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Difference between revisions of "Council on Chiropractic Guidelines and Practice Parameters"

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(CMT - Upper Extremity)
(Safety of Spinal Manipulative Therapy/Chiropractic Care)
 
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{{Ccgpp}}
 
{{Infobox association
 
{{Infobox association
 
| Name              = Council on Chiro. Guidelines and Practice Parameters
 
| Name              = Council on Chiro. Guidelines and Practice Parameters
Line 6: Line 7:
 
| Location          = Lexington, SC (USA)
 
| Location          = Lexington, SC (USA)
 
| Country            = {{USA}}
 
| Country            = {{USA}}
| President          = Dr. Ronald Farabaugh {{USA}}
+
| President          = Thomas J. Augat, DC, MS, [[CCSP]], FASA  {{USA}}
 
| Website            = [http://www.ccgpp.org  CCGPP]
 
| Website            = [http://www.ccgpp.org  CCGPP]
 
}}
 
}}
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==Resource Center==
 
==Resource Center==
 
=='''Guidelines'''==
 
 
In 2008 the [[Council on Chiropractic Guidelines and Practice Parameters]] ([[CCGPP]]) embarked upon an ambitious project to help clarify [[treatment guidelines]] related to low back disorders.  Although a number of guidelines addressing manipulation exist, none to that point in time had incorporated a broad-based consensus of chiropractic research and clinical experts representing mainstream chiropractic practice into a practical document designed to provide standardized parameters of care. Following a RAND/UCLA methodology for consensus development, this broad-based panel of experienced chiropractors was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to care for patients with low back pain, based on both the scientific evidence and their clinical experience. In general, if the patient is improving up to two rounds of up to 12 visits per round were deemed appropriate.  <ref name="Globe"> {{Cite paper
 
| last1 = Globe
 
| first1 = G
 
| last2 = Morris
 
| first2 = CE
 
| last3 = Whalen
 
| first3 = WM
 
| last4 = Farabaugh
 
| first4 = RJ
 
| last5 = Hawk
 
| first5 = C
 
| title = Chiropractic management of low back disorders: report from a consensus process
 
| journal = JMPT
 
| volume = 31
 
| issue = 9
 
| pages = 651-8
 
| year = 2008 Nov-Dec
 
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Chiropractic+Management+of+Low+Back+Disorders%3A+Report+from+a+Consensus+Process
 
| accessdate = 3/09/2013}}</ref>
 
 
In 2010 CCGPP researchers conducted another Delphi panel again following the RAND/UCLA protocol for consensus development, and sought to address the issue of proper treatment related to the management of chronic spine-related conditions.  Chronic spine-related conditions are very problematic in terms of treatment and indemnity costs, diagnostic complexity, and appropriate case management. The purpose of this project was to develop a broad-based multidisciplinary consensus of medical and chiropractic clinical experts representing mainstream medical and chiropractic practice to produce a document designed to provide standardized parameters of care and documentation.  After a very tedious process, a multidisciplinary panel of experienced practitioners was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to care for complex patients with chronic spine-related conditions, based on both the scientific evidence and their clinical experience.  In general this panel concluded that conservative management of chronic spine-related disorders could include "episodic" treatment (ex. 1-6 visits for a mild episode of chronic pain flare-up), to "scheduled" chronic pain management, which could include up to 1-4 treatments per month, to be re-evaluated at a minimum every 12 visits.  <ref name="Farabaugh-Chronic Guideline"> {{Cite paper
 
| last1 = Farabaugh
 
| first1 = RJ
 
| last2 = Dehen
 
| first2 = MD
 
| last3 = Hawk
 
| first3 = C
 
| title = Management of chronic spine-related conditions: consensus recommendations of a multidisciplinary panel.
 
| journal = JMPT
 
| volume = 33
 
| issue = 7
 
| pages = 484-92
 
| year = 2010 Sept
 
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Farabaugh%3A+Chronic+Spine+Pain%3A
 
| accessdate = 3/09/2013}}</ref>
 
  
 
==Research / vetted papers==
 
==Research / vetted papers==
 
+
[[Directory_of_CCGPP_Vetted_Articles | '''CCGPP ARTICLE DIRECTORY''']]
==='''Diagnostic Imaging'''===
+
 
+
The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) formed a diagnostic imaging team who was asked to review the literature on the use of diagnostic imaging in chiropractic practice. On its website, the CCGPP states, “The literature on this topic is quite extensive. In 2007-8, a series of literature syntheses was published in the [[JMPT |Journal of Manipulative and Physiologic Therapeutics]] on this topic.”  Essentially, instead of developing new guidelines the diagnostic imaging team in conjunction with CCGPP supported the existing papers on this topic. 
+
 
+
Bussieres et al published evidence-based diagnostic imaging practice guidelines for chiropractors/primary care physicians focusing on appropriate use of conventional and advanced radiography/imaging for adult musculoskeletal disorders.  In general, when used properly, guidelines are designed to avoid “unnecessary radiographs, increase examination precision, and decrease health care costs without compromising the quality of care. <ref name="Diagnostic Imaging"> {{Cite paper
+
| last1 = Bussieres
+
| first1 = AE et al
+
| title = Diagnostic imaging practice guidelines for musculoskeletal complaints in adults--an evidence-based approach: introduction.
+
| journal = JMPT
+
| volume = 30
+
| issue = 9
+
| pages = 617-683
+
| year = Nov-Dec 2007
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Diagnostic+imaging+practice+guidelines+for+musculoskeletal+complaints+in+adults--an+evidence-based+approach%3A+introduction.
+
| accessdate = 11-30-2013}}</ref> <ref name="Diagnostic Imaging2"> {{Cite paper
+
| last1 = Bussieres
+
| first1 = AE et al
+
| title = Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders
+
| journal = JMPT
+
| volume = 31
+
| issue = 1
+
| pages = 33-88
+
| year = Jan 2008
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Diagnostic+imaging+practice+guidelines+for+musculoskeletal+complaints+in+adults-an+evidence-based+approach-part+3%3A+spinal+disorders
+
| accessdate = 11-30-2013}}</ref>
+
 
+
===Physiotherapy===
+
====(see:) '''[[Low level laser]]'''====
+
 
+
==='''[[Exercise therapy| Exercise]]'''===
+
 
+
===='''(See:) [[Exercise_therapy#Neck_pain|Neck pain]]'''====
+
 
+
===='''(See:) [[Exercise_therapy#Low_Back_pain|Low Back Pain]]'''====
+
 
+
===='''(See:) [[Exercise_therapy#Rotator_Cuff_impingement|Rotator cuff Impingement]]'''====
+
 
