Posts Tagged ‘Spine’

MAKING EVERY ADJUSTMENT COUNT

Saturday, February 6th, 2010

I’ve organised a lot of seminars over quite a few years now (my first was in 1996) and as a result I have had the privilege of meeting every “type” of Chiropractor – and I have found that there is one constant trait that exists across all philosophies, techniques, practice management styles and scopes of practice – and that is a strong desire to provide the best possible therapeutic benefit from each and every “treatment”. Ignoring the very small segment of the profession that is more interested in the bottom line, than the spinal column – I know that each one of us hopes for and even expects that when we adjust someone, something good is going to happen for that person.

And that encounter can look quite different between practitioners. For example, it’s Monday morning and the first patient for the day is waiting, eagerly anticipating that they will be feeling “better” after their adjustment: Here are some possible generic scenarios:

1) The Chiropractor goes through their standard procedure of adjusting both sides of the neck, thrusts on a few thoracics, then rolls the patient onto both sides to loosen up the low Back.

2) The Chiropractor checks their notes from the last progress exam to see which segments had been determined to be needing adjustment for the next course of corrections, and then follows that recipe.

3) The Chiropractor palpates down the spine to find tight and tender points then proceeds to manipulate those symptomatic areas to improve the mechanical function of the spinal joints.

4) The Chiropractor uses some form of orthopaedic or neurological examination which can lead them to adjust anywhere between 6 and 12 subluxations on any given visit.

But there are some inherent weaknesses in the above approaches which must be reconciled if our goal is truly to deliver adjustments with that something extra:

1) If we don’t have a method to prioritise where someone really needs to be adjusted then should we call ourselves practitioners or technicians? One root of burnout is boredom: When every spine starts to look the same and when we start to diminish the value of each adjustment, then our sense of importance and passion also diminishes.

2) If we believe that adjustments initiate change, then shouldn’t the adjustments need to change through time? If a person’s spine and nervous system is healing, adapting and even evolving under our care, then why would today’s adjustment be the same as last month’s adjustment? And if someone’s life circumstances have altered since they started care, wouldn’t the pattern of Subluxation change to reflect this, and last week’s adjustment would now be inappropriate?

3) Chiropractors have long made the claim to be treating the cause. But if we treat based on symptoms, whether pain or tenderness, then don’t we make a mockery of this claim? If we claim to be removing interference from the nervous system, then shouldn’t we have some means of determining where that interference is, and how best to reduce that interference?

4) Most chiropractic techniques have talked about concepts such as primary and secondary subluxations, compensations, referral, distant effects from local interference, reflex projection. In other words not all Subluxations are created equal, and not all Subluxations need to be adjusted on every visit, because adjusting the “primary” subluxation will influence and reduce the connected secondary and compensatory malfunction. If we don’t have a method to differentiate between these types of Subluxations then won’t we be wasting some of our precious time?

Now consider a fifth option: On any given day, at the very moment that you are examining a spine, depending on the most recent physical, chemical and emotional stresses to your practice member’s nervous system, and superimposed over the long term accumulation of tension in their spinal system – there is one predominating subluxation, which if adjusted will produce bigger neurological changes than adjusting any other segment in the spine at that time. You would want to know how to differentially diagnose that segment wouldn’t you?

Watch Short Video Explaining The Concept of Primary Subluxations…

(If you can’t view this video try this link: http://www.screencast.com/t/YjliZjgwN )

This model has been developed during the research method design for a ground breaking, randomised, placebo controlled, prospective scientific project run in conjunction between Holder Research Institute, Turning Point Addiction Recovery facility, and the University of Miami School of Medicine’s famous Biostatistician Bob Duncan. This technique is today called Torque Release Technique and has been published in major journals such as Molecular Psychiatry, the Journal of Psychoactive Drugs, and Journal of Vertebral Subluxation Research, as well as being featured on the Discovery Health Channel.

Thankfully modern chiropractic can stand on the shoulders of its technique pioneering giants: Palmer, Thompson, DeJarnette, Van Rumpt, Logan, Toftness and more contemporary ground breakers like Epstein; and the development of TRT saw the best of the best being integrated to produce an amazingly streamlined and efficient means of determining which segment of the spine needs to be adjusted, with precise correctional vectors, and to confirm the success of a single adjustment or plot the objective improvement in indicators of subluxation through time.

