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The methodology involved a literature review and panel assessments.

• To determine the appropriateness of manipulation and mobilization for chronic neck pain, we convened a nine-member modified-Delphi panel of clinicians.
• The initial ratings of appropriateness were made individually and without group discussion.
• The second-round ratings followed a structured face-to-face method that was based on procedures often used to bring people closer to consensus or agreement.
• The project staff compiled the initial indications list using a literature review, the advice of chiropractors and an internist, and a list of indications created for an earlier study on manipulation for neck pain.

The panel rated 186 indications to assess the appropriateness of manipulation and mobilization for chronic neck pain.

• There was agreement among the panelists for 13.3 percent to 37.0 percent of indications.
• The average median appropriateness ratings ranged from 3.9 to 4.7 on a nine-point scale, and 8.6 percent to 20.4 percent of indications were rated appropriate.
• Appropriateness ratings for mobilization were higher than the ratings for manipulation.
• Panelists agreed on the ratings for between 33.9 percent and 44.1 percent of the indications.
• Rates of agreement increased after panelists met to discuss the issues.