+
==='''[[CMT]] - Lower Extremity'''===
+
 
+
In 2006 researcher Jim Brantingham et al. conducted a literature review <ref name="lower extremity"> {{Cite paper
+
| last1 = Hoskins
+
| first1 = W et al
+
| title = Chiropractic treatment of lower extremity conditions: a literature review
+
| journal = J Manipulative Physiol Ther
+
| volume = 29
+
| issue = 8
+
| pages = 658-671
+
| year = Oct 2006
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/17045100
+
| accessdate = 12-2-2013}}</ref> and concluded the following:
+
 
+
* Fair evidence (Grade B) for manipulative therapy (MT) combined with multiple modalities or exercise for knee osteoarthritis, patellofemoral pain syndrome, and ankle inversion sprain <ref name="Brantingham-LE"> {{Cite paper
+
| last1 = Brantingham
+
| first1 = JW et al
+
| title = Manipulative therapy for lower extremity conditions: expansion of literature review
+
| journal = J Manipulative Physiol Ther
+
| volume = 32
+
| issue = 1
+
| pages = 53-71
+
| year = Jan 2009
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Manipulative+therapy+for+lower+extremity+conditions%3A+expansion+of+literature+review
+
| accessdate = 12-2-2013}}</ref>
+
 
+
* Limited evidence (Grade C) for hip osteoarthritis <ref name="Brantingham-LE"/>
+
* Limted evidence for plantar fasciitis, metatarsalgia and hallux limitus/rigidus <ref name="Brantingham-LE"/>
+
* Insufficient evidence (Grade I) for hallux abducto valgus <ref name="Brantingham-LE"/>
+
* Additionally investigators found that range of motion in the lower extremities is increased with MT and stretching in comparison to one or the other <ref name="Brantingham-LE"/>
+
 
+
Brantingham et al later updated the previous literature reviews (Hoskins 2006 <ref name="lower extremity"/> and Brantingham 2009 <ref name="Brantingham-LE"/>:
+
 
+
* Fair evidence (Grade B) for MT in combination with multiple modalities or exercise therapy for short-term treatment of hip osteoarthritis (OA) and limited evidence (Grade C) for long-term treatment <ref name="Brantingham-LE Update"> {{Cite paper
+
| last1 = Brantingham
+
| first1 = JW et al
+
| title = Manipulative therapy for lower extremity conditions: update of a literature review
+
| journal = J Manipulative Physiol Ther
+
| volume = 35
+
| issue = 2
+
| pages = 127-166
+
| year = Feb 2012
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/22325966term=Manipulative+therapy+for+lower+extremity+conditions%3A+expansion+of+literature+review
+
| accessdate = 12-2-2013}}</ref>
+
 
+
* Fair evidence for short-term treatment of knee OA, patellofemoral pain syndrome and and ankle inversion sprain
+
* Limited evidence for long-term treatment <ref name="Brantingham-LE Update"/>
+
* Fair evidence  for short-term treatment of plantar fasciitis <ref name="Brantingham-LE Update"/>
+
* Limited evidence (Grade C) for short-term treatment of metatarsalgia and hallux limitus/rigidus and for loss of proprioception and balance <ref name="Brantingham-LE Update"/>
+
* Insufficient evidence (Grade I) for hallux abducto valgus <ref name="Brantingham-LE Update"/>
+
 
+
==='''[[CMT]] - Upper Extremity'''===
+
 
+
*Fair evidence (Grade B) for manual and manipulative therapy (MMT) alone or in combination with multimodal treatments for
+
 
+
:* Lateral epicondylopathy in short term (≤ 3-6 months) <ref name="Brantingham-UE Update"> {{Cite paper
+
| last1 = Brantingham
+
| first1 = JW et al
+
| title = Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review
+
| journal = J Manipulative Physiol Ther
+
| volume = 36
+
| issue = 3
+
| pages = 143-201
+
| year = Mar-Apr 2013
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Manipulative+and+multimodal+therapy+for+upper+extremity+and+temporomandibular+disorders%3A+a+systematic+review
+
| accessdate = 1-15-2014}}</ref>
+
:* Carpal tunnel syndrome in short term <ref name="Brantingham-UE Update"/>
+
:* TMJ disorders in short term <ref name="Brantingham-UE Update"/>
+
 
+
* Insufficient evidence (Grade I) for MMT and multimodal treatment for other wrist, hand and finger disorders in the short term <ref name="Brantingham-UE Update"/>
+
* Multimodal treatments include manipulation, mobilization, exercise, strengthening and stretching, soft tissue therapies, mobilization or manipulation instruments, proprioceptive neuromuscular facilitation, splinting or orthoses, electrical and mechanical modalities and other myofascial, functional and soft tissue techniques <ref name="Brantingham-UE Update"/>
+
 
+
==='''[[CMT]] - Shoulder'''===
+
* Fair evidence (Grade B) for MMT alone or in combination with multimodal treatments for
+
:* Rotator cuff injuries disease or disorder <ref name="Brantingham-Shoulder"> {{Cite paper
+
| last1 = Brantingham
+
| first1 = JW et al
+
| title = Manipulative therapy for shoulder pain and disorders: expansion of a systematic review
+
| journal = J Manipulative Physiol Ther
+
| volume = 34
+
| issue = 5
+
| pages = 314-346
+
| year = Jun 2011
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Manipulative+therapy+for+shoulder+pain+and+disorders%3A+expansion+of+a+systematic+review
+
| accessdate = 1-15-2014}}</ref>
+
:* Shoulder complaints, disorders, dysfunction and/or pain <ref name="Brantingham-Shoulder"/>
+
:* Adhesive capsulitis (especially helpful was the inclusion of proprioceptive retraining) <ref name="Brantingham-Shoulder"/>
+
:* Soft tissue disorders (focus on soft tissue or myofascial treatments) <ref name="Brantingham-Shoulder"/>
+
* Limited evidence (Grade C) for cervical lateral glide mobilization and/or HVLA (including soft tissue release and exercise) for
+
:* Minor neurogenic shoulder pain (aka minor peripheral nerve injuries and/or disorders) <ref name="Brantingham-Shoulder"/>
+
* Insufficient level of evidence (Grade I) for MMT alone or in combination with multimodal treatments for
+
:* OA <ref name="Brantingham-Shoulder"/>
+
 
