Table 3.

Changes Made in the Chronic Neck Pain Panel for Spinal Mobilization

	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)	4.3	4.3	4.3	4.2	4.7	4.7	4.6	4.6
Average MAD from median	1.2	1.3	1.1	1.1	1.2	1.1	1.0	1.0
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%)
Inappropriate	64 (34.4%)	65 (34.9%)	67 (36.0%)	69 (37.1%)	51 (10.0%)	51 (27.4%)	58 (31.2%)	58 (31.2%)
Equivocal	95 (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 equivocal	10 (5.4%)	7 (3.8%)	14 (7.5%)	13 (7.0%)	19 (10.2%)	19 (10.2%)	24 (12.9%)	24 (12.9%)
Disagreement	2 (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 equivocal	83 (44.6%)	86 (46.2%)	80 (43.0%)	79 (42.5%)	74 (39.8%)	73 (39.2%)	66 (35.5%)	66 (35.5%)
Appropriate	27 (14.5%)	26 (14.0%)	25 (13.4%)	25 (13.4%)	38 (20.4%)	39 (21.0%)	38 (20.4%)	38 (20.4%)
Total	186	186	186	186	186	186	186	186

RUAM = RAND/UCLA Appropriateness Method – the traditional version of this did not consider patient preferences and cost

*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