Another gift from the research project was the Integrator – the first chiropractic instrument to be specifically designed and patented for the correction of Subluxations. What makes the Integrator stand alone is its ability to deliver a three-dimensional correction which includes all of the defining features of a Toggle Recoil adjustment – high speed, recoil, and torque. Plus it offers a feature that takes reproducibility and reliability to new levels – a preloading trigger that means that every adjustment delivers just the right amount of force and frequency.

Because of these breakthroughs TRT developed the reputation for being the twenty first century technique for Chiropractors to shift their practice model away from a mechanical and orthopaedic paradigm, towards a neurological and tonal application of our wonderful vitalistic philosophy.

And the consistent feedback from the hundreds of Chiropractors who have now completed TRT training is that it provides that missing piece in the technique puzzle – how to provide an adjustment which responds to the current physiological needs of the practice members’ nervous system, and how to generate big changes in state of wellbeing on each and every adjustment – physical, chemical and emotional.

2010 sees TRT in its 8th year of training Australian Chiropractors with Dr Nick Hodgson offering training programs in varied locations each year. Nick has organised numerous TRT training programs, has been personally mentored by the developer of TRT, Dr Jay Holder, and is one of Australia’s most experienced practitioners.

Click Here To See Upcoming Dates and Locations…

CHIROPRACTIC ADJUSTMENTS ALTERING BRAIN FUNCTION

Monday, December 15th, 2008

New Science Behind Chiropractic Care

Ground-breaking research has, for the first time, identified the actual changes that occur in the body, the nervous system and the brain during chiropractic spinal adjustments.

The study was conducted by award-winning Auckland researcher, Dr Heidi Haavik-Taylor. It demonstrates that chiropractic care sends signals to the brain that change the way the brain controls muscles.

The process of a spinal adjustment is like rebooting a computer. The signals that these adjustments send to the brain, via the nervous system, reset muscle behavior patterns,” said Dr Haavik-Taylor.

“By stimulating the nervous system we can improve the function of the whole body. This is something that chiropractors and their patients have known for years; and now we have some scientific evidence to prove it.”

Dr Haavik-Taylor has spent the last seven years researching the effects of chiropractic adjustments on the nervous system. However, in her latest research, carried out in conjunction with fellow New Zealander, Dr Bernadette Murphy, she was able to measure how brain waves are altered before and after spinal adjustments.

“This is the first time that anyone has used EEGs to prove that there are definite changes to the way the brain processes information after chiropractic care.”

Click Here To Read More At Scoop…

SUPER HEALTHY TIP… 

The statement that this is the first time Chiropractic has been studied using EEG is not entirely correct. Other investigators have shown that chiropractic adjustments change EEG patterns…

There is a growing body of scientific evidence that shows that chiropractic adjustments influence brain activity. How can that be? Someone “cracking” your back changing what is happening in your skull? Consider the following:

1) The spine houses the spinal cord - modern thinking sees this as being a component of the brain - maybe even the home of the subconscious mind.

2) Most chiropractors use modern, precise and gentle adjusting methods which go way beyond someone randomly twisting your spinal column to stretch joints open - the primary focus of “good” chiropractic is to detect the source of neurological dysfunction in the spine and to correct the function in this area.

Recently while training a group of Chiropractors in Johannesburg, we had a visiting PhD psychologist who specialises in brain EEG mapping do some testing before and after adjustments; and we consistently saw a “shift” in brain activity - on each occasion towards a more balanced, relaxed and focussed electrical state.

This may explain why so many people get up off a chiropractic table and the day seems brighter, their body feels looser and they experience increased feelings of wellbeing.

Healthier spine? Healthier Brain…

CHIROPRACTIC HELPING VERTIGO - SCIENTIFIC PROOF

Monday, December 15th, 2008

Below is some excerpts of research into Chiropractic helping Vertigo…

Chronic Vertigo Sufferers Find Relief With Chiropractic

Many people aren’t aware of the relationship between upper cervical (neck) trauma and vertigo. With all that modern science has accomplished, there are still more unanswered questions than answered ones. This is also true in the case of vertigo research. It’s been difficult to pinpoint the exact reason(s) why certain people suffer vertigo. However, research is beginning to point toward upper cervical trauma as an underlying cause for many types of vertigo, including Meniere’s disease, Disembarkment Syndrome, and Benign Position Vertigo.

