THE APPROPRIATENESS OF CHIROPRACTIC SPINAL MANIPULATION FOR LOW-BACK-PAIN - A PILOT-STUDY

Objective: Spinal manipulation is an efficacious therapy for some pati ents with low back pain (LBP). In this pilot study, we tested the feas ibility of assessing the appropriateness of chiropractic spinal manipu lation for patients with LBP. Methods: Criteria for the appropriate an d inappropriate use of spinal manipulation for low back pain were deve loped using the RAND/UCLA appropriateness method. Two separate expert panels, one multidisciplinary and one all chiropractic, each rated a c omprehensive array of clinical scenarios for appropriateness. A random sample of practicing chiropractors was selected, and data were collec ted from ten randomly selected office records from each participating clinician. Assessment of the appropriateness for the use of spinal man ipulation was made by comparing the care delivered with the appropriat eness criteria determined by each expert panel. Results: Eight of thir teen (62%) eligible chiropractors agreed to participate. For the remai nder, by the multidisciplinary panel's criteria, 38% of care was appro priate and 26% of care was inappropriate. By the all-chiropractic pane l's criteria, the same cases were judged 74% appropriate and 7% inappr opriate. The two panel's appropriateness ratings were in agreement on 48% of all cases. Conclusions: In this geographic area, the rate of ap propriate care is between 38% and 74% and the rate of inappropriate ca re is between 7% and 19%, depending on the criteria used to assess app ropriateness. Data from other geographic areas of the U.S. will be nee ded before inferences to a larger population may be drawn, and we have demonstrated that such a study is feasible.