+
==='''Non-Musculoskeletal conditions'''===
+
 
+
==='''ADHD'''===
+
 
+
* A 2010 systematic review states that the evidence is insufficient to support or refute the benefit of chiropractic care for ADHD in children. <ref name="ADHD"> {{Cite paper
+
| last1 = Karpouzis
+
| first1 = F et al
+
| title = Chiropractic care for paediatric and adolescent Attention-Deficit/Hyperactivity Disorder: A systematic review
+
| journal = Chiropr Osteopat
+
| volume = 18
+
| issue = 13
+
| year = June 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20525195http://www.ncbi.nlm.nih.gov/pubmed/22325966term=Manipulative+therapy+for+lower+extremity+conditions%3A+expansion+of+literature+review
+
| accessdate = 12-7-2013}}</ref>
+
 
+
==='''Asthma'''===
+
 
+
* A 2010 systematic review states that SMT is not effective for asthma, compared to sham manipulation. <ref name="Asthma"> {{Cite paper
+
| last1 = Bronfort
+
| first1 = G et al
+
| title = Effectiveness of manual therapies: the UK evidence report
+
| journal = Chiropr Osteopat
+
| volume = 18
+
| issue = 3
+
| year = Feb 25 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20184717
+
| accessdate = 12-7-2013}}</ref> However, a 2007 review indicates that the entire clinical encounter of chiropractic care, including SMT, is beneficial to patients with asthma. <ref name="Asthma-Hawk"> {{Cite paper
+
| last1 = Hawk
+
| first1 = C et al
+
| title = Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research
+
| journal = J Altern Complement Med
+
| volume = 13
+
| issue = 5
+
| pages = 491-512
+
| year = Jun 2007
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Chiropractic+care+for+nonmusculoskeletal+conditions%3A+a+systematic+review+with+implications+for+whole+systems+research
+
| accessdate = 12-7-2013}}</ref>
+
 
+
* Another 2010 systematic review states that “chiropractic care showed improvements in subjective measures and, to a lesser degree objective measures, none of which were statistically significant. Some asthmatic patients may benefit from this treatment approach; however, at this time, the evidence suggests chiropractic care should be used as an adjunct, not a replacement, to traditional medical therapy.” <ref name="Asthma-Kaminskyj"> {{Cite paper
+
| last1 = Kaminskyj
+
| first1 = A et al
+
| title = Chiropractic care for patients with asthma: A systematic review of the literature
+
| journal = The Journal of the Canadian Chiropractic Association
+
| volume = 54
+
| issue = 1
+
| pages = 24-32
+
| year = Mar 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20195423
+
| accessdate = 12-7-2013}}</ref>
+
 
+
==='''Autism spectrum disorders'''===
+
 
+
* A 2011 systematic review suggests that, although the literature is limited, “a trial of chiropractic care for sufferers of autism is warranted.” <ref name="Autism"> {{Cite paper
+
| last1 = Alcantara
+
| first1 = J et al
+
| title = A systematic review of the literature on the chiropractic care of patients with autism spectrum disorder
+
| journal = Explore (NY)
+
| volume = 7
+
| issue = 6
+
| pages = 384-390
+
| year = Nov-Dec 2011
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=A+systematic+review+of+the+literature+on+the+chiropractic+care+of+patients+with+autism+spectrum+disorder
+
| accessdate = 12-7-2013}}</ref>
+
 
+
==='''Cervicogenic vertigo'''===
+
 
+
* A 2010 systematic review indicates that SMT is effective for cervicogenic vertigo. <ref name="Asthma"/>
+
 
+
==='''Infantile colic'''===
+
 
+
* A 2011 systematic review suggests that chiropractic care is safe and “a viable alternative” for infantile colic. <ref name="Infantile Colic"> {{Cite paper
+
| last1 = Alcantara
+
| first1 = J et al
+
| title = The chiropractic care of infants with colic: a systematic review of the literature
+
| journal = Explore (NY)
+
| volume = 7
+
| issue = 3
+
| pages = 168-174
+
| year = May-Jun 2011
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/21571236
+
| accessdate = 12-7-2013}}</ref>
+
 
+
* A Cochrane database systematic review stated,“… it [is] impossible to arrive at a definitive conclusion about the effectiveness of manipulative therapies for infantile colic.” <ref name="Infantile Colic-Dobson"> {{Cite paper
+
| last1 = Dobson
+
| first1 = D et al
+
| title = Manipulative therapies for infantile colic
+
| journal = Cochrane Database Syst Rev
+
| volume = 7
+
| issue = 3
+
| year = 2012 Dec
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/23235617
+
| accessdate = 12-7-2013}}</ref>
+
 
+
* A 2010 systematic review found that the evidence is inconclusive for SMT for infantile colic. <ref name="Asthma"/>
+
 
+
==='''Otitis media'''===
+
 
+
* A 2012 narrative review stated, “there [is] currently no evidence to support or refute using SMT for OM and no evidence to suggest that SMT produces serious adverse effects for children with OM.” <ref name="Otitis Media-Pohlman"> {{Cite paper
+
| last1 = Pohlman
+
| first1 = KA et al
+
| title = Otitis media and spinal manipulative therapy: a literature review
+
| journal = J Chiropr Med
+
| volume = 11
+
| issue = 3
+
| pages = 160-169
+
| year = Sep 2012
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/23449823
+
| accessdate = 12-7-2013}}</ref>
+
 
+
* A 2007 systematic review stated, “Evidence was promising for potential benefit of manual procedures for children with otitis media…” <ref name="Asthma-Hawk"/>
+
 
+
==='''Premenstrual syndrome and dysmenorrhea'''===
+
 
+
* A 2010 review found that SMT is not effective for dysmenorrhea, compared to a sham manipulation, and that the evidence for premenstrual syndrome is inconclusive. <ref name="Asthma"/>
+
 
+
==='''Respiratory disease'''===
+
 
+
* A 2013 systematic review of manual therapy for pediatric respiratory disease indicated that it appears to be beneficial; the most commonly used manual therapies for this population are chiropractic and osteopathic manipulation and massage. <ref name="Ped Res Disease"> {{Cite paper
+
| last1 = Pepino
+
| first1 = VC et al
+
| title = Manual therapy for childhood respiratory disease: a systematic review
+
| journal = J Manipulative Physiol Ther
+
| volume = 36
+
| issue = 1
+
| pages = 57-65
+
| year = Jan 2013
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/23380215
+
| accessdate = 12-7-2013}}</ref>
+
 