The upper cervical area of the spine refers to the two vertebrae located at the top of the spine, directly underneath the head. C1 (known as Atlas,) along with C2 (known as Axis,) are chiefly responsible for the rotation and flexibility of the head and neck. Like the rest of the vertebrae, they are extremely vulnerable to injury and trauma. In some cases, patients may recall a specific trauma to the head or neck (such as a car accident or a blow to the head.) In other cases, patients may not be able to point to a specific injury after which vertigo became a problem. This is not unusual, since it may take months or years for vertigo to develop after head trauma.

Because so many nerves transmit through the upper cervical spine (to and from the brain,) trauma to this area results in problems to other parts of the body. This is where the relationship between the upper cervical area and vertigo becomes evident. If these vertebrae become displaced, even slightly, vertigo can occur. Unless the neck injury is addressed, the symptoms persist.

Chiropractic care involves correcting the position of these injured cervical vertebrae, particularly C1 and C2. Realigning these vertebrae may reduce or eliminate many types of vertigo…

When these conditions occur as the result of irritation to the neck vertebrae caused by trauma, chiropractic care may be beneficial. Treatments are given to relieve the irritation by realigning the vertebrae back into their proper positions. Once this occurs, the vertigo may diminish or disappear entirely.

Click Here To Read More…

Sixty Patients With Chronic Vertigo Undergoing Upper Cervical Chiropractic Care to Correct Vertebral Subluxation: A Retrospective Analysis

Two diagnostic tests, paraspinal digital infrared imaging and laser-aligned radiography, were performed according to IUCCA protocol. These tests objectively identify trauma-induced upper cervical subluxations (misalignments of the upper cervical spine from the neural canal) and resulting neuropathophysiology. Upper cervical subluxations were found in all 60 cases. All 60 patients responded to IUCCA upper cervical care within one to six months of treatment. Forty-eight patients were symptom-free following treatment and twelve cases were improved in that the severity and/or frequency of vertigo episodes were reduced.

Click Here To Read More…

Clinical Study on Manipulative Treatment of Derangement of the Atlantoaxial Joint

The derangement of the atlantoaxial joint is one of main cervical sources of dizziness and headache, which were based on the observation on the anatomy of the upper cervical vertebrae, analysis of X-ray film of the atlantoaxial joint, and the manipulative treatment in 35 patients with cervical spondylosis. The clinical diagnosis of derangement consists of: dizziness, headache, prominence and tenderness on one side of the affected vertebra, deviation of the dens for 1 mm-4 mm on the open-mouth X-ray film, abnormal movement of the atlantoaxial joint on head-rotated open-mouth X-ray film. An accurate and delicate adjustment is the most effective treatment.

Click Here To Read More…

Therapy of Functional Disorders of the Craniovertebral Joints in Vestibular Diseases

Cervicogenic vertigo is caused by functional disorders of the craniovertebral joints. The therapeutic effect of chiropractic treatment in 28 patients with vertigo and purely functional disorders of the upper cervical spine or with a combination of functional disorders of the upper cervical spine and the labyrinth was evaluated. In our opinion chiropractic treatment is mandatory for the therapy of patients with vestibular affections and functional disorders of the craniovertebral joints.

Click Here To Read More…

Upper Cervical Protocol to Reduce Vertebral Subluxation in Ten Subjects with Menieres: A Case Series

The objective of this case series was to review the management outcome of upper-cervical protocol on ten patients diagnosed with Menieres disease. Prior to the onset of symptoms all ten cases suffered neck traumas, most from automobile accidents, resulting in undiagnosed whiplash injuries.

Chiropractic care for the reduction of subluxation was undertaken. Custom x-rays and analysis of the upper cervical vertebrae were used to determine chiropractic listings of subluxation. Thermographs of the cervical spine were utilized using a DTG-25 instrument. A Toggle adjustment was used to reduce the subluxation. The condition of Menieres, which is poorly understood, responded favorably to chiropractic care using an upper cervical approach to reduce a specific subluxation complex.

