CCP Guidelines 4th Edition 2013 COUNCIL ON CHIROPRACTIC PRACTICE Clinical Practice Guidelines Fourth Edition - 2013 “Subluxation Chiropractic Practice” 1 CCP Guidelines 4th Edition 2013 Clinical Practice Guideline: Subluxation Chiropractic Practice Published by: Council on Chiropractic Practice Copyright 2013 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. ISBN: 978-1-60725-426-3 2 CCP Guidelines 4th Edition 2013 Council on Chiropractic Practice Board of Directors [with term expiration date]: WILLIAM MARTIN SLOANE, B.A., M.A.R., M.B.A., J.D., LL.M. (Labor), Ph.D. [2016], President Anglican Bishop; Attorney at Law; Pro-Chancellor, International University for Graduate Studies Adj. Professor, Widener University School of Law; Part-Time Lecturer, Mount St. Mary's University Carlisle, Pennsylvania, and Emmitsburg, Maryland, USA, and Basseterre, KNA RICHARD GEORGE BARWELL, D.C. [2015], Vice President President, Chiropractic Equity Offices, Inc. Cocoa Beach, Florida, USA ALAN D. JENKS, B.Sc., D.C. [2016], Secretary & Guidelines Committee Chair Chiropractor, Chiropractie Westland Maasdijk, NLD TERRY A. RONDBERG, D.C. [2016], Treasurer Chiropractor and Licensed Massage Therapist Founder and President, World Chiropractic Alliance; Founder, The Chiropractic Journal Chandler, Arizona, USA KENNETH JAMES VINTON, B.S., D.C. [2015], Nominating Committee Chair President, Vinton Chiropractic Center, Inc. Grove City, Pennsylvania, USA ROBERT H. I. BLANKS, B.S., M.S., Ph.D. [2014], Research Committee Chair Professor of Biomedical Science, Florida Atlantic University College of Medicine Affiliated Faculty, Cell Biology and Anatomy, University of Miami School of Medicine Boca Raton and Miami, Florida, USA RICHARD EUGENE APLIN, B.S., B.S., D.C. [2016] Owner, InVision Chiropractic; Lead Instructor, NeuroInfiniti Huntsville, Alabama, USA SUSAN M. BROWN, B.S., D.C. [2015] Owner, Essence Quality of Life Center; Founder and Developer, Bio-Geometric Integration Carol Stream, Illinois, USA ANDRE CAMELLI, D.C. [2015] LQWC Clinic Director; Founder, Quantum Integration Warren, Ohio, USA GARY CARLESS, D.C. [2014] Director General, Global Chiropractic Europa Barcelona, ESP JOHN DAVILA, D.C. [2014] Custom ChiroSolutions Murrells Inlet, South Carolina, USA JOSEPH DEMYEN, B.S., D.C. [2016] President, Demyen Family Chiropractic Canton, Georgia, USA JERRY I. HOCHMAN, B.A., D.C. [2015] Chiropractor, AmeriCare Chiropractic; Professor of Chiropractic Sciences, Life University Marietta, Georgia, USA 3 CCP Guidelines 4th Edition 2013 BRIAN D. JENSEN, D.C. [2015] Chiropractor, Kennedy Chiropractic President, DMX of Virginia, Inc. Salem, Virginia, USA PETER J. KEVORKIAN, B.S., D.C. [2015] Chiropractor, Westwood Family Chiropractic Instructor, International Chiropractic Pediatric Association Westwood, Massachusetts, USA JOHN F. MARKHAM, B.E.T., D.C. [2016] Executive Director of Level III Clinic Programs, Life University Marietta, Georgia, USA TIMOTHY MERRICK, D.C. [2016] Chiropractor New York, New York, USA JUSTIN PAUL PEATLING, BSc, BChiroSc, MChiroprac [2016] Chiropractor, Joshua Wellness Practice Toongabbie, New South Wales, AUS TAMMY VERLAAN-ROSS, BAppSc, BChiroSc [2015] Chiropractor, Life and Balance Centre Dublin, IRL DAVID CHADWICK WALLS-KAUFMAN, D.C. [2015] Chiropractor, Capitol Hill Chiropractic Center Washington, District of Columbia, USA JULIAN KATHERINE WETTERLIN, B.S., D.C. [2014] Owner, Expression Chiropractic Atlanta and Decatur, Georgia, USA ROBERT WIEGAND, D.C. [2014] Perception Instructor, getACCESS! Workshop Portland, Oregon, USA Organizations are listed for identification purposes only. Guidelines Committee: Dr. Alan D. Jenks, Chair Dr. Richard Eugene Aplin Dr. Richard George Barwell Dr. Robert H. I. Blanks Dr. Susan M. Brown Dr. John Davila Dr. Peter J. Kevorkian Dr. John F. Markham Dr. Terry A. Rondberg Dr. William Martin Sloane Dr. Kenneth James Vinton Dr. David Chadwick Walls-Kaufman Dr. Julian Katherine Wetterlin Dr. Robert Wiegand 4 CCP Guidelines 4th Edition 2013 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 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 subluxation 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 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 CCP Guidelines 4th Edition 2013 TABLE OF CONTENTS I. INTRODUCTION AND METHODOLOGY ............................................................................................ 8 THE COUNCIL ON CHIROPRACTIC PRACTICE .................................................................................... 8 INCLUSION IN THE NATIONAL GUIDELINE CLEARING HOUSE ...................................................... 9 OVERVIEW OF THE DEVELOPMENT OF THE 1998 GUIDELINES ...................................................... 9 GUIDELINES DEVELOPMENT PROCESS AND METHODOLOGY .................................................... 10 RATIONALE AND IMPORTANCE OF THE GUIDELINES .................................................................... 11 SUBLUXATION& EVIDENCE-BASED PRACTICE ............................................................................... 14 PARTICIPANTS IN THE CCP GUIDELINE DEVELOPMENT PROCESS ............................................. 15 MECHANICS OF THE REVIEW ............................................................................................................... 15 RATINGS AND CATEGORIES OF EVIDENCE ...................................................................................... 15 RATINGS .................................................................................................................................................... 16 CATEGORIES OF EVIDENCE .................................................................................................................. 16 SCOPE ......................................................................................................................................................... 18 DEVELOPMENT ........................................................................................................................................ 19 DISSEMINATION ...................................................................................................................................... 19 REVIEW, UPDATING AND REVISION OF THE 1998, 2003, 2008, 2013 GUIDELINES ...................... 19 2013 CCP GUIDELINES AND SUMMARY .............................................................................................. 21 2013 REVISION OF ‘SUBLUXATION’: ................................................................................................. 21 HEALTHCARE COSTS: A NATIONAL DILEMMA ................................................................................ 22 COST-EFFECTIVENESS OF CHIROPRACTIC SERVICES: .................................................................. 23 COST- EFFECTIVENESS STUDIES