Practice Guidelines This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.orgThe intention of this page is to inform our profession about information reporting standards within the Third Party (Insurance) arena. The future of regulated health care will be “accountability”. Doctors are required to document patient complaints, exam findings, their conclusions, diagnoses, and patient progress. Patient “care plans” will need to be driven by those findings. Please refer to the Outcome Assessment Section and the Documentation Section for additional information. You may also want to explore the shift from Guidelines (usually contains numbers/suggested treatment time frames that are often mistakenly applied as arbitrary limits) to “Best Practices” (clinical judgments regarding patient care that are informed by the best evidence and balanced by patient complexity and provider experience to improve the quality and reduce the costs of care).
Jump to: Articles about Guidelines Guidelines From Around The World
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.
Articles about Guidelines
Rigorous Development Does Not Ensure That Guidelines are Acceptable
to a Panel of Knowledgeable Providers
J Gen Intern Med. 2008 (Jan); 23 (1): 37–44
Despite very rigorous development methods compared with guidelines assessed in prior studies, experts felt that these guidelines omitted common clinical situations and contained much content of uncertain validity. Guideline acceptability should be independently and formally evaluated before dissemination.
A Comparison of North American Guideline Reports
Journal of the Canadian Chiropractic Assoc 2001 (Sep); 45 (3): 141–153 ~ FULL TEXT
In the past two decades, clinical guidelines have become practical tools that assist clinicians, policy makers and insurers make informed decisions about the clinical and administrative management of patients. The popularity of these tools has increased so rapidly that clinicians now face the dilemma of having to choose from a plethora of documents of varying quality that were developed by various scientific, professional, political and commercial parties. In this context, a key challenge for the users of clinical practice guidelines is to determine whether their recommendations are valid, useful, based on the best available evidence and developed with sound scientific methodology.
J Manipulative Physiol Ther 2001 (Feb); 24 (2): 131–139 ~ FULL TEXT
Moves are afoot in Australia to publish Evidence-Based Clinical Guidelines for the Management of Acute Low Back Pain.1 A draft has been prepared by Professor Nikolai Bogduk of the University of Newcastle and the Newcastle Bone and Joint Institute, New South Wales. Bogduk has made a gallant attempt to address the issue of acute low back pain, but the document is seriously flawed in many respects. This is surprising and alarming, given the author's prominence in the international spine community. You might also want to read additional comments on this document made by Anthony L. Rosner, PhD, research director for FCER.
J Manipulative Physiol Ther 2001 (Mar); 24 (3): 170–176
The literature reviewed suggests that professional organizations or groups should undertake a critical review of guidelines using available critical guideline appraisal tools. Guideline validity appraisal should be done before acceptance by the chiropractic profession. To avoid unwarranted utilization of poorly constructed guidelines, it is strongly recommended that all future guidelines be reviewed for validity and scientific accuracy with the findings published in a medically indexed journal before they are adopted by the chiropractic community.
British Medical Journal 1999 (Feb 27); 318: 593–596 ~ FULL TEXT
The methods of guideline development should ensure that treating patients according to the guidelines will achieve the outcomes that are desired. This article presents a combination of the literature about guideline development and the results of our combined experience in guideline development in North America and Britain. It considers the five steps in the initial development of an evidence based guideline
Chiropractic Care for Common Industrial Low Back Conditions
Chiropractic Technique 1993 (Aug); 5 (3): 119–125 ~ FULL TEXT
This is the first guideline I have seen which actually states the number of visits which may be appropriate for a variety of common low back conditions. I have used these "care plans" for years, presenting them to third party's as a "working diagnosis" care plan, which need ongoing "fine tuning" during patient care. Check out this Chiropractic Technique article, and the attached care plans, which have been released exclusively to Chiro.Org by the National College of Chiropractic. Thanks, Dana!Download the “Care Plans” – in Word 97 Format or
in Adobe Acrobat Format
They are formatted, so you can add your own letterhead and mail them out to claim adjusters tomorrow! Just use "save-as" and they are all yours!Download The Adobe Acrobat Reader for Free
Guidelines From Around The World
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. Come review all the CCGPP literature syntheses on low back, upper and lower extremities, non-musculoskeletal conditions, prevention and health promotion, and soft tissue conditions. You may also enjoy the Evidence-based Practice Page.