Conclusion: It is possible that the true cause of Menieres disease is not only endolymphatic hydrops as theorized, but that vertebral subluxation plays a role. Further study is recommended.

Click Here To Read More…

Chiropractic Care of a Patient with Temporomandibular Disorder and Atlas Subluxation

A 41-year-old woman had bilateral ear pain, tinnitus, vertigo, altered or decreased hearing acuity, and headaches. She had a history of ear infections, which had been treated with prescription antibiotics. Her complaints were attributed to a diagnosis of temporomandibular joint syndrome and had been treated unsuccessfully by a medical doctor and dentist. High-velocity, low-amplitude adjustments were applied to findings of atlas subluxation. The patient’s symptoms improved and eventually resolved after 9 visits.

Click Here To Read More…

Vertigo, Tinnitus, and Hearing Loss in the Geriatric Patient

A 75-year-old woman with a longstanding history of vertigo, tinnitus, and hearing loss experienced an intensified progression of these symptoms 5 weeks before seeking chiropractic care. The patient received upper cervical-specific chiropractic care. Through the course of care, the patient’s symptoms were alleviated, structural and functional improvements were evident through radiographic examination, and audiologic function improved. The clinical progress documented in this report suggests that upper cervical manipulation may benefit patients who have tinnitus and hearing loss.

CHIROPRACTIC REDUCING HEARING LOSS - SCIENTIFIC PROOF

Monday, December 15th, 2008

Below is a selection of excerpts from research documenting improvements in hearing following Chiropractic Care…

Can You Hear Me Now?

Hearing loss is more than just a pain in the neck; it’s a brain thing too.

If you can’t turn up the volume on your television without waking the neighbors, consider a visit to your local chiropractor. Research suggests that mild to moderate hearing loss can be improved or restored by a single chiropractic visit. According to a study published in the journal Chiropractic & Osteopathy, 15 patients who had been diagnosed with significant hearing loss volunteered for a routine spinal adjustment. Of the 15, 6 had their hearing restored completely, 7 showed improvement, and 2 did not change.

According to Joseph Di Duro, a researcher and chiropractic neurologist at Palmer Center for Chiropractic Research in Davenport, Iowa, the biggest improvements occurred where patients needed it most – in the quieter decibel levels in everyday conversations. A year later, the researchers followed up on 3 of the study participants – all showed their hearing had remained improved and intact…

Regular visitors to the chiropractic table might be surprised to learn that the first adjustment given in 1895 wasn’t for back pain at all. It instead cured the patient’s deafness on the spot.

In another more recent case, a 36-year-old soccer player, who slammed the ball with his head and suffering severe hearing loss, had his hearing restored after a few adjustments to his spine and neck. Di Duro has been studying this intricate relationship between the nervous system, the brain, and the body…

Di Duro’s theory is based on findings from chiropractic neurology. Experts speculate that spinal manipulations spark a response back to a muscle, a joint, or the periphery, and into the central nervous system where it affects a wide range of neurological problems, including hearing deficits. Chiropractic neurology patients have reported relief from vertigo, learning disorders, pain, hyperactivity, attention deficit disorder, and other problems…

Click Here To Read More…

Hearing Loss, Otalgia and Neck Pain: A Case Report on Long-Term Chiropractic Care That Helped to Improve Quality of Life

Chiropractic Journal of Australia 2002 (Dec); 32 (4): 119-130

Observation over an extended period assists in understanding the progression of chronic disorders. This patient experienced substantially reduced symptoms with chiropractic care during the 7-year observation period. Of note is the repeated exacerbation of neck pain that often precedes exacerbation in ear symptoms, along with the relief of both following adjustment and an association between improved hearing and improved cervical alignment.

Vertebrogenic Hearing Deficit, the Spine, and Spinal Manipulation Therapy (SMT): A Search to Validate the D.D. Palmer/Harvey Lillard Experience

The claim that hearing can be improved following SMT has been scoffed at as physiologically impossible, but a review of the medical and chiropractic literature suggests that hearing deficits may be associated with spinal joint motion restriction, spondyloarthrosis, irritation of the sympathetic nervous system, decreased cervico-cerebral circulation and/or decrease in tinnitus.

