Chiropractic care guideline for older adults with musculoskeletal disorders
An interdisciplinary panel used systematic reviews, a modified Delphi process and public comment to reach consensus on 148 recommendations for chiropractic care of older adults with chronic musculoskeletal disorders. [1]
Automatic summary · not editorially reviewed
The key findings
The guideline offers whole-encounter guidance for older adults with common musculoskeletal conditions, including low back pain, neck pain, lumbar spinal stenosis with neurogenic claudication, hip osteoarthritis and degenerative cervical myelopathy. [1]
A panel of 53 practitioners completed three modified Delphi rounds and reached consensus on 148 recommendations and 61 sub-recommendations. [1]
The authors note that disparities in the healthcare system may limit patient access and implementation. [1]
The source at a glance
- Study type / format
- Clinical practice guideline based on systematic reviews, a modified Delphi consensus process and public comment (abstract).
- Population / context
- Older adults with chronic musculoskeletal disorders, addressed by a 53-member interdisciplinary practitioner panel.
- Summary based on
- Study abstract
- Publication status
- Preprint · peer-review status not confirmed
- Original publication
- September 25, 2026
Guideline aims at common musculoskeletal conditions
The guideline addresses the needs of an aging population and offers guidance for the whole encounter, aligned with age-specific frameworks (What Matters Most, Medications, Mind/Mentation, Mobility and Multicomplexity). It focuses on common musculoskeletal conditions frequent in older adults. Specific guidance covers low back pain, neck pain, lumbar spinal stenosis with neurogenic claudication, hip osteoarthritis and degenerative cervical myelopathy.
Supporting source [1]
Consensus built through Delphi and public comment
An interdisciplinary research team ran a multi-phased, ethics-approved project: systematic reviews on efficacy and adverse events of chiropractic spinal manipulation, targeted literature searches, seed statements, a modified Delphi process and a 30-day public comment period. A panel of 53 practitioners completed three Delphi rounds, reaching consensus on 148 recommendations and 61 sub-recommendations. Statements were rated until 80% of panelists gave appropriateness of at least 7 out of 9. Public comment from 8 more individuals led to revision of five statements and two new statements; a fourth round brought all statements to consensus.
Supporting source [1]
Screening topics and stated implementation limits
Recommendations cover patient communication, informed consent, identifying what matters most, history and evaluation (including identifying dependent abuse and cognitive and mental health decline), diagnostic imaging, management and treatment (care planning, precautions and contraindications, co-management, manual therapy, rehabilitative exercise) and lifestyle interventions. Screening guidance addresses related disorders in older adults: abdominal aortic aneurysm, osteoporosis/osteopenia, chronic compression deformity, sarcopenia and falls. The authors describe the statements as evidence-based consensus reflecting contemporary chiropractic practice, and note that disparities in the healthcare system may limit patient access and implementation.
Supporting source [1]
How to interpret this
Abstract only; the full text was not reviewed. The abstract reports a consensus guideline process, not a trial testing whether the recommendations improve patient outcomes. Panel size, consensus thresholds and public comment numbers are reported, but the abstract gives no effect sizes or adverse-event rates from the cited systematic reviews.
Based on the study abstract; the full paper, tables and supplementary data were not reviewed.
Source & supporting passages
Daniels CJ, Maiers MJ, Schielke AL, Trager RJ, Salsbury SA, Price MR, Farabaugh RJ, Whalen WM, Stevans JM, Shastri VG, Rundell SD, Pham AV, Anderson KR, Wilcox RD, Walters SA, Killinger LZ, Lawrence DJ. · europepmc.org · September 25, 2026