Council on Chiropractic Guidelines and Practice Parameters

1. 2010 Activity Update Council on Chiropractic Guidelines and Practice Parameters

2. “Council on Chiropractic Guidelines and Practice Parameters (CCGPP)” • 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: • The American Chiropractic Association, • Association of Chiropractic Colleges, • Council on Chiropractic Education, • Federation of Chiropractic Licensing Boards, • Foundation for the Advancement of Chiropractic Sciences, • Foundation for Chiropractic Education and Research, • International Chiropractors Association, • National Association of Chiropractic Attorneys and • The National Institute for Chiropractic Research.

3. “Council on Chiropractic Guidelines and Practice Parameters (CCGPP)” The CCGPP's mission is to provide consistent and widely adopted chiropractic practice information, to perpetually distribute and update this data as is necessary, so that consumers and others have reliable information on which to base informed health care decisions.

4. “Council on Chiropractic Guidelines and Practice Parameters (CCGPP)” CCGPP was also delegated to examine all existing guidelines, parameters, protocols and best practices in the United States and other nations with a chiropractic lens. Participation and process have been as transparent as possible and a major goal is to represent a diverse cross-section of the profession on the projects that CCGPP has been involved in.

5. “Council on Chiropractic Guidelines and Practice Parameters (CCGPP)” CCGPP was charged with developing guidelines regarding the most common conditions treated by chiropractic physicians. Condition-based care is consistent with that found throughout the healthcare industry today, thus the focus of CCGPP’s efforts.

6. “Council on Chiropractic Guidelines and Practice Parameters (CCGPP)” The CCGPP Council is charged with directing the activities of both the Commissionand the Clinical Compass/DIER programs.

7. “Council on Chiropractic Guidelines and Practice Parameters (CCGPP)” “The Clinical Compass” • Is the “process” for translating evidence into knowledge. • Includes the various strategies of the DIER process (Dissemination, Implementation, Evaluation, Revision). • Products: Seminars, products, webinars, articles, websites, various versions of the literature syntheses recommendations. “The Commission” • The Commission is the scientific arm of the organization (i.e. the researchers) • Products: Literature syntheses, guidelines, inclusion in the National Guideline Clearinghouse.

8. CCGPP Website Information http://www.ccgpp.org A wealth of information is available on the CCGPP website at www.ccgpp.org. All completed literature syntheses and consensus guidelines have been published in JMPT and submitted for inclusion in the National Guideline Clearinghouse at www.guideline.gov.

9. CCGPP Website Information http://www.ccgpp.org Published articles include: Background and Methodology Low back and leg complaints Chiropractic Management of Low Back Disorders Lower Extremity Conditions Tendinopathy Fibromyalgia Myofascial trigger points and myofascial pain syndrome Nonmuscuoloskeletal conditions

10. Topic: Background and Methodology • What constitutes evidence for best practice? • Triano JJ. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):637-43. • Literature syntheses for the Council on Chiropractic Guidelines and Practice Parameters: methodology. • Triano JJ. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):645-50.

11. Topic: Low back and leg complaints • Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis. • Lawrence DJ, Meeker W, Branson R, Bronfort G, Cates JR, Haas M, Haneline M, Micozzi M, Updyke W, Mootz R, Triano JJ, Hawk C. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):659-74. • Chiropractic management of low back disorders: report from a consensus process. • Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8.

12. Topic: Lower Extremity Conditions • Manipulative therapy for lower extremity conditions: expansion of literature review. • Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, • Hoskins W. J Manipulative Physiol Ther. 2009 Jan;32(1):53-71. • Manipulative therapy of lower extremity conditions: Summary of Clinical Practice • Recommendations from the Commission of the Council on • Chiropractic Guidelines and Practice Parameters

13. Topic: Tendinopathy • Chiropractic management of tendinopathy: a literature synthesis. • Pfefer MT, Cooper SR, Uhl NL. J Manipulative Physiol • Ther. 2009 Jan;32(1):41-52. • Chiropractic management of tendinopathy: Summary of Clinical Practice • Recommendations from the Commission of the Council on • Chiropractic Guidelines and Practice Parameters

14. Topic: Fibromyalgia • Chiropractic management of fibromyalgia syndrome: a systematic review of the literature. • Schneider M, Vernon H, Ko G, Lawson G, Perera J. J Manipulative Physiol Ther. 2009 Jan;32(1):25-40. • Chiropractic management of fibromyalgia syndrome: Summary of Clinical Practice • Recommendations from the Commission of the Council on • Chiropractic Guidelines and Practice Parameters

15. Topic: Myofascial trigger points and myofascial pain syndrome • Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature. • Vernon H, Schneider M J Manipulative Physiol Ther. 2009 • Jan;32(1):14-24. • Chiropractic management of myofascial trigger points and myofascial pain syndrome: Summary of Clinical Practice • Recommendations from the Commission of the Council on • Chiropractic Guidelines and Practice Parameters

16. Topic: Nonmusculoskeletal conditions/Wellness • Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. • Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW. • J Altern Complement Med. 2007 Jun;13(5):491-512.

