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Best practices recommendations for chiropractic care for infants, children, and adolescents: results of a consensus
Cheryl Hawk1, Michael Schneider, Randy J Ferrance
1Cleveland Chiropractic College, Overland Park, KS 66210, USA. cheryl.hawk@cleveland.edu
Insights
Experienced chiropractors reached consensus on best practices for pediatric chiropractic care, focusing on evaluation and spinal manipulation. This provides evidence-based recommendations for managing young patients.
Area of Science:
- Chiropractic care
- Pediatric health
- Evidence-based practice
Background:
- Limited evidence-based guidelines exist for pediatric chiropractic care.
- Previous reviews found insufficient high-quality evidence for standard clinical guidelines.
- Chiropractic management of pediatric patients remains a topic of discussion.
Purpose of the Study:
- To develop consensus-based recommendations for best practices in pediatric chiropractic care.
- To focus on the evaluation and spinal manipulation aspects of pediatric chiropractic care.
- To address the need for evidence-based guidelines in pediatric chiropractic.
Main Methods:
- A Delphi panel of 37 multidisciplinary experts, primarily doctors of chiropractic with pediatric experience, was convened.
- Seed statements were developed based on literature review and clinical experience.
- Consensus (≥80% agreement) was achieved through 4 rounds of electronic circulation.
Main Results:
- The panel comprised experienced chiropractors (mean 18 years practice) with postgraduate pediatric training.
- Participants represented diverse geographic locations (5 countries, 17 states) and professional organizations.
- A minimum of 80% consensus was reached on 51 seed statements after 4 rounds.
Conclusions:
- Experienced chiropractors can achieve high consensus on pediatric chiropractic best practices.
- Recommendations cover clinical evaluation, management, and manual treatment for pediatric patients.
- The consensus integrates scientific evidence with extensive clinical experience.
Objective:
There has been much discussion about the role of chiropractic care in the evaluation, management, and treatment of pediatric patients. To date, no specific guidelines have been adopted that address this issue from an evidence based perspective. Previous systematic reviews of the chiropractic literature concluded that there is not yet a substantial body of high quality evidence from which to develop standard clinical guidelines. The purpose of this project was to develop recommendations on "best practices" related primarily to the evaluation and spinal manipulation aspects of pediatric chiropractic care; nonmanipulative therapies were not addressed in detail.
Methods:
Based on both clinical experience and the results of an extensive literature search, a set of seed documents was compiled to inform development of the seed statements. 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:
A multidisciplinary panel of 37 was made up primarily of doctors of chiropractic with a mean of 18 years in practice, many with post-graduate training in pediatrics. The panel represented 5 countries and 17 states; there were members of the American Chiropractic Association, the International Chiropractors Association, and the International Chiropractic Pediatric Association. The panel reached a minimum of 80% consensus on the 51 seed statements after 4 rounds.
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 clinical evaluation, management, and manual treatment for pediatric patients, based on both scientific evidence and clinical experience.
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