Table 4.

Changes Made in the Chronic Neck Pain Panel for Spinal Manipulation

	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

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