Click Here To Read More…

Chiropractic Care of a Patient with Temporomandibular Disorder and Atlas Subluxation

A 41-year-old woman had bilateral ear pain, tinnitus, vertigo, altered or decreased hearing acuity, and headaches. She had a history of ear infections, which had been treated with prescription antibiotics. Her complaints were attributed to a diagnosis of temporomandibular joint syndrome and had been treated unsuccessfully by a medical doctor and dentist. High-velocity, low-amplitude adjustments were applied to findings of atlas subluxation. The patient’s symptoms improved and eventually resolved after 9 visits.

Click Here To Read More…

Vertigo, Tinnitus, and Hearing Loss in the Geriatric Patient

A 75-year-old woman with a longstanding history of vertigo, tinnitus, and hearing loss experienced an intensified progression of these symptoms 5 weeks before seeking chiropractic care. The patient received upper cervical-specific chiropractic care. Through the course of care, the patient’s symptoms were alleviated, structural and functional improvements were evident through radiographic examination, and audiologic function improved. The clinical progress documented in this report suggests that upper cervical manipulation may benefit patients who have tinnitus and hearing loss.

Cervicogenic Hearing Loss

Findings in 62 patients suffering from vertebragenic hearing disorders are reported before and after chiropractic management. Results indicate that these hearing disorders are reversible, as demonstrated by audiometry and OAE. The therapy of choice is chiropractic manipulation of the upper cervical spine. The commoness of vertebragenic hearing disorders emphasizes their clinical and forensic importance.

Click Here To Read More…

Hearing Improved With Chiropractic - Case Series

The study is significant as it looked for a scientific basis for the story behind the first chiropractic adjustment. In 1895, in Davenport Iowa, Dr. DD Palmer, a self taught healer, encountered a janitor, Harvey Lillard who was working in the building that housed the office of Dr. Palmer.  As history records, Harvey had lost most of his hearing 17 years earlier while working and bending.

Although accounts vary, it is accepted that Dr. Palmer examined Harvey and determined that a bone in his spine was out of place. He concluded that this spinal misalignment was the cause of the hearing loss that Harvey was experiencing. Dr. Palmer then proceeded to give Harvey the first intentional and purposeful chiropractic adjustment. The result was that Harvey’s hearing was restored.

In this series case study, fifteen people with various degrees of hearing loss were tested for certain frequencies to establish their degree of hearing loss. These subjects were then given only a single chiropractic adjustment and subsequently re-tested for any changes in hearing.

After just one adjustment most of the participants experienced significant hearing improvement at various tone levels. Using a standardized testing process known as the Ventry & Weinstein criteria, improvement was shown at various levels of hearing. At 40dB,  6 subjects had hearing restored, 7 subjects improved and 2 had no change. At 25dB using the Speech-frequency criteria, none of the subjects were totally restored, however, 11 had showed improvement, while 4 had no change and 3 missed a tone.

The results of this limited study add further credibility to the story of the first chiropractic adjustment. The researchers concluded, “The observations documented in this case series provide limited support to previous works indicating that, when hearing is tested immediately after a single chiropractic adjusting visit, hearing may be improved in both ears.”

Click Here To Read More…

Click Here To Read The Full Paper…

GUIDELINES FOR CLINICAL GUIDELINES?

Sunday, November 2nd, 2008

There seems to be a progressively increasing number of practice guidelines appearing on the horizon for Chiropractors. If enough of these are generated could it get to the point that depending on whom a Chiropractor is dealing with, they will need to behave and practice in a chameleon-like fashion – what’s good for one patient, may be very different to what is good for another – depending on which guideline oversees that person’s situation?

Some of these guidelines appear to be less like best practice guidelines and more like agenda-based guidelines.

Most recently the Chiropractors Registration Board of Victoria has crossed over a boundary not previously entered into, and that is into the arena of clinical practice guidelines (http://www.chiroreg.vic.gov.au/comment.php). This is being justified on the basis that they act to protect the public against unethical chiropractice – but once reviewed against the standard of everyday chiropractic one might ask who will protect the chiropractor from the public and other third parties?

And if many established and widespread chiropractic practices such as X-raying for biomechanical assessment, use of physiological assessments such as surface EMG, adjusting children and newborns, caring for people with non-musculoskeletal conditions, maintenance and even wellness adjustments are guidelined as fringe, questionable and even unacceptable behaviours, then will future chiropractic practice resemble the service that so many chiropractors have offered to their communities for over 100 years?