+
* A 2007 systematic review stated, “Evidence was promising for potential benefit of manual procedures for elderly patients with pneumonia,” <ref name="Asthma-Hawk"/>  while a 2010 systematic review said the evidence was inconclusive. <ref name="Asthma"/>
+
 
+
==='''Safety of Spinal Manipulative Therapy/Chiropractic Care'''===
+
 
+
The 2007 clinical practice guidelines on low back pain (LBP) from the American College of Physicians and the American Pain Society found that serious adverse events related to spinal manipulative therapy (SMT) for LBP are apparently rare but that the data on adverse events were poorly reported in the literature. <ref name="Safety of SMT-Chou"> {{Cite paper
+
| last1 = Chou
+
| first1 = R et al
+
| title = Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society
+
| journal = Ann Intern Med
+
| volume = 147
+
| issue = 7
+
| pages = 478-491
+
| year = Oct 2 2007
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/17909209
+
| accessdate = 12-7-2013}}</ref>
+
 
+
A 2008 population-based, case-control and case-crossover study found no evidence of increased risk of vertebrobasilar artery (VBA) stroke related to chiropractic care, compared to primary medical care. <ref name="Risk of VBS-Cassidy"> {{Cite paper
+
| last1 = Cassidy
+
| first1 = JD et al
+
| title = Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study
+
| journal = Spine
+
| volume = 33
+
| issue = 4
+
| pages = S176-183
+
| year = Feb 15 2008
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/18204390
+
| accessdate = 12-7-2013}}</ref> This comprehensive study, published in Spine, involved evaluation of nine years of medical records in the Canadian province of Ontario (covering 100 million patient years).
+
 
+
Characterization of risk for adverse events related to SMT and comparison to adverse events from medications used for the same conditions:
+
* Serious adverse events 5-6 per 100,000 cervical spine manipulations.
+
* Serious adverse events no more than 1 per million patient visits for lumbar spine manipulation. <ref name="Manual therapy-Bronfort"> {{Cite paper
+
| last1 = Bronfort
+
| first1 = G et al
+
| title = Effectiveness of manual therapies: the UK evidence report.
+
| journal = Chiropr Osteopat
+
| volume = 18
+
| issue = 3
+
| year = 2010 Feb 25
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20184717
+
| accessdate = 12-7-2013}}</ref>
+
 
+
* In the trials included in a 2010 systematic review, the relative risk (RR) for high velocity manipulation causing minor/moderate adverse events was significantly less than the RR of the comparison medication (usually NSAIDs). <ref name="Manual therapy-Carnes"> {{Cite paper
+
| last1 = Carnes
+
| first1 = D et al
+
| title = Adverse events and manual therapy: a systematic review
+
| journal = Man Ther
+
| volume = 15
+
| issue = 4
+
| pages = 355-363
+
| year = Aug 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20097115
+
| accessdate = 12-7-2013}}</ref>
+
 
+
* Risk of death from NSAIDs for osteoarthritis has been estimated to be 100–400 times the risk of death from cervical manipulation. <ref name="Manual therapy-Carnes"/> <ref name="CMT vs NSAIDs-Dabbs"> {{Cite paper
+
| last1 = Dabbs
+
| first1 = V et al
+
| title = A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain
+
| journal = J Manipulative Physiol Ther
+
| volume = 18
+
| issue = 8
+
| pages = 530-536
+
| year = Oct 1995
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/8583176
+
| accessdate = 12-7-2013}}</ref>
+
 
+
Concerning adverse events related to chiropractic care/SMT for children, 2 systematic reviews, one covering databases from inception through 2004 <ref name="Pediatric SMT safety"> {{Cite paper
+
| last1 = Vohra
+
| first1 = S et al
+
| title = Adverse events associated with pediatric spinal manipulation: a systematic review
+
| journal = Pediatrics
+
| volume = 119
+
| issue = 1
+
| pages = 275-283
+
| year = Jan 2007
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/17178922
+
| accessdate = 12-7-2013}}</ref> and the other 2004-2010, <ref name="Adverse events children"> {{Cite paper
+
| last1 = Humphreys
+
| first1 = BK
+
| title = Possible adverse events in children treated by manual therapy: a review
+
| journal = Chiropr Osteopat
+
| volume = 18
+
| issue = 12
+
| year = 2010 Jun 2
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Possible+adverse+events+in+children+treated+by+manual+therapy%3A+a+review
+
| accessdate = 12-7-2013}}</ref> found 9 severe adverse events and 20 indirect adverse events (effects due to delayed diagnosis or inappropriate use of SMT for certain conditions).  <ref name="Pediatric SMT safety"/> <ref name="Adverse events children">{{Cite paper
+
| last1 = Humphreys
+
| first1 = BK
+
| title = Possible adverse events in children treated by manual therapy: a review
+
| journal = Chiropr Osteopat
+
| volume = 18
+
| issue = 12
+
| year = 2010 Jun 2
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Possible+adverse+events+in+children+treated+by+manual+therapy%3A+a+review
+
| accessdate = 12-7-2013}}</ref>
+
 
+
In summary, adverse events from spinal manipulation occur rarely, and the safety profile of SMT compares favorably to that of medications used for similar musculoskeletal conditions.
+
 
+
==='''Soft Tissue'''===
+
 
+
===='''Trigger points and myofascial pain syndrome'''====
+
 
+
* Evidence level B (moderately strong evidence) – manual therapies provide immediate pain relief for trigger points (TrPs) <ref name="Myofascial Pain">{{Cite paper
+
| last1 = Vernon
+
| first1 = H et al
+
| title = Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature
+
| journal = J Manipulative Physiol Ther
+
| volume = 32
+
| issue = 1
+
| pages = 14-24
+
| year = Jan 2009
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Chiropractic+management+of+myofascial+trigger+points+and+myofascial+pain+syndrome%3A+a+systematic+review+of+the+literature
+
| accessdate = 12-8-2013}}</ref>
+
 
+
* Evidence level C (limited evidence) – supporting manual therapies for long term use in management of TrPs and myofascial pain syndrome (MPS) <ref name="Myofascial Pain"/>
+
 
+
* Level A (substantial evidence) – laser therapy is effective for TrPs and MPS <ref name="Myofascial Pain"/>
+
 
+
* Level B – TENS may be effective for immediate relief for TrPs <ref name="Myofascial Pain"/>
+
 
