Chiropractic management of low back disorders: report from a consensus process

J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. doi: 10.1016/j.jmpt.2008.10.006.


Objective: Although a number of guidelines addressing manipulation, an important component of chiropractic professional care, exist, none to date have incorporated a broad-based consensus of chiropractic research and clinical experts representing mainstream chiropractic practice into a practical document designed to provide standardized parameters of care. The purpose of this project was to develop such a document.

Methods: Development of the document began with seed materials, from which seed statements were distilled. These were circulated electronically to the Delphi panel until consensus was reached, which was considered to be present when there was agreement by at least 80% of the panelists.

Results: The panel consisted of 40 clinically experienced doctors of chiropractic, representing 15 chiropractic colleges and 16 states, as well as both the American Chiropractic Association and the International Chiropractic Association. The panel reached 80% consensus of the 27 seed statements after 2 rounds. Specific recommendations regarding treatment frequency and duration, as well as outcome assessment and contraindications for manipulation were agreed upon by the panel.

Conclusions: A broad-based panel of experienced chiropractors was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to care for patients with low back pain, based on both the scientific evidence and their clinical experience.

Publication types

  • Consensus Development Conference
  • Review

MeSH terms

  • Chiropractic / standards*
  • Clinical Protocols / standards*
  • Consensus
  • Delphi Technique
  • Evidence-Based Medicine
  • Humans
  • Low Back Pain / classification
  • Low Back Pain / therapy*
  • Manipulation, Chiropractic / standards*
  • Monitoring, Physiologic / standards
  • Outcome Assessment, Health Care
  • Practice Guidelines as Topic / standards*
  • Practice Patterns, Physicians' / standards*