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Table 4 Changes Made in the Chronic Neck Pain Panel for Spinal Manipulation

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 care

Nonmanipulative conservative care has failed

Final ratings following traditional RUAM

At home ratings

In-person ratings not due to presentations

In-person ratings due to presentations

Final ratings following traditional RUAM

At home ratings

In-person ratings not due to presentations

In-person ratings due to presentations

Average median (1–9 scale)

3.9

3.8

3.8

3.8

4.2

4.2

4.2

4.2

Average MAD from median

1.3

1.3

1.2

1.2

1.2

1.2

1.2

1.2

Agreement [n (%)]*

63 (33.9%)

61 (32.8%)

74 (39.8%)

75 (40.3%)

75 (40.3%)

72 (38.7%)

84 (45.2%)

85 (45.7%)

Uncertain [n (%)]

122 (65.6%)

124 (66.7%)

111 (59.7%)

110 (59.1%)

110 (59.1%)

113 (60.8%)

102 (54.8%)

101 (54.3%)

Disagreement [n (%)]

1 (0.5%)

1 (0.5%)

1 (0.5%)

1 (0.5%)

1 (0.5%)

1 (0.5%)

0 (0.0%)

0 (0.0%)

Inappropriate

80 (43.0%)

82 (44.1%)

83 (44.6%)

84 (45.2%)

66 (35.5%)

67 (36.0%)

66 (35.5%)

67 (36.0%)

Equivocal

90 (48.4%)

89 (47.8%)

88 (47.3%)

87 (46.8%)

94 (50.5%)

91 (48.9%)

92 (49.5%)

92 (49.5%)

 Agreement and equivocal

4 (2.2%)

4 (2.2%)

10 (5.4%)

10 (5.4%)

7 (3.8%)

7 (3.8%)

12 (6.5%)

12 (6.5%)

 Disagreement

1 (0.5%)

1 (0.5%)

1 (0.5%)

1 (0.5%)

1 (0.5%)

1 (0.5%)

0 (0.0%)

0 (0.0%)

 Uncertain and equivocal

85 (45.7%)

84 (45.2%)

77 (41.4%)

76 (40.9%)

86 (46.2%)

83 (44.6%)

80 (43.0%)

80 (43.0%)

Appropriate

16 (8.6%)

15 (8.1%)

15 (8.1%)

15 (8.1%)

26 (14.0%)

28 (15.1%)

28 (15.1%)

27 (14.5%)

Total

186

186

186

186

186

186

186

186

  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 (p < .001) between at-home and in-person ratings under both conditions