+
* Level C – (frequency modulated neural stimulation) FREMS, (high-voltage galvanic stimulation) HVGS, (electrical muscle stimulation) EMS and Interfential current (IFC) <ref name="Myofascial Pain"/>
+
 
+
* Level C – ultrasound no more effective than placebo <ref name="Myofascial Pain"/>
+
 
+
* Level B - magnets may be effective for TrPs and MPS <ref name="Myofascial Pain"/>
+
 
+
* Level B – deep acupuncture for TrPs for up to 3 months <ref name="Myofascial Pain"/>
+
 
+
===='''Tendinopathy'''====
+
 
+
* Clinically important benefit - therapeutic US for calcific shoulder tendinopathy <ref name="Tendiopathy">{{Cite paper
+
| last1 = Pfefer
+
| first1 = MT et al
+
| title = Chiropractic management of tendinopathy: a literature synthesis
+
| journal = J Manipulative Physiol Ther
+
| volume = 32
+
| issue = 1
+
| pages = 41-52
+
| year = Jan 2009
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Chiropractic+management+of+tendinopathy%3A+a+literature+synthesis
+
| accessdate = 12-8-2013}}</ref>
+
 
+
* Lack of evidence – “thermotherapy, therapeutic exercise, massage, transcutaneous electrical stimulation and other forms of electrical stimulation, mechanical traction, combined rehabilitation approaches” <ref name="Tendiopathy"/>
+
 
+
* No recommendations – manipulation/mobilization alone or in combination with other interventions <ref name="Tendiopathy"/>
+
 
+
===='''Fibromyalgia'''====
+
 
+
* Fibromyalgia syndrome “is not a peripheral disorder of the soft tissues, but rather a disorder of aberrant pain processing and central sensitization” <ref name="Fibromyalgia">{{Cite paper
+
| last1 = Schneider
+
| first1 = M et al
+
| title = Chiropractic management of fibromyalgia syndrome: a systematic review of the literature
+
| journal = J Manipulative Physiol Ther
+
| volume = 32
+
| issue = 1
+
| pages = 25-40
+
| year = Jan 2009
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/19121462
+
| accessdate = 12-8-2013}}</ref>
+
 
+
* Strong evidence – low-dose antidepressants; light aerobic exercise and Cognitive Behavioral Treatment (CBT) <ref name="Fibromyalgia"/>
+
 
+
* Moderate evidence – massage, muscle strength training, acupuncture and spa therapy (balneotherapy) <ref name="Fibromyalgia"/>
+
 
+
* Limited evidence – spinal manipulation; movement/body awareness; and vitamins, herbs and dietary modifications <ref name="Fibromyalgia"/>
+
 
+
* “No single therapy or intervention that can be considered a cure” <ref name="Fibromyalgia"/>
+
 
+
* Combination of therapies is most helpful <ref name="Fibromyalgia"/>
+
 
+
* More research is necessary <ref name="Fibromyalgia"/>
+
 
+
==='''Special Populations'''===
+
 
+
===='''Geriatrics'''====
+
 
+
*'''Strength training and balance''' exercises improve function and reduces impairment
+
 
+
*'''Strong evidence to support'''<ref name="Geriatric">{{Cite paper
+
| last1 = Hawk
+
| first1 = C et al
+
| title = Best practices recommendations for chiropractic care for older adults: results of a consensus process
+
| journal = J Manipulative Physiol Ther
+
| volume = 33
+
| issue = 6
+
| pages = 464-473
+
| year = Jul-Aug 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Best+practices+recommendations+for+chiropractic+care+for+older+adults%3A+results+of+a+consensus+process
+
| accessdate = 12-22-2013}}</ref>
+
:*Counseling for physical activity and exercise<ref name="Geriatric"/>
+
:*Counseling for general health<ref name="Geriatric"/>
+
:*Counseling for fall prevention<ref name="Geriatric"/>
+
 
+
*'''Screen for fall risks factors'''
+
:*Medication use (including polypharmacy)<ref name="Geriatric"/>
+
:*Blood pressure<ref name="Geriatric"/>
+
:*Balance and gait<ref name="Geriatric"/>
+
:*Heart health<ref name="Geriatric"/>
+
:*Home safety<ref name="Geriatric"/>
+
 
+
*'''Tables included in the article'''
+
:*Outlines geriatric red flags for immediate referral and those requiring co-management or appropriate referral<ref name="Geriatric"/>
+
:*“Agency for Healthcare Research and Quality (AHRQ) recommendations for screening and counseling for adults aged 65 and older”<ref name="Geriatric"/>
+
*Hawk et al. provides “a general framework for what constitutes an evidence-based and reasonable approach to the chiropractic management of older adults”<ref name="Geriatric"/>
+
*Dougherty et al. article focuses on SMT, acupuncture, physical activity/exercise, nutritional counseling and fall prevention<ref name="Geriatric-Dougherty">{{Cite paper
+
| last1 = Dougherty
+
| first1 = PE et al
+
| title = The role of chiropractic care in older adults
+
| journal = Chiropr Man Therap
+
| volume = 20
+
| issue = 1
+
| pages = 3
+
| year = Feb 21, 2012
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/22348431
+
| accessdate = 12-22-2013}}</ref>
+
*Observational studies and RCTs “have reported improvement of spinal pain (acute, sub-acute and chronic) among seniors using SMT, BioEnergetic Synchronization Technique and Cox Flexion-Distraction technique”<ref name="Geriatric-Dougherty"/>
+
*2010 UK Report of Manual therapies:
+
:*“SMT is effective in adults for: acute, subacute and chronic LBP; migraine and cervicogenic headache; cervicogenic dizziness”<ref name="Geriatric-Dougherty"/>
+
:*“Manipulation/mobilization is effective for several extremity joint conditions”<ref name="Geriatric-Dougherty"/>
+
:*“Thoracic manipulation/mobilization is effective for acute/subcute neck pain”<ref name="Geriatric-Dougherty"/>
+
*Limited evidence for SMT for “COPD, constipation, depression (associated with back pain), Parkinson’s disease, MS, pneumonia, spinal stenosis, urinary incontinence, and OA pain and dysfunction, especially of the knee”<ref name="Geriatric-Dougherty"/>
+
*Acupuncture and chronic MSK pain:
+
:*Insufficient experimental evidence showing it benefit over other modalities<ref name="Geriatric-Dougherty"/>
+
*Limited evidence for supplement use impacting health outcomes
+
:*Most beneficial:  Vitamin D and calcium as an “adjunct to pharmacologic regimen in treatment of osteoporosis and in the prevention of hip fractures and other non-vertebral fractures”<ref name="Geriatric-Dougherty"/>
+
::*Recommended 1,200 mg calcium; 1,000 IU of Vitamin D<ref name="Geriatric-Dougherty"/>
+
:*Other supplements have “inadequate evidence or evidence of significant side effects”<ref name="Geriatric-Dougherty"/>
+
*Positive effects of aerobic exercise and strength training (strength, balance and physical functioning)<ref name="Geriatric-Dougherty"/>
+
:*Modest beneficial effect of resistive training on strength outcomes<ref name="Geriatric-Dougherty"/>
+
:*Strong evidence for improving gait speed and chair stands<ref name="Geriatric-Dougherty"/>
+
:*Decreased levels of arthritic knee pain with resistive training<ref name="Geriatric-Dougherty"/>
+
*“DCs should collect falls history information, and provide treatment and exercises for musculoskeletal conditions”<ref name="Geriatric-Dougherty"/>
+
 
