The “Best Practice” Initiative This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
Jump to: Introduction Literature Syntheses Articles About
Evidence-based Practice The Guidelines Section
Conditions That Respond Well Alternative Medicine Approaches to Disease
Chiro.Org is proud to support Logan College and the ICPA for their continuous research into the health benefits of chiropractic care. Please offer them your financial support.
The Council on Chiropractic Guidelines and Practice Parameters (CCGPP), was formed in 1995 at the behest of the Congress of Chiropractic State Associations (COCSA) and with assistance from numerous national associations to create an equitable chiropractic practice document. CCGPP was delegated to examine all existing guidelines, parameters, protocols and best practices in the United States and other nations in the construction of this document. Their first mission was to describe the difference between “Guideline” and “Best Practice”.
This Page was previously located in the Evidence-based Practice Page
Consensus Terminology for Stages of Care:
Acute, Chronic, Recurrent, and Wellness
J Manipulative Physiol Ther 2010 (Jul); 33 (6): 458–463
As the chiropractic profession pursues its role in the emerging health care marketplace, it will become increasingly important that the scope of appropriate chiropractic case management is clearly delineated. To ensure equitable inclusion in the health care arena, it is imperative that the terms used in our interprofessional discussions are common to all health care providers. Therefore, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP), at the behest of the American Chiropractic Association (ACA) Insurance Relations Committee, engaged in a multidisciplinary consensus process to address the terminology related to “levels of care.” You may also enjoy this ACA Press release titled: Chiropractic Reaches Consensus On Terminology For Stages Of Care
The Chiropractic Report ~ March 2009
In North America the relentless upwards spiral of healthcare costs in the last quarter of the 20th century produced the current era of managed care. There is no question that the excessive cost of American medical care needed to be reined in. There is also no question that third party payers in managed care have been ruthless in establishing rules and procedures based on financial targets rather than reasonable patient care. Money that should be going to patient care is going to a bloated administration and managed care owners. In the US the ratio of physicians to administrators is now almost 1 to 1 (1 to 0.95) Research is quoted and used selectively. Valuable evidence of effectiveness of treatments from prospective studies, from individual randomized controlled trials (RCTs) and for subgroups of patients, is excluded or diluted in broad systematic reviews that typically make tentative conclusions only – allowing payers to assert there is insufficient evidence. Crucial differences in quality of care are ignored. In the field of spinal manipulation for example, there are fundamentally different levels of education and skill for different health professions. This is apparent from trials such as Meade et al., where chiropractors received significantly superior results for back pain patients than did physical therapists, and Carey et al., where medical doctors given postgraduate training in spinal manipulation proved unable to assess and treat back pain patients successfully.
Preface ~ August 13, 2007
CCGPP Literature Syntheses
Consensus Recommendations of a Multidisciplinary Panel
J Manipulative Physiol Ther 2010 (Sep); 33 (7): 484–492
Acute, Chronic, Recurrent, and Wellness
J Manipulative Physiol Ther 2010 (Jul); 33 (6): 458–463
Background and Methodology
J Manipulative Physiol Ther 2008 (Nov); 31 (9): 637–643
and Practice Parameters: Methodology
J Manipulative Physiol Ther 2008 (Nov); 31 (9): 645–650
Low Back and Leg Complaints
Leg Complaints: A Literature Synthesis
J Manipulative Physiol Ther 2008 (Nov); 31 (9): 659–674
Report From a Consensus Process
J Manipulative Physiol Ther 2008 (Nov); 31 (9): 651–658
Nonmuscuoloskeletal Conditions
A Systematic Review With Implications for Whole Systems Research
J Alternative and Complementary Medicine 2007 (Jun); 13 (5): 491–512 ~ FULL TEXT
Myofascial Trigger Points/Myofascial Pain Syndrome
A Systematic Review of the Literature
J Manipulative Physiol Ther 2009 (Jan); 32 (1): 25–40
Myofascial Pain Syndrome: Summary of Clinical Practice
Recommendations from the Commission of the Council on Chiropractic Guidelines and Practice Parameters
Lower Extremity Conditions
Expansion of Literature Review
J Manipulative Physiol Ther 2009 (Jan); 32 (1): 53–71
Summary of Clinical Practice
Recommendations from the Commission of the Council on Chiropractic Guidelines and Practice Parameters
Tendinopathy
A Literature Synthesis
J Manipulative Physiol Ther 2009 (Jan); 32 (1): 41–52
Summary of Clinical Practice
Recommendations from the Commission of the Council on Chiropractic Guidelines and Practice Parameters
Fibromyalgia
A Systematic Review of the Literature
J Manipulative Physiol Ther 2009 (Jan); 32 (1): 25–40
Summary of Clinical Practice
Recommendations from the Commission of the Council on Chiropractic Guidelines and Practice Parameters
Projects in Process
Articles About Guideline Development
International Chiropractors Association's
Best Practices and Practice Guidelines
Chiropractors Association members, contained herein, are evidence-based suggestions for appropriate care of patients seeking chiropractic care. While no guideline can replace the clinical decisions made by a chiropractic practitioner in the course of caring for an individual patient’s health problem, the suggestions contain herein, are based on the best available published evidence. Any approach, by a practitioner, that is different from these ICA-BPPG Guidelines, does not necessarily mean that the approach in question was below the standard of care. However, any chiropractic practitioner, who adopts a course of action different from these ICA-BPPG Guidelines, is advised to keep sufficient patient records to explain why such an action was undertaken.
