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Vertebral Subluxation in Chiropractic Practice ~ 2003

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Vertebral Subluxation in Chiropractic Practice ~ 2003 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice 2003 ________________________________________________________ 1 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision Clinical Practice Guideline: Vertebral Subluxation in Chiropractic Practice Published by: Council on Chiropractic Practice Copyright © 2003 by Council on Chiropractic Practice All rights reserved. This publication may not be reproduced, stored in a retrieval system, or transmitted in whole or in part, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher. Library of Congress Control Number: 2003111260 ISBN: 0-9666598-9-9 ________________________________________________________ 2 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision CCP Board of Directors Christopher Kent, D.C., F.C.C.I. President, Council on Chiropractic Practice Veronica Gutierrez, D.C. Post-grad Faculty Life University White House Commission on Complementary Ramsey, New Jersey and Alternative Medicine Private Practitioner - Arlington, Washington Matthew McCoy, D.C., D.A.C.S. (Cand.) Vice President & Guidelines Committee Jerry Hardee, D.C. Chair, Council on Chiropractic Practice President, Sherman College of Straight Director of Research - Life University Chiropractic Marietta, Georgia Jay M. Holder, D.C., C.Ad., DACACD Terry Rondberg, D.C. President, American College of Treasurer, Council on Chiropractic Practice Addictionology & Compulsive Disorders President, World Chiropractic Alliance Private Practitioner Chandler, Arizona Developer - Torque Release Technique Miami Beach, Florida Barbara Bigham, B.A. Secretary, Council on Chiropractic Practice David Koch, D.C. Director of Communications Vice President for International Affairs World Chiropractic Alliance Palmer College of Chiropractic Davenport, Iowa Robert Blanks, Ph.D Professor, Dept of Biomedical Sciences Michael McGee, M.Ed Florida Atlantic University CCP Consumer Member Chair, Research Committee Student Life Department Council on Chiropractic Practice Lock Haven University Madeline Behrendt, D.C. Edward F. Owens, Jr. M.S., D.C. Associate Editor, Journal of Vertebral Director of Research, Sherman College of Subluxation Research Straight Chiropractic Chair, World Chiropractic Alliance Editorial Board – Journal of Vertebral Council on Women's Health Subluxation Research W. Ralph Boone, D.C., Ph.D Steve Renner, D.C., D.A.C.S. Past President - New Zealand College of Member A. Board of Forensic Examiners Chiropractic. Editor Emeritus – Journal of Private Practitioner Washington State Vertebral Subluxation Research William Sloane, J.D., LL.M, Ph.D, Patrick Gentempo Jr., D.C. Academic Dean, Capital University of CEO - Chiropractic Leadership Alliance Integrative Medicine Paterson, New Jersey Fellow, American College of Wellness ________________________________________________________ 3 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision Disclaimer The purpose of these guidelines is to provide the doctor of chiropractic with a “user friendly” compendium of recommendations based upon the best available evidence. It is designed to facilitate, not replace, clinical judgment. As Sackett wrote, “External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision. Similarly, any external guideline must be integrated with individual clinical expertise in deciding whether and how it matches the patient’s clinical state, predicament, and preferences, and thereby whether it should be applied. 1 The most compelling reason for creating, disseminating, and utilizing clinical practice guidelines is to improve the quality of health care. The recommendations made in this guideline are specific to the clinical entity of vertebral subluxation and are applicable to the stated goals of the guideline. Consistent with Sackett’s statement, the recommendations are meant to be flexible based upon each patient encounter and the goals of both the practitioner and the patient being cared for. These guidelines are for informational purposes. Utilization of these guidelines is voluntary. They are not intended to replace the clinical judgment of the chiropractor. It is acknowledged that alternative practices are possible and may be preferable under certain clinical conditions. The appropriateness of a given procedure must be determined by the judgment of the practitioner and the needs and preferences of the individual patient. It is not the purpose or intent of these guidelines to provide legal advice, or to supplant any statutes, rules, and regulations of a government body having jurisdiction over the practice of chiropractic. These guidelines address vertebral subluxation in chiropractic practice, and do not purport to include all procedures which are permitted by law in the practice of chiropractic. Lack of inclusion of a procedure in these guidelines does not necessarily mean that the procedure is inappropriate for use in the practice of chiropractic. Participation in the guidelines development process does not necessarily imply agreement with the final product. This includes persons who participated in the technique conference, leadership conference, open forum, and peer review process. Listing of names acknowledges participation only, not necessarily approval or endorsement. The _________________________________________________________ 4 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision guidelines reflect the consensus of the panel, which gave final approval to the recommendations. 1. Sackett DL. Editorial: Evidence-based medicine. Spine 1998; 23(10):1085. _________________________________________________________ 5 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision Council on Chiropractic Practice Clinical Guideline Number 1. Vertebral Subluxation in Chiropractic Practice. 2003 Update and Revision. This document contains the changes, additions and revisions to the 1998 Council on Chiropractic Practice Clinical Guideline Number 1. Vertebral Subluxation in Chiropractic Practice and is organized in the following manner: • Introduction to the development of Clinical Guideline Number 1 and the updating and revision process. • Description of the development methodology for both the 1998 and 2003 documents. • A description of the changes, additions and revisions to the Recommendations, Sub-recommendations and Commentary as a result of the 2003 review. • If changes to a Recommendation have been made this is listed and discussed. • If changes in Commentary following any recommendation have been made this is listed and discussed. • If changes to a Conclusion have been made this is listed and discussed. • If additional literature on the topic was found and reviewed then these references are listed at the end of the chapter. • If a Recommendation, Commentary or Conclusion was added that was not included in the 1998 Guidelines, this is noted. • If a Recommendation, Commentary or the literature remains as it did in the 1998 guidelines a simple statement that the Recommendation, Commentary or literature remains unchanged follows that section/topic. _________________________________________________________ 6 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision Contents Introduction and Methodology…………………………………………………….9 1. History and Chiropractic Examination…………………………………….43 Case History Chiropractic Examination Elements of the Examination Chiropractic Analysis Clinical Impression Initial Consultation References…………………………………………………………………44 2. Instrumentation……………………………………………………………46 Postural Analysis Bilateral and Four-Quadrant Weight Scales Moire Contourography Inclinometry Goniometry Algometry Current Perception Threshold (CPT) Testing Electroencephalography (EEG) Somatosensory Evoked Potentials (SSEP) Skin Temperature Instrumentation Surface Electromyography Muscle Strength Testing Questionnaires Heart Rate Variability References………………………………………………………………...51 3. Radiographic and Other Imaging…………………………………………69 Videofluoroscopy Magnetic Resonance Imaging (MRI) Computed Tomography (CT) Spinal Ultrasonography Radioisotope Scanning (Nuclear Medicine Studies) Radiographic Digitizing References………………………………………………………………..72 _________________________________________________________ 7 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision 4. Clinical Impression and Assessment……………………………………84 Record Keeping Peer Review Chiropractic Necessity References………………………………………………………….……91 5. Reassessment and Outcomes Assessment………………………………98 References……………………………………………………………….99 6. Modes of Adjustive Care……………………………………………..…100 References……………………………………………………………….101 7. Duration of Care for Correction of Vertebral Subluxation………………134
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