Purpose
The purpose of this project was to develop and evidence and consensus based clinical clinical practice guideline on the most appropriate approach to providing chiropractic care to older adults with chronic musculoskeletal conditions. It updates our 2010 (1) and 2017 (2) guidelines on this topic.
Overview
The clinical practice guideline presented on this site was developed using a structured, evidence-informed process that combined systematic literature review with a multi-round modified Delphi consensus approach. This methodology was designed to integrate the best available research with expert clinical judgment to establish recommendations for the chiropractic management of older adults with chronic musculoskeletal conditions.
A brief summary of the methodology is provided below. The full methodology document is available for download..
Methodology Summary
A multidisciplinary panel of clinicians and researchers was convened to participate in a modified Delphi consensus process aimed at developing evidence-based recommendations. The panel included stakeholders from a variety of professional backgrounds and clinical disciplines.
The process was informed by prior guideline work, newly conducted systematic reviews evaluating both the efficacy and safety of chiropractic care in older adults, and targeted literature searches addressing relevant clinical topics. These sources were used to generate initial seed statements for evaluation.
Panelists participated in multiple rounds of structured rating using a standardized scale, with anonymized feedback provided between rounds. Predefined consensus criteria—requiring a high level of agreement among participants—were used to determine which statements were accepted. Statements not meeting consensus were revised and re-evaluated in subsequent rounds.
This rigorous and iterative approach, based on the RAND/UCLA appropriateness methodology, was selected to enhance transparency, reduce bias, and support reproducible, evidence-informed guideline development..