title: Best practices recommendations for chiropractic care for older adults: results of a consensus process.
abstract: OBJECTIVE
  At this time, the scientific evidence base supporting the effectiveness of chiropractic care for musculoskeletal conditions has not yet definitively addressed its appropriateness for older adults. Expert consensus, as a form of evidence, must be considered when higher levels of evidence are lacking. The purpose of this project was to develop a document with evidence-based recommendations on the best practices for chiropractic care of older adults.
  
  
  METHODS
  A set of 50 seed statements was developed, based on the clinical experience of the multidisciplinary steering committee and the results of an extensive literature review. A formal Delphi process was conducted, following the rigorous RAND-UCLA (University of California, Los Angeles) methodology. The statements were circulated electronically to the Delphi panel until consensus was reached. Consensus was defined as agreement by at least 80% of the panelists. There were 28 panelists from 17 US states and Canada, including 24 doctors of chiropractic, 1 physical therapist, 1 nurse, 1 psychologist, and 1 acupuncturist.
  
  
  RESULTS
  The Delphi process was conducted in January-February 2010; all 28 panelists completed the process. Consensus was reached on all statements in 2 rounds. The resulting best practice document defined the parameters of an appropriate approach to chiropractic care for older adults, and is presented in this article.
  
  
  CONCLUSIONS
  A multidisciplinary panel of experienced chiropractors was able to reach a high level (80%) of consensus on evidence-informed best practices for the chiropractic approach to evaluation, management, and manual treatment for older adult patients.
authors: Cleveland Chiropractic College, Overland Park, KS 66210, USA. cheryl.hawk@cleveland.edu
authors: Cheryl
authors: C
authors: Hawk
authors: Michael
authors: M
authors: Schneider
authors: Paul
authors: P
authors: Dougherty
authors: Brian J
authors: BJ
authors: Gleberzon
authors: Lisa Z
authors: LZ
authors: Killinger
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000379:methods*; D003697:Delphi Technique; D019317:Evidence-Based Medicine / Q000379:methods*; D015444:Exercise; D005104:Expert Testimony; D006285:Health Planning; D006801:Humans; D026882:Manipulation, Chiropractic; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy*; D014481:United States