+
===='''Pediatrics'''====
+
 
+
A 2012 systematic reviewed stated, “studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to SMT, especially among children with asthma.” <ref name="Pediatrics-SMT">{{Cite paper
+
| last1 = Gleberzon
+
| first1 = BJ et al
+
| title = The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature
+
| journal = The Journal of the Canadian Chiropractic Association
+
| volume = 56
+
| issue = 2
+
| pages = 128-141
+
| year = Jun 2012
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=The+use+of+spinal+manipulative+therapy+for+pediatric+health+conditions%3A+a+systematic+review+of+the+literature
+
| accessdate = 1-9-2014}}</ref>
+
 
+
* '''ADHD'''
+
:* Evidence is insufficient to support chiropractic care for ADHD in children. <ref name="Pediatrics-Karpouzis">{{Cite paper
+
| last1 = Karpouzis
+
| first1 = F et al
+
| title = Chiropractic care for paediatric and adolescent Attention-Deficit/Hyperactivity Disorder: A systematic review
+
| journal = Chiropr Osteopat
+
| volume = 18
+
| issue = 13
+
| year = Jun 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20525195
+
| accessdate = 1-9-2014}}</ref>  <ref name="Pediatrics-Ferrance">{{Cite paper
+
| last1 = Ferrance
+
| first1 = RJ et al
+
| title = Chiropractic diagnosis and management of non-musculoskeletal conditions in children and adolescents
+
| journal = Chiropr Osteopat
+
| volume = 18
+
| issue = 14
+
| year = Jun 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Chiropractic+diagnosis+and+management+of+non-musculoskeletal+conditions+in+children+and+adolescents
+
| accessdate = 1-9-2014}}</ref>
+
 
+
* '''Autism spectrum disorders'''
+
:* Limited literature regarding chiropractic care and autism.4 Preliminary studies suggest some benefit from chiropractic care. <ref name="Pediatrics-Autism">{{Cite paper
+
| last1 = Alcantara
+
| first1 = J et al
+
| title = A systematic review of the literature on the chiropractic care of patients with autism spectrum disorder
+
| journal =  Explore (NY)
+
| volume = 7
+
| issue = 6
+
| pages = 384-390
+
| year = Nov-Dec 2011
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=A+systematic+review+of+the+literature+on+the+chiropractic+care+of+patients+with+autism+spectrum+disorder
+
| accessdate = 1-9-2014}}</ref>
+
+
:* “Given the ineffectiveness of pharmaceutical agents, a trial of chiropractic care for sufferers of autism is prudent and warranted.”<ref name="Pediatrics-Autism"/>
+
 
+
* '''Asthma'''
+
:* A 2010 systematic review states that SMT is not effective for asthma, compared to sham manipulation. <ref name="Pediatrics-Asthma">{{Cite paper
+
| last1 = Bronfort
+
| first1 = G et al
+
| title = Effectiveness of manual therapies: the UK evidence report
+
| journal =  Chiropr Osteopat
+
| volume = 18
+
| issue = 3
+
| year = Feb 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20184717
+
| accessdate = 1-9-2014}}</ref> However, a 2007 review indicates that the entire clinical encounter of chiropractic care, including SMT, is beneficial to patients with asthma. <ref name="Pediatrics-Hawk">{{Cite paper
+
| last1 = Hawk
+
| first1 = C et al
+
| title = Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research
+
| journal = J Altern Complement Med
+
| volume = 13
+
| issue = 5
+
| pages = 491-512
+
| year = Jun 2007
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Chiropractic+care+for+nonmusculoskeletal+conditions%3A+a+systematic+review+with+implications+for+whole+systems+research
+
| accessdate = 1-9-2014}}</ref>
+
 
+
:* Another 2010 systematic review states that “chiropractic care showed improvements in subjective measures and, to a lesser degree objective measures, none of which were statistically significant. Some asthmatic patients may benefit from this treatment approach; however, at this time, the evidence suggests chiropractic care should be used as an adjunct, not a replacement, to traditional medical therapy.” <ref name="Pediatrics-Kaminskyj">{{Cite paper
+
| last1 = Kaminskyj
+
| first1 = A et al
+
| title = Chiropractic care for patients with asthma: A systematic review of the literature
+
| journal = The Journal of the Canadian Chiropractic Association
+
| volume = 54
+
| issue = 1
+
| pages = 24-32
+
| year = March 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20195423
+
| accessdate = 1-9-2014}}</ref>
+
 
+
* '''Best practices recommendations'''
+
:* Figure included in article listing “Red Flags” that require emergent treatment or referral and co-management (Figure 2) <ref name="Pediatrics-Best Practice">{{Cite paper
+
| last1 = Hawk
+
| first1 = C et al
+
| title = Best practices recommendations for chiropractic care for infants, children, and adolescents: results of a consensus process
+
| journal = J Manipulative Physiol Ther
+
| volume = 32
+
| issue = 8
+
| pages = 639-647
+
| year = Oct 2009
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Best+practices+recommendations+for+chiropractic+care+for+infants%2C+children%2C+and+adolescents%3A+results+of+a+consensus+process
+
| accessdate = 1-9-2014}}</ref>
+
+
:* Standards for pediatric education should be developed in chiropractic college curriculum including post graduate education <ref name="Pediatrics-Best Practice"/>
+
:* Chiropractic treatment for infants, children and adolescents include, but are not limited to spinal manipulation, vitamins, dietary interventions, therapeutic exercise, posture correction, and physical agents. Patient preference is important. <ref name="Pediatrics-Best Practice"/>
+
:* Adult research may not be generalizable to pediatric population <ref name="Pediatrics-Best Practice"/>
+
 