Britain's Department of Health, in collaboration with the Foundation for Integrated Medicine has published Complementary Medicine, a document that explains the benefits of the top six complementary therapies provided by Britain's National Health Service (NHS).
This section defines California's recommendations for Neuromusculoskeletal, Low Back, Neck and Shoulder complaints.
These evidence-based diagnostic imaging practice guidelines are intended to assist primary care providers and students in decision making regarding the appropriate use of diagnostic imaging for specific clinical presentations. The guidelines are intended to be used in conjunction with sound clinical judgment and experience.
This section contains documentation recommendations from State and National associations.Documentation Recommendations
Clinical Impression and Diagnosis
Please browse our Guidelines book shelf. Any books you purchase will help to support our non-commercial website. You may also find value in the The OUTCOME ASSESSMENT Book Shelf
This section defines terminology, outlines "accepted (and unaccepted) diagnostic tests" in Personal Injury, and offers you access to Allstate's "confidential" Employee Training Manual.
A new addition is the Danish Institute's Low Back Pain Guidelines, available in HTML or Adobe Acrobat. This section also includes recommendations from the California Industrial Medical Council, the Royal College of General Practitioners, the 1994 AHCPR guides, the "Mercy Conference Document", and the New Zealand "Psychosocial Yellow Flags" Page
New additions include 6 tables from Art Croft DC's Whiplash Injuries: The Cervical Acceleration/ Deceleration Syndrome which contain information on complicating factors for recovery, guidelines for frequency and duration of care, treatment adjuncts and contraindications to manipulation. It also includes guidelines from the California Industrial Medical Council. You may also want to view the Whiplash Page.
From the Council on Chiropractic Physiological Therapeutics and Rehabilitation
Includes the original 1993 and the updated 1998 recommendations to the Canadian Government about inclusion of chiropractic in their Health Care System.
Review the International Chiropractors Association (ICA) and Canadian guides for care, documentation, and outcome assessments.
Includes Guidelines from the International Chiropractors Association (ICA) and the Council on Chiropractic Practice (CCP) regarding Instrumentation, Radiographic and other Imaging, Clinical Impression and Assessment, Reassessment and Outcome Assessment, Modes of Adjustive Care, Duration of Care for Correction of Vertebral Subluxation, and Chiropractic Care for Children.
The original Agency for Health Care Policy and Research (AHCPR) has now evolved into Agency for Healthcare Quality and Research (AHRQ).
More to review:
- Fordyce WE, editor. Back pain in the workplace. Management of disability in nonspecific conditions. International Association for the Study of Pain. Seattle, Wash: IASP Press, 1995.
- Victorian WorkCover Authority. Guidelines for the management of employees with compensable low back pain. Melbourne: Victorian WorkCover Authority, 1996.
- Gross A, Aker P, Goldsmith CH, Peloso P. Conservative management of mechanical neck pain: systematic overview and meta-analysis. British Medical Journal 1996; 313: 1291-1296.
- Van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain. A systemic review of randomized controlled trials of the most common interventions. Spine 1997; 22: 2128-2156.
- Waddell G, Feder G, McIntosh A, et al. Low back pain evidence review. London: Royal College of General Practitioners, 1998.
Return to the Documentation Section
Return to the LINKS Table of Contents
Return to the REHABILITATION DIPLOMATE Section
Since 3-01-2000
Updated 2-01-2013
| Home Page | Visit Our Sponsors | Become a Sponsor |
Please read our DISCLAIMER |