Guidelines for the practice and performance of manipulation under anesthesia
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CHIROPRACTIC & MANUAL THERAPIES
RESEARCH
Open Access
Guidelines for the practice and performance of manipulation under anesthesia Robert Gordon1, Edward Cremata2,3 and Cheryl Hawk4*
Abstract Background: There are currently no widely accepted guidelines on standards for the practice of chiropractic or manual therapy manipulation under anesthesia, and the evidence base for this practice is composed primarily of lower-level evidence. The purpose of this project was to develop evidence-informed and consensus-based guidelines on spinal manipulation under anesthesia to address the gaps in the literature with respect to patient selection and treatment protocols. Methods: An expert consensus process was conducted from August-October 2013 using the Delphi method. Panelists were first provided with background literature, consisting of three review articles on manipulation under anesthesia. The Delphi rounds were conducted using the widely-used and well-established RAND-UCLA consensus process methodology to rate seed statements for their appropriateness. Consensus was determined to be reached if 80% of the 15 panelists rated a statement as appropriate. Consensus was reached on all 43 statements in two Delphi rounds. Results: The Delphi process was conducted from August-October 2013. Consensus was reached on recommendations related to all aspects of manipulation under anesthesia, including patient selection; diagnosis and establishing medical necessity; treatment and follow-up procedures; evaluation of response to treatment; safety practices; appropriate compensation considerations; and facilities, anesthesia and nursing standards. Conclusions: A high level of agreement was achieved in developing evidence-informed recommendations about the practice of chiropractic/manual therapy manipulation under anesthesia. Keywords: Manipulation under anesthesia, Chiropractic, Spinal manipulation, Spine-related pain
Introduction Spinal manipulation under anesthesia (MUA) is a procedure that was originally practiced by orthopedic surgeons and osteopathic physicians for the treatment of spinal pain since the late 1930’s [1,2]. Since the 1960’s, Doctors of Chiropractic (DC) have come to perform the majority of spinal MUA procedures [3]. Fibrosis Release Procedures is a term which includes MUA and perhaps better describes the comprehensive nature of the procedures used by DCs in performing MUA, since more than spinal manipulation is involved [4]. There are currently no widely accepted guidelines on standards for chiropractic MUA. The 1993 Guidelines for Chiropractic Quality Assurance and Practice Parameters considered MUA “equivocal”, and these guidelines have * Correspondence: [email protected] 4 Logan University, 1851 Schoettler Rd 63017 Chesterfield, MO, USA Full list of author information is available at the end of the article
not been updated since 1993 [5]. In 2012, the American Association of Manipulation Under Anesthesia Providers (AAMUAP), a multidisciplinary panel of MUA experts, developed a set of guidelines for the practice,
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