What does spinal manipulative therapy specificity mean to you? An international survey of chiropractors

Introduction: Chiropractors often use spinal manipulative therapy (SMT) to manage spinal pain. In order to apply SMT, chiropractors may undertake several steps, starting with attempting to locate a clinically relevant site to provide SMT. This is followed by applying a specific force to that site, often in a precise direction (i.e., the thrust vector), and finally inducing a specific local force to the site (e.g., movement in the vertebral motion segment). It is believed that these steps are indicators for the clinical effect of SMT and could be labeled as providing "specific" SMT. However, recent research has called the validity of the specific identification and application of SMT into question. Nevertheless, chiropractors appear to value specificity in SMT but the term may mean different things to different people as it has not been explored previously by research. We aim to understand what SMT specificity means for chiropractors globally and how the chiropractic profession values concepts of SMT specificity. Methods (preliminary): We will develop a survey that examines both the meaning and perceived importance of SMT specificity for chiropractors as a function of their role in healthcare. The survey will be developed as follows: i) We will search the literature for systematic reviews relating to SMT and SMT procedures in PubMed and Epistemonikos. The results will be manually screened according to the inclusion and exclusion criteria. Inclusion criteria are systematic reviews of trials investigating "specificity terms" or "effects" of SMT. We will then extract information regarding SMT procedures, application site, technique, and clinical effects from included studies. These items will provide the initial framework for the items included in the survey. Next, a consensus of relevant items to include will be decided by a team of SMT experts (chiropractors, researchers, and the author team). The survey will be piloted on volunteer chiropractors. We will translate it to relevant languages using Beaton's cross-cultural adaptation technique modified version. This survey will also include items related to chiropractors' perceived role in the health care system and provider characteristics according to the Institute for Alternative Futures grouping. We expect to invite Chiropractors from registered National Associations in including Denmark, Norway, Sweden, Canada, the United States, Australia, and Switzerland. Data will be reported descriptively and will repor