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The CCA/CFCREAB Clinical Practice Guidelines Project Status of Guidelines Process May 2009

The CCA/CFCREAB Clinical Practice Guidelines Project Status of Guidelines Process May 2009. Newfoundland & Labrador Chiropractic Association Newfoundland & Labrador Chiropractic Board Board of the Nova Scotia College of Chiropractors Council of the Nova Scotia College of Chiropractors

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The CCA/CFCREAB Clinical Practice Guidelines Project Status of Guidelines Process May 2009

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  1. The CCA/CFCREABClinical Practice Guidelines ProjectStatus of Guidelines ProcessMay 2009

  2. Newfoundland & Labrador Chiropractic Association Newfoundland & Labrador Chiropractic Board Board of the Nova Scotia College of Chiropractors Council of the Nova Scotia College of Chiropractors Prince Edward Island Chiropractic Association New Brunswick Chiropractors' Association Association des Chiropraticiens du Québec Ordre des Chiropraticiens du Québec Ontario Chiropractic Association College of Chiropractors of Ontario Manitoba Chiropractors' Association The Chiropractors' Association of Saskatchewan Alberta College and Association of Chiropractors British Columbia Chiropractic Association College of Chiropractors of British Columbia Chiropractic Registrar, Department of Justice, Yukon Territory The Canadian Chiropractic Association Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards Canadian Memorial Chiropractic College Université du Québec à Trois Rivières Canadian Chiropractic Historical Association Canadian Chiropractic Protective Association Canadian Chiropractic Research Foundation Chiropractic Awareness Council College of Chiropractic Orthopedists College of Chiropractic Rehabilitation Sciences Chiropractic College of Radiologists College of Chiropractic Sciences College of Chiropractic Sports Sciences Stakeholder Organizations

  3. Task Force • Ron Brady, DC, The CCA, Saskatchewan • Grayden Bridge, DC, The CCA, Alberta • Dean Wright, DC, The CCA, Ontario • Wanda Lee MacPhee, BSc, DC, CFCREAB, Nova Scotia • Keith Thomson, BSc, DC, NC, CFCREAB, Ontario • Jim Duncan, BFA, CAE, The CCA • Peter Waite, BA, CAE, CFCREAB • Wayne Glover, BA, CAE, General Manager

  4. Guidelines Development Committee • Roly Bryans, BA, DC, Chair, Newfoundland & Labrador • Liz Anderson-Peacock, BSc, DC, Ontario • Martin Descarreaux, PhD, DC, UQTR • Mireille Duranleau, DC, Québec • Henri Marcoux, DC, DABCA, FCCS(C), FCCO(C), Manitoba • Brock Potter, BSc, DC, British Columbia • Rick Ruegg, BSc, PhD, DC, CMCC • Lynn Shaw, BSc, MSc, PhD, inter-professional member • Robert Watkin, BA, LLB, public member • Eleanor White, MSc, DC, Ontario • Karin Sorra, PhD (Harvard)

  5. Review Panel • Steven Silk, DC, Ontario • Roy Till, DC, Ontario • Andrea Furlan, PhD, MD, Inter-professional • Richard Roy, DC, MSc, PhD candidate,Québec • Robert Burton, DC, Newfoundland & Labrador

  6. Evidence Monitoring Committees For Neck Pain and Structure & Function • Roly Bryans, BA, DC • Rick Ruegg, BSc, PhD, DC • Henri Marcoux, DC, DABCO, FCCS(C), FCCO(C) • Richard Roy, DC, MSc, PhD candidate • Thor Eglington, MSc, RN

  7. Why Guidelines? • Public safety • Most effective and appropriate care • Practice assistance • Research assessment • Chiropractic specific

  8. Agenda • Introduction and Welcome: Dr. Ron Brady • Improvements to the Guideline Development Process based on Responses to Whiplash Guideline: Dr. Grayden Bridge • Status of Guidelines Project: Dr. Ron Brady • Structure and Function Guideline Update: Dr. Wanda Lee MacPhee • Editor Search and Future Actions: Dr. Ron Brady

  9. The CCA/CFCREABClinical Practice Guidelines Project

  10. WAD Guideline Evidence-Based Care of Whiplash Associated Disorders in Adults

  11. WAD Guideline Feedback Technical and Advice drafts posted Expected academic, research and practitioner feedback Very little formal feedback Informal feedback insightful Concerns voiced Editor-in-Chief should be a science-PhD chiropractor Academic, research and practicing chiropractors who saw Technical version were frustrated by complexity

