topics in Clinical Chiropractic, v. 2, no. 3. 1995, pp. 54-62.
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