Most of these guidelines are presented under the umbrella of “evidence-based practice”: Evidence-based clinical practice is defined as “The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients… (it) is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions.” (Sackett DL. Editorial. Evidence Based Medicine. Spine 1998.)

However it appears that some guideline developers twist the definition of “best” – disqualifying research and publication, or evidence, which isn’t the “best” – that is, if it isn’t a randomised, placebo-controlled, longitudinal, multi-centred, independently peer reviewed, published in a journal which the expert panel subscribes to, then it ain’t “best” and therefore it doesn’t exist…

In fact “best evidence” means the best level of evidence that we can find and what it tells us… If we don’t have the gold standard evidence, then do we have silver, bronze and even minor placing evidence to review and interpret? It is no secret that not only is chiropractic not very amenable to controlled study for a plethora of reasons, but the bulk of our evidence exists in the realm of longitudinal outcome studies, case series, and case studies. If this is the “best evidence” what does it tell us – there can be no denying that they tell us that a massive diversity of health complaints present in chiropractors’ offices, and that positive changes seem to happen?

We can’t say that if 100 “Syndrome A” sufferers present to chiropractic offices tomorrow, what percentage of these people will receive some degree of improvement let alone a complete resolution. But based on the evidence wouldn’t it be fair to say that if a “Syndrome A” sufferer presents to your office tomorrow, that it would be rational to initiate a course of treatment with clear goals and terms for review? How does that seem inferior or unacceptable to any other health care profession’s plan of action? Even after the gold standard research measures that 45% of patients receive an average of 35% improvement, what can we guarantee Mrs Jones on Monday morning? A course of care with clear goals and terms for review…

“Well it might mean that they aren’t receiving necessary medical intervention and maybe they have some terminal condition and detection will be delayed by this unproven approach!” Welcome to the life of a health care consumer trying to deal with a “primary care practitioner” – maybe the medications that the MD would prescribe as an “alternative” to our care would be ineffective or even damaging; may mask or delay the identification of other pathology; and maybe it could take months and even years to get a correct diagnosis in the medical system anyway? Sound familiar?

The chiropractic profession is not alone in the struggle to produce relevant and applicable guidelines which guide best practice, as opposed to restricting practice. “The National Health and Medical Research Council (NHMRC – an Australian Government body) has statutory responsibilities to raise the standard of individual and public health throughout Australia and to foster the development of consistent health standards. As part of this role, the NHMRC encourages the development of evidence-based guidelines by expert bodies.” (NHMRC standards and procedures for externally developed guidelines, updated September 2007)

Is a health care profession’s registration board an example of such an “expert body”? A quick read of the profiles of members of the board suggests that there is not much representation of the chiropractic profession’s academic and scientific community. So has the board received significant funding to employ the services of such experts? Who would know – no names or qualifications of any contributors or peer review panel members are listed in any of the guidelines. The guideline which covers the issue of paediatric care is an exception: It gives thanks to a Medical Paediatrician and an American Chiropractor who also holds Medical Degree, who is a self proclaimed “Quackbuster” who deals with healthcare consumer protection, and is therefore about quackery, health fraud, chiropractic, and other forms of so-Called “Alternative” Medicine (“sCAM”): Is this our desired expert body?

“It is now widely recognised that guidelines should be based, where possible, on the systematic identification and synthesis of the best available scientific evidence. The NHMRC requirements for developing clinical practice guidelines are rigorous so as to ensure that this standard is upheld. As such, guidelines with NHMRC approval are recognised in Australia and internationally as representing best practice in health and medical knowledge and practice.”

I’ll leave it to the educated reader to review the current proposed guidelines based on the following information:

Key principles for developing guidelines:

The nine key principles are:

1. The guideline development and evaluation process should focus on outcomes: This statement shouldn’t be glossed over as it seems that some of the worst examples of guidelines are more interested in practice than outcomes.

2. The guidelines should be based on the best available evidence and include a statement concerning the strength of recommendations. Evidence can be graded according to its level, quality, relevance and strength; (Ideally, recommendations would be based on the highest level of evidence. However, it has been acknowledged that the levels of evidence used by the NHMRC for intervention studies are restrictive for guideline developers, especially where the areas of study do not lend themselves to randomised controlled trials. It is proposed that this issue will be addressed when the toolkit publications are reviewed.)