+
* '''Colic'''
+
:* “Chiropractic care is a viable alternative to the care of infantile colic and congruent with evidence-based practice, particularly when one considers that medical care options are no better than placebo or have associated adverse events.” <ref name="Pediatrics-Colic">{{Cite paper
+
| last1 = Alcantara
+
| first1 = J et al
+
| title = The chiropractic care of infants with colic: a systematic review of the literature
+
| journal = Explore (NY)
+
| volume = 7
+
| issue = 3
+
| pages = 168-174
+
| year = May-Jun 2011
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/21571236
+
| accessdate = 1-9-2014}}</ref>
+
 
+
:* Cochrane database systematic review and a 2010 review found that evidence was insufficient to make conclusions about the effectiveness of SMT.<ref name="Pediatrics-Ferrance"/> <ref name="Pediatrics-Colic-Dobson">{{Cite paper
+
| last1 = Dobson
+
| first1 = D et al
+
| title = Manipulative therapies for infantile colic
+
| journal = Cochrane Database Syst Rev
+
| volume = 12
+
| issue = CD004796
+
| year = Dec 2012
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/23235617
+
| accessdate = 1-9-2014}}</ref>
+
 
+
* '''Musculoskeletal conditions'''
+
:* Evidence is insufficient for manual therapy for spinal disorders in the pediatric population specifically. There was one RCT for TMJ disorders. <ref name="Pediatrics-MSK">{{Cite paper
+
| last1 = Hestbaek
+
| first1 = L et al
+
| title = The evidence base for chiropractic treatment of musculoskeletal conditions in children and adolescents: The emperor's new suit?
+
| journal = Chiropr Osteopat
+
| volume = 18
+
| issue = 15
+
| year = June 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=The+evidence+base+for+chiropractic+treatment+of+musculoskeletal+conditions+in+children+and+adolescents%3A+The+emperor's+new+suit%3F
+
| accessdate = 1-9-2014}}</ref>
+
 
+
* '''Nocturnal enuresis'''
+
:* Evidence is insufficient for SMT. <ref name="Pediatrics-Ferrance"/>
+
 
+
* '''Otitis media'''
+
:* Evidence is insufficient  to support or refute SMT for OM3,12 but there is no evidence of serious adverse events from SMT for children with OM. <ref name="Pediatrics-Otitis Media">{{Cite paper
+
| last1 = Pohlman
+
| first1 = KA et al
+
| title = Otitis media and spinal manipulative therapy: a literature review
+
| journal = J Chiropr Med
+
| volume = 11
+
| issue = 3
+
| pages = 160-169
+
| year = Sep 2012
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/23449823
+
| accessdate = 1-9-2014}}</ref>
+
 
+
* '''Respiratory disease'''
+
:* Study looked at osteopathic manipulation, massage and chiropractic and found that the literature is insufficient. <ref name="Pediatrics-Resp Disease">{{Cite paper
+
| last1 = Pepino
+
| first1 = VC et al
+
| title = Manual therapy for childhood respiratory disease: a systematic review
+
| journal = J Manipulative Physiol Ther
+
| volume = 36
+
| issue = 1
+
| pages = 57-65
+
| year = Jan 2013
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/23380215
+
| accessdate = 1-9-2014}}</ref>
+
 
+
===='''Pregnancy'''====
+
 
+
*A 2009 systematic review indicates that, although the body of evidence is limited,  it supports the use of SMT for back pain and related symptoms during pregnancy. <ref name="Pregnancy-Khorsan"> {{Cite paper
+
| last = Khorsan 
+
| first = R et al
+
| title = Manipulative therapy for pregnancy and related conditions: a systematic review
+
| journal = Obstet Gynecol Surv
+
| volume = 64 
+
| issue = 6
+
| pages = 416-427
+
| date = Jun 2009
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/19445815
+
| accessdate = 1/11/2014}}</ref>
+
 
+
* RCT conducted by George et al. concluded, “A multimodal approach to low back and pelvic pain in mid pregnancy benefits patients more than standard obstetric care.” <ref name="Pregnancy-George"> {{Cite paper
+
| last = George 
+
| first = JW et al
+
| title = A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy
+
| journal = Am J Obstet Gynecol
+
| volume = 208 
+
| issue = 4
+
| pages = 295 e291-297
+
| date = Apr 2013
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=A+randomized+controlled+trial+comparing+a+multimodal+intervention+and+standard+obstetrics+care+for+low+back+and+pelvic+pain+in+pregnancy
+
| accessdate = 1/11/2014}}</ref>
+
 
+
==='''Spinal Decompression'''===
+
 
+
* A 2006 systematic review indicated that the evidence was insufficient to prove the efficacy of motorized spinal decompression for chronic discogenic low back pain. <ref name="Spinal Decompression"> {{Cite paper
+
| last = Macario 
+
| first = A et al
+
| title = Systematic literature review of spinal decompression via motorized traction for chronic discogenic low back pain
+
| journal = Pain practice : the official journal of World Institute of Pain
+
| volume = 6
+
| issue = 3
+
| pages = 171-178
+
| date = Sep 2006
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Systematic+literature+review+of+spinal+decompression+via+motorized+traction+for+chronic+discogenic+low+back+pain
+
| accessdate = 1/11/2014}}</ref>
+
 
+
A 2007 review stated, “only limited evidence is available to warrant the routine use of non-surgical spinal decompression, particularly when many other well investigated, less expensive alternatives are available.” <ref name="Spinal Decompression-Daniel"> {{Cite paper
+
| last = Daniel 
+
| first = DM
+
| title = Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media?
+
| journal = Chiropr Osteopat
+
| volume = 15
+
| issue = 7
+
| date = May 2007
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Non-surgical+spinal+decompression+therapy%3A+does+the+scientific+literature+support+efficacy+claims+made+in+the+advertising+media%3F
+
| accessdate = 1/11/2014}}</ref>
+
 
+
==='''Spinal Manipulative Therapy (SMT)'''===
+
 
+
===='''SMT for low back pain (LBP)'''====
+
 
+
SMT is effective for acute, subacute, and chronic low back pain in adults <ref name="SMT-LBP-Bronfort"> {{Cite paper
+
| last = Bronfort 
+
| first = G et al
+
| title = Effectiveness of manual therapies: the UK evidence report
+
| journal = Chiropr Osteopat
+
| volume = 18
+
| issue = 1
+
| date = Feb 25 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/20184717
+
| accessdate = 1/11/2014}}</ref>
+
 