17. Current projects • Care Definitions project: will finally have everyone on the same page regarding terms. Status: Submitted for publication to JMPT. • Chronic care guideline: will finally have a chiropractic-driven fair guideline providing direction on how to identify the chronic/recurrent pain patient, documentation, and treatment guidelines. Status: Delphi panel has agreement on all but one seed statement. Will be done by the end of March.

18. Current projects • Chronic care guideline: This guideline when published will help solve the problems caused by bad consultants and payors and doctors who may need some direction regarding the management of chronic pain patients. • It will provide a roadmap for appropriate case management and help ensure that chiropractic-directed care when appropriate will remain a viable option for chronic pain patients. Currently, too many patients are being redirected to medical physicians due to lack of a guideline for chronic pain management related to non-pharmacological care provided by chiropractic physicians.

19. New Chapter: “Site of Care: Evidence as to Indicator for Focus of SMT“ Clinical Indicators for Locating Spinal Manipulation Project Goal: • This chapter will provide the evidence related to the rationale basis of performing spinal manipulation on a particular spine site.

20. New Chapter: “Site of Care: Evidence as to Indicator for Focus of SMT“ Clinical Indicators for Locating Spinal Manipulation Literature inclusion criteria: a) Articles on PARTS & related evaluation procedures commonly used by DCs to locate where to treat. b) must contain data related to the parameters themselves. c) cervical, thoracic, lumbar or pelvic focus.

21. New Chapter: “Site of Care: Evidence as to Indicator for Focus of SMT“ Clinical Indicators for Locating Spinal Manipulation This is a project of historical importance! • Regardless of philosophical beliefs, this is one project the entire profession can rally behind. • While not all will be used, the research team already identified 80 papers of mixed quality and validity demonstrating the deleterious effects of loss of range of motion alone. • Effort spearheaded by Drs. Carl Cleveland III and Jay Triano.

22. Current projectsHistorical Importance! The physical therapists have declared war on chiropractic and have staked out “spinal manipulation” as the main battleground in the musculoskeletal treatment market. This project will cost $60,000, and funding from the field is critical to its success!

23. Current projectsRapid Response Team We continue to receive requests from the field to help with issues which affect doctors and the patients we serve: • Ex: UHC-wanted to exclude payment for tx of infants, adolescents and headaches. • Ex: UHC: issues every year since 2006, including treatment related to patients injured in motor vehicle collisions. • Ex: Humana/Healthways (ACA), NY, CA, ODG, Milliman, and over 30 other projects

24. Current projectsSeminars: Affiliation with State Associations Two types of seminars: • Train the Trainers Each state association will be invited (for a very small fee to cover expenses) to send one or two representatives to this seminar where they will be provided with the tools/PowerPoint and learn how to present the published chapters and guidelines to doctors in each state.

25. Current projectsSeminars: Affiliation with State Associations Two types of seminars: • State Association license renewal seminarsusing CCGPP/Clinical Compass certified speakers from each state. • Goal: To educate our doctors and help translate evidence into clinical practice. We will show them how to use evidence to grow strong and healthy practices. • Goal: To create a financial win-win for each state association and CCGPP, with a small percent of each seminar profit being returned to CCGPP to help fund the Clinical Compass and future research/iterations.

26. Empowerment Contribution Opportunities • We need funding, from both the field doctors and corporate sponsors, in order to fund the Clinical Compass, the Rapid Response Team and future research projects. • Our mission is to generate a pool of funds which can be granted to the colleges to fund research projects and “fill in the gaps” which have been identified through the CCGPP process thus far.

27. Corporate Supporters • Many thanks to our corporate supporters: • ChiroCode Institute and late D. Henry Leavitt • Core Products and President Philip Mattison who recently committed up to $10,000 in the form of a matching donation. He will donate $1 for every dollar donated by the profession, up to $10,000!

28. The Core Products challenge/gift! Core Products will provide a free pillow per $100 donated to the CCGPP. This “product rebate” will be capped at a total of 500 pillows and will equate to a potential of $50,000 raised by the profession. Doctors pay only freight on pillows earned. Core Products will provide a 10% discount on ALL products available through the Core Website for anyone who signs up for a recurring $84/mo for 12 month “membership” to CCGPP.

29. Corporate Support We invite and encourage other corporate entities to financially support CCGPP/The Clinical Compass in our efforts to help doctors build strong and healthy evidence-based practices by translating evidence into knowledge and improved patient outcomes.

30. CCGPP Web Site • Please visit our web site at: www.ccgpp.org

31. From all of us at CCGPP • Thank you for your ongoing support! • If we can do anything to help you, please let us know. CCGPPP.O. Box 2542Lexington, SC 29071803-356-6809ccgpp@sc.rr.com