It is tradition when presenting scientific evidence, to cite the source of your evidence. The proposed guidelines of the Registration Board list no references, and request for such evidence is refused on the grounds of “intellectual property”. Does this mean that there is no evidence? Is it only some “expert’s” opinion? Or are there too many pages of citations to fit in the publication? Who would know?

3. The method used to synthesise the available evidence should be the strongest applicable;

4. The process of guideline development should be multidisciplinary and include consumers early in the development process. Involving a range of generalist and specialist clinicians, allied health professionals and experts in methodology and consumers has the potential to improve quality and continuity of care and assists in ensuring that the guidelines will be adopted;

The board’s approach is to implement this step as late as possible, input only being sort after the guidelines have been drafted; and if past guidelines are representative, additional input will only lead to minor amendments at best.

That’s also why it is best to employ a medical paediatrician and an overseas chiropractor to produce a guideline on chiropractic care for children in Victoria. Perhaps the Australian chiropractic paediatric specialists that abound and the university academia that are responsible for the undergraduate paediatric curriculum were out to lunch when the document was written?

5. Guidelines should be flexible and adaptable to varying local conditions;

6. Guidelines should consider resources and should incorporate an economic appraisal, which may assist in choosing between alternative treatments;

7. Guidelines are developed for dissemination and implementation with regard to their target audiences. Their dissemination should ensure that practitioners and consumers become aware of them and use them;

In the case of the guidelines being discussed here you can download them from the web-site – otherwise you can get someone else to download them from the web-site for you.

8. The implementation and impact of the guidelines should be evaluated; and

9. Guidelines should be updated regularly.

I look forward to the dissemination of the steps and process for implementation of steps 3 and 5 to 9 with our newest guidelines – don’t hold your breath.

So, if the Registration Board’s attempt to offer guidelines is severely flawed where can we turn?

Guidelines have been produced which would more likely live up to the standards of the NHRMC. The Council on Chiropractic Practice Clinical Practice Guideline (“CCP”) is currently undergoing its’ second revision. Following publication of the CCP Guidelines the document was submitted to the National Guideline Clearinghouse for consideration for inclusion. The NGC is sponsored by the U.S. Agency for Health Care Research and Quality and is in partnership with the American Medical Association and the American Association of Health Plans.

Its mission is as follows: “The NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.” In other words the US equivalency of the NHRMC.

The AHRQ contracts with ECRI, a nonprofit health services research agency, to perform the technical work for the NGC. ECRI is an international nonprofit health services research agency and a Collaborating Center of the World Health Organization.

In November of 1998, following review by ECRI, the CCP Guidelines were accepted for inclusion within the National Guideline Clearinghouse.

The CCP has developed practice guidelines for vertebral subluxation with the active participation of field doctors, consultants, seminar leaders, and technique experts. In addition, the Council has utilized the services of interdisciplinary experts in the Agency for Health Care Policy and Research (AHCPR), guidelines development, research design, literature review, law, clinical assessment, chiropractic education, and clinical chiropractic.

The Council additionally included consumer representatives at every stage of the process and had individuals participating from several major chiropractic political and research organizations, chiropractic colleges and several other major peer groups. The participants in the guidelines development process undertaken by the CCP and their areas of expertise are clearly disclosed.

The Guidelines offer ratings of practices based on the following system:

Established: Accepted as appropriate for use in chiropractic practice for the indications and applications stated.

Investigational: Further study is warranted. Evidence is equivocal, or insufficient to justify a rating of “established.”

Inappropriate: Insufficient favorable evidence exists to support the use of this procedure in chiropractic practice.

Categories of Evidence underpinning each rating are presented as:

E: Expert opinion based on clinical experience, basic science rationale, and/or individual case studies. Where appropriate, this category includes legal opinions.

L: Literature support in the form of reliability and validity studies, observational studies, “pre-post” studies, and/or multiple case studies. Where appropriate, this category includes case law.

C: Controlled studies including randomized and non-randomized clinical trials of acceptable quality.

To download the full version and updates of the CCP guidelines go to http://www.worldchiropracticalliance.org/