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Table 3 Changes Made in the Chronic Neck Pain Panel for Spinal Mobilization

From: The impact of patient preferences and costs on the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain

 No other adequate conservative careNonmanipulative conservative care has failed
Final ratings following traditional RUAMAt home ratingsIn-person ratings not due to presentationsIn-person ratings due to presentationsFinal ratings following traditional RUAMAt home ratingsIn-person ratings not due to presentationsIn-person ratings due to presentations
Average median (1–9 scale)4.34.34.34.24.74.74.64.6
Average MAD from median1.21.31.11.11.21.11.01.0
Agreement [n (%)]*70 (37.6%)65 (34.9%)76 (40.9%)78 (41.9%)82 (44.1%)81 (43.5%)91 (48.9%)92 (49.5%)
Uncertain [n (%)]114 (61.3%)119 (64.0%)110 (59.1%)108 (58.1%)100 (53.8%)101 (54.3%)95 (51.1%)94 (50.5%)
Disagreement [n (%)]2 (1.1%)2 (1.1%)0 (0.0%)0 (0.0%)4 (2.2%)4 (2.2%)0 (0.0%)0 (0.0%)
Inappropriate64 (34.4%)65 (34.9%)67 (36.0%)69 (37.1%)51 (10.0%)51 (27.4%)58 (31.2%)58 (31.2%)
Equivocal95 (51.1%)95 (51.1%)94 (50.5%)92 (49.5%)97 (65.8%)96 (51.6%)90 (48.4%)90 (48.4%)
 Agreement and equivocal10 (5.4%)7 (3.8%)14 (7.5%)13 (7.0%)19 (10.2%)19 (10.2%)24 (12.9%)24 (12.9%)
 Disagreement2 (1.1%)2 (1.1%)0 (0.0%)0 (0.0%)4 (2.2%)4 (2.2%)0 (0.0%)0 (0.0%)
 Uncertain and equivocal83 (44.6%)86 (46.2%)80 (43.0%)79 (42.5%)74 (39.8%)73 (39.2%)66 (35.5%)66 (35.5%)
Appropriate27 (14.5%)26 (14.0%)25 (13.4%)25 (13.4%)38 (20.4%)39 (21.0%)38 (20.4%)38 (20.4%)
Total186186186186186186186186
  1. RUAM = RAND/UCLA Appropriateness Method – the traditional version of this did not consider patient preferences and cost
  2. *The numbers of clinical scenarios for which there was agreement across panelists increased significantly between at-home and in-person ratings; p < .001 for when there was no other adequate conservative care and p = .0076 for when nonmanipulative conservative care has failed