February 2004

CCP releases revised guidelines

New edition addresses maternity care, peer review, numerous other issues

The Council on Chiropractic Practice (CCP) has completed its review and revision of the "Clinical Guideline Number 1: Vertebral Subluxation in Chiropractic Practice," first published in 1998.

The revision process took nearly two years and involved more than 250 chiropractors, scientists, researchers, technique experts, lay people and others around the world. The revised guidelines include new recommendations dealing with maternity care, peer review, open adjusting rooms, heart rate variability, radiographic digitizing, record keeping, and patient privacy. In addition, commentary was added to many of the previous recommendations to bring them up to date with the current literature.

"We completed an exhaustive review of the literature since the last review and also included a thorough review of the guideline development literature that was published since the first publication of the Guidelines in 1998," stated CCP President Christopher Kent, D.C. "This is a document the whole profession can be proud of."

Matthew McCoy, D.C., CCP vice president and project manager for the revision explained that, prior to beginning the actual revision of the document, the CCP panel conducted an intensive review of current literature relating to guideline development and methodology. The panel was able to incorporate many of the new concepts and procedures into the process.

Because, according to Dr. McCoy, the CCP considers the guidelines process one of "continuing evolution," the Council did not disband after the original document was published. Instead, it performed ongoing reviews of new evidence and literature in order to comply with the NGC recommendation to complete updates and revisions every five years. The next scheduled review and updating of the CCP Guidelines is scheduled for August 2008.

One of the first steps in the update process, which began in early 2001, was a meeting of technique developers and experts. Representatives of several technique systems that were not involved in the development of the original document participated in these early meetings and those previously involved were invited to submit additional material. At the initial revision meeting, more than 40 named technique systems were represented and a technique panel was formed that now has about 125 members representing the widest possible range of techniques.

"The involvement of technique experts is crucial to the development of any chiropractic guideline," stated McCoy. "Unfortunately these dedicated and unsung heroes have effectively been shut out of other groups' guideline development efforts and the research community. Instead, they need to be deeply involved in this process since the art of chiropractic is the application of the philosophy and science."

Of major concern to McCoy and the CCP were reports of state boards and regulatory agencies attacking D.C.s based on the technique they use. Without evidence‑based research and guideline recommendations to rely upon, regulatory officials often demonstrate bias based on their own personal opinions of various techniques.

"Some of these people just seem to wake up one morning and decide for themselves that this or that technique should be banned," McCoy complained. "The scary thing is that most times there is more research and evidence supporting the technique they are attacking than the gross, non‑specific manipulative procedures they are advocating."

Other areas where chiropractors are increasingly under scrutiny include wellness practices, corrective care procedures, extended care plans and related practices, McCoy noted. "According to the CCP Guideline, the need for high frequency initial and extended wellness care plans should be based on a combination of basic science, technique, objective assessment of physiological function, structural changes and quality of life issues," he stated. "Practitioners should rely on one or more of these elements to develop their care plan."

Veronica Gutierrez, D.C., a member of the CCP Board of Directors and the only chiropractor to serve on the White House Special Commission on Complementary and Alternative Medicine, emphasized that practice procedures must be based upon "patient understanding and acceptance of mutual health care and quality of life goals."

Because vertebral subluxation and these related concepts are central to the practice of chiropractic and the profession, guidelines that specifically address them are clearly needed, Kent noted.

For more information on the CCP Guidelines, or to download a copy of the revised document at no cost, visit the CCP website.