Notably, the criteria recommended by members of the chiropractic profession are distinctly different from the criteria established by the American Academy of Osteopathy. Moreover, the Delphi method is a consensus process which represents consenting opinion from an impaneled group of experts. But with expert opinion serving as the lowest level of evidence (Level V) in the medical evidence hierarchy, the MUA-related Delphi process publication of 2014 does not enhance the state of the evidence for spinal MUA. Therefore, the largely anecdotal basis for procedural effectiveness, and continued reliance upon the spinal MUA protocols historically used, are what principally influence the practice of MUA today.