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Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors: Results of a Delphi
Genevieve Keating1,2, Cheryl Hawk3,4, Lyndon Amorin-Woods5,6
1Fielding Graduate University, Santa Barbara, CA, USA.
Insights
Chiropractors now have updated best practice guidelines for managing pediatric patients, developed through expert consensus and evidence synthesis. These recommendations cover communication, examination, red flags, and treatment modifications for children.
Area of Science:
- Chiropractic Care
- Pediatric Health
- Evidence-Based Practice
Background:
- Existing recommendations for pediatric chiropractic care require enhancement.
- A formal consensus process and best evidence synthesis are needed to update best practices.
Purpose of the Study:
- To develop a best practice guide for the chiropractic management of pediatric patients.
- To synthesize current evidence and expert consensus for pediatric chiropractic care.
Main Methods:
- A literature search was conducted to inform recommendations.
- A multidisciplinary steering committee and a formal Delphi panel consensus process were utilized.
- Sixty panelists achieved over 80% consensus on recommendations after three rounds.
Main Results:
- Recommendations cover patient communication, history taking, and physical examination.
- Guidelines address red flags, contraindications, and management of infants and children.
- Specifics include modifications for spinal manipulation, referral, comanagement, and health promotion.
Conclusions:
- The developed recommendations provide a framework for evidence-informed chiropractic care of pediatric patients.
- This guide supports a reasonable approach to managing children in chiropractic practice.
Abstract:
Objective: To build upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Design: Best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. Methods: Synthesis of results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process. Results: The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed these aspects of the clinical encounter: patient communication, including informed consent; appropriate clinical history, including health habits; appropriate physical examination procedures; red flags/contraindications to chiropractic care and/or spinal manipulation; aspects of chiropractic management of pediatric patients, including infants; modifications of spinal manipulation and other manual procedures for pediatric patients; appropriate referral and comanagement; and appropriate health promotion and disease prevention practices. Conclusion: This set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.
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