CCP releases revised guidelines
New edition addresses maternity care, peer review,
numerous other issues
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.
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.
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 chiropractic profession can be proud of."
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
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.
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.
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
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.
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."
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
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."
vertebral subluxation and these related concepts are central
to the practice of chiropractic and the profession,
guidelines that specifically address them are clearly
needed, Dr. Kent noted.