Dr. Mark D. Dehen ~ Vice Chair of the CCGPP ~ April 26, 2007
The Introductory Chapter has been reviewed and revised, per our discussion with COCSA. This was done to improve its clarity and readability without amending the existing research or conclusions, as necessitated maintaining the editorial independence of the project. Currently, the CCGPP is in the process of hiring a healthcare editor to further revise the "evidence synthesis" to make it more user-friendly to the profession at large. Dr. Bill Meeker and Dr. Dana Lawrence, team leads for the low back evidence synthesis chapter, are completing the review and synthesis of the commentary received. Once that commentary has been collated, it will be reviewed by the team for consideration as part of the expert opinion process. That commentary and the team response will then be included in the final version of the low back evidence synthesis.
J Manipulative Physiol Ther 2004 (May); 28 (4): 215-216 ~ FULL TEXT
Like most social trends, evidence-based care, originally conceived as a method to inform clinicians and improve patient outcomes, has been propelled beyond its original intent. It has now become evidence-based policy making. In debate, the vanguard of its proponents and its opponents often use stereotypical descriptions that further polarize as they express their views.
Ronald J. Farabaugh, D.C. ~ CCGPP Board Member
A rumor has it that the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is developing a new guideline. I say rumor, because like all rumors the information released so far has been filled with a combination of fact, fiction, and at times outright misinformation. I intend on producing a series of short articles over the next six months explaining the facts in an effort to help the Chiropractic profession understand the process, and the difference between a “Best Practice” initiative and a “Guideline”. Did you know there is a major difference?
Eugene A. Lewis, DC, MPH, CCGPP Chairman
The best practice initiative undertaken by the Chiropractic Guidelines and Practice Parameters is progressing at a steady pace, with the Introduction and first completed chapter of the document (lumbar spine disorders) scheduled for release in early 2005.
Jeffrey R. Cates, DC, MS, DABCO, DABCC
So, how can DCs use the new CCGPP best practice document to their advantage? Read it! Understand it! It tells you how to document the necessity of supportive care, how to document exacerbations and so much more. If we as a profession don’t adopt the CCGPP’s fair and valid best practice guide, the insurance companies will use their own guidelines to assess our work, and it is very unlikely that they will be as balanced and fair as those put forth by our own scholars.
John J. Triano, DC, PhD
The pace at which information is being published is almost too intensive to conceive. Critical appraisal of the literature is a skill unto itself. It has been estimated that if an individual attempted to keep up with all the literature related to his or her own discipline by reading one article per day, by the end of one year, they would be 99 years behind. The AHCPR guidelines, the first governmentally sanctioned review leading to the recognition of the value of high-velocity, low-amplitude procedures for acute, adult low back pain, located over 10,317 articles. When articles relevant for the task were culled, 3,918 were left.
Mark Dehen, D.C.
One important reason for moving to a best practice approach and away from a “guidelines” approach is the unfortunate tendency for guidelines to be used as care end points rather than as suggestions for typical cases. Best practices documents like the Compass recognize the individuality of the patient, his or her physician and the circumstances of care.
Return to ChiroZINE ARTICLES
Return to the GUIDELINES Section
Return to the Documentation Section
Return to the LINKS Table of Contents
Return to the EVIDENCE–BASED PRACTICE Page
Since 6-08-2005
Updated 5-10-2011
| Home Page | Visit Our Sponsors | Become a Sponsor |
Please read our DISCLAIMER |