+
A review conducted for the clinical practice guideline of the American College of Physicians and American Pain Society states that there is good evidence for moderate effectiveness of SMT for LBP of more than 4 weeks’ duration compared to placebo, sham or no treatment. They report fair evidence for small to moderate effectiveness of SMT for acute LBP. <ref name="SMT-Chou"> {{Cite paper
+
| last = Chou 
+
| first = R et al
+
| title = Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline
+
| journal = Ann Intern Med
+
| volume = 147
+
| issue = 7
+
| pages = 492-504
+
| date = Oct 2 2007
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Nonpharmacologic+therapies+for+acute+and+chronic+low+back+pain%3A+a+review+of+the+evidence+for+an+American+Pain+Society%2FAmerican+College+of+Physicians+clinical+practice+guideline
+
| accessdate = 1/11/2014}}</ref>
+
 
+
The 2007 clinical practice guideline from the American College of Physicians and the American Pain Society states that for patients who have not shown improvement with self-care, nonpharmacologic approaches with proven benefits should be considered. They recommend SMT for both acute and chronic LBP. <ref name="SMT-Chou"> {{Cite paper
+
| last = Chou 
+
| first = R et al
+
| title = Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society
+
| journal = Ann Intern Med
+
| volume = 147
+
| issue = 7
+
| pages = 478-491
+
| date = Oct 2 2007
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/17909209
+
| accessdate = 1/11/2014}}</ref>
+
 
+
===='''SMT for chronic low back pain (LBP) in adults'''====
+
 
+
* A 2011 Cochrane review finds no clinically importance differences between SMT and other treatments for pain and functional improvement for chronic LBP. <ref name="SMT-Chronic LBP-Rubinstein"> {{Cite paper
+
| last = Rubinstein 
+
| first = SM et al
+
| title = Spinal manipulative therapy for chronic low-back pain
+
| journal = Cochrane Database Syst Rev
+
| volume = 36
+
| issue = 1
+
| date = 2011 Jun
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/21593658
+
| accessdate = 1/11/2014}}</ref>
+
 
+
* Regarding dosage (frequency of visits) for chiropractic management of chronic spine-related pain, it has been found that high-dose SMT has better very-short-term outcomes than low-dose SMT. <ref name="SMT-Chronic LBP-Bronfort"> {{Cite paper
+
| last = Bronfort 
+
| first = G et al
+
| title = Evidence-informed management of chronic low back pain with spinal manipulation and mobilization
+
| journal = Spine J
+
| volume = 8
+
| issue = 1
+
| pages = 213-225
+
| date = Jan-Feb 2008
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/18164469
+
| accessdate = 1/11/2014}}</ref>
+
 
+
* Expert consensus recommends the following dosages for chronic spine-related pain: <ref name="SMT-Chronic LBP-Farabaugh"> {{Cite paper
+
| last = Farabaugh 
+
| first = RJ et al
+
| title = Management of chronic spine-related conditions: consensus recommendations of a multidisciplinary panel
+
| journal = J Manipulative Physiol Ther
+
| volume = 33
+
| issue = 7
+
| pages = 484-492
+
| date = Sep 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Management+of+chronic+spine-related+conditions%3A+consensus+recommendations+of+a+multidisciplinary+panel
+
| accessdate = 1/11/2014}}</ref> <ref name="SMT-Chronic LBP-Globe"> {{Cite paper
+
| last = Globe 
+
| first = GA
+
| coauthors = Morris CE, Whalen WM, Farabaugh RJ, Hawk C.
+
| title = Chiropractic management of low back disorders: report from a consensus process
+
| journal = J Manipulative Physiol Ther
+
| volume = 33
+
| issue = 9
+
| pages = 651-658
+
| date = Nov-Dec 2008
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=Chiropractic+management+of+low+back+disorders%3A+report+from+a+consensus+process
+
| accessdate = 1/11/2014}}</ref>
+
 
+
:* 2-3 visits/week for 2-4 weeks.
+
:* Mild exacerbation: 1-6 visits; scheduled ongoing care 1-4 visits/month:<ref name="SMT-Chronic LBP-Globe"/>
+
 
+
===='''SMT for neck pain in adults'''====
+
 
+
* Manual therapy and exercise are more effective than other non-invasive approaches to neck pain. <ref name="SMT-Neck pain-Hurwitz"> {{Cite paper
+
| last = Hurwitz 
+
| first = EL et al
+
| title = Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
+
| journal = Spine
+
| volume = 33
+
| issue = 4
+
| pages = S123-152
+
| date = Feb 15 2008
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/18204386
+
| accessdate = 1/11/2014}}</ref>
+
 
+
* Concerning whiplash-associated disorders (WAD): a 2010 systematic review finds that chiropractic care decreases pain, but that the level of evidence is low and includes expert consensus. <ref name="SMT-Neck pain-WAD"> {{Cite paper
+
| last = Shaw
+
| first = L et al
+
| title = A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research
+
| journal = Work
+
| volume = 35
+
| issue = 3
+
| pages = 369-94
+
| date = 2010
+
| url = http://www.ncbi.nlm.nih.gov/pubmed/?term=A+systematic+review+of+chiropractic+management+of+adults+with+Whiplash-Associated+Disorders%3A+recommendations+for+advancing+evidence-based+practice+and+research
+
| accessdate = 1/11/2014}}</ref>
+
 
+
 
== References ==
 
== References ==
 
{{reflist | 2}}
 
{{reflist | 2}}

Latest revision as of 19:55, 18 February 2014

Template:Infobox association/missing member
Council on Chiro. Guidelines and Practice Parameters
Logo
Foundation 1987
Location Lexington, SC (USA)
Country Flag usa.gif United States
President Thomas J. Augat, DC, MS, CCSP, FASA Flag usa.gif United States
Website CCGPP

The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) researches and rates evidence for the chiropractic profession, and compiles it into a summary document containing a literature synthesis.[1]

History

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

Mission

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.

Structure

Six members were appointed to represent the Congress of Chiropractic State Associations (COCSA). Other members were appointed by the organizations that created CCGPP. The CCGPP is a steering organization comprised of 21 individuals. 16 are chiropractors with one in education, one in research and 14 in full-time private practice. There is a vendor representative, a representative from chiropractic colleges and attorneys representing the National Association of Chiropractