Determining the Appropriateness of Spinal Manipulation and Mobilization for Chronic Low Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel
Jul 24, 2018
The approach developed by researchers at the RAND Corporation for assessing the appropriateness of health care makes it feasible to take the best of what is known from research and apply it — using the expertise of experienced clinicians — over the wide range of patients and health problems seen in real-world clinical practice. The major limitation of the RAND approach is that it utilizes a limited definition of appropriateness that that relies heavily on safety, efficacy, and effectiveness. This report, which focuses on appropriateness of indications for spinal manipulation and mobilization for chronic neck pain, presents results from one part of a broader study designed to develop a methodology to integrate patient-reported outcomes, patient preferences, and cost into the appropriateness panel process. It describes the results and methodology of convened panels of neck pain experts who met to discuss and rate appropriateness of 186 indications for spinal manipulation and mobilization for chronic neck pain, and serves four objectives: (1) Describe the methodology of the process of obtaining appropriateness ratings that can be used later to calculate rates of appropriate care and can be replicated by other studies; (2) provide the list of actual indications used in this study so that future studies can use them or adapt them without going through the extensive and costly process we did; (3) provide further data on the modified Delphi process for generating consensus by exploring whether ratings of appropriateness changed between rounds and whether agreement or disagreement went up after panelists met face to face; and (4) present final ratings of the appropriateness of manipulation and mobilization for neck pain for 186 indications.
Definitions Provided to Panelists
Final Panel Ratings of Indications, by Chapter