  12. Response Editor-in-Chief Immediate hire of Dr. Karin Sorra, PhD (Harvard) Exploration of options to hire a Canadian PhD, DC Hired Dr. Richard Roy to assist on Structure & Function and dissemination for Whiplash & Neck Pain Guidelines Complexity Process change Content changes Back to Basics

  13. Guiding Principles • Benefit to Chiropractors and the patients they treat • Identification of the Current Evidence • External credibility

  14. Role of a Clinical Guideline • Public confidence/public interest • Risk management to bring research knowledge to practitioners in a useable format for clinical decision making • Improves standard of care • To review and coordinate existing chiropractic research

  15. Work Process Changes Literature Search Evidence Extraction Evidence Rating Technical Version Review Panel Journal Version GDC Authorship Process Practitioner Version GDC Authorship Process Task Force GDC Authorship Process Task Force Stakeholder feedback Task Force GDC Authorship Process The CCA and CFCREAB Boards Ratification JCCA Peer Review Publication in the CCA Journal Available upon Request Practitioner version distribution

  16. Content changes • Simplification of text • Simplification of Figures • Written in practitioner terms

  17. Results • Practice Guide: • Posting period complete • Profession’s feedback being addressed • Journal Article: • Draft is complete • Feedback from Practice Guide being incorporated • Submission to JCCA for peer review

  18. The CCA/CFCREABClinical Practice Guidelines Project

  19. Headache Guideline • Evidenced Based Care of Headache in Adults • Timeline: • Extraction Update: May 2009 • Review Panel: June 2009 • Journal Article and Practice Guide Written: July 2009 • Practice Guide Posted for Comment: September 2009 • Journal Peer Review of Journal Article: September 2009 • Publishing: December 2009 or March 2010

  20. Lumbar Guideline • Treatment of the Lumbar Spine • Extraction Work: • Identification of Evidence Extractors: Complete • Contract: Complete • Begin work: September 2009

  21. Neck Pain Guideline • Two updates to the guideline • Publication in JCCA • Evidence Monitoring Committee’s work • Future Updates of the guideline

  22. Neck Pain Guideline: Next Steps • Continue EMC activities • Inclusion of BJD data and dissection information • Disseminate information • Use guideline for excellent public care

  23. How We Are Funded

  24. Our Expenses

  25. The CCA/CFCREABClinical Practice Guidelines Project

  26. Structure and Function Guideline • Insufficient evidence to write an evidence-based guideline in 2005 • Commitment made to create a guideline once there is sufficient literature to create an evidence-based guideline • Have monitored literature/research since then • Two searches done: July 2008, January 2009 • Expanded the search terms

  27. Structure and Function Guideline • Difficulties in 2009: • Need a clear definition of “Structure and Function” approved by all stakeholder groups • Need to assess the evidence against that definition • Survey done in March 2009 to gain input

  28. Structure and Function Guideline • Results of Survey: • No clear definition common to all stakeholder groups • Some stakeholder groups offering a representative to assist with clarification of the question

  29. Structure and Function Guideline • Next Steps: • Determine stakeholder support • Work with stakeholder representatives to define “Structure and Function” • Identify the parameters of that definition • Review the literature • Bring forward a recommendation to the stakeholders on how to proceed

  30. The CCA/CFCREABClinical Practice Guidelines Project

  31. Editor in Chief Actions • Decision made in August 2008 to create a Research Chair in Chiropractic Clinical Practice Guidelines working through the CCRF • Chair would coordinate the Guidelines Project • Five year financial commitment • Costs are within our current financial structure/budget

  32. Editor in Chief Actions • Discussions have been positive • Goal is to have in place by September 2009 • Announcement will be made as soon as possible

  33. Future Directions • Headache Guideline • Lumbar Guideline • Maintenance of completed guidelines • BJD Work • Evidence Monitoring Committees • Neck pain • Structure and Function

  34. Future Directions • Investigation of the ability to create guidelines in other areas • Encourage research to continue with evidence-based guidelines • Focus attention on dissemination and implementation • Keep current

  35. Value of Guidelines • Serving the public interest/Used in Québec inquiry and Ontario inquest • Profession-made guidelines relevant to chiropractic • Defensible • User-friendly to improve the standard of care • Public interest in high quality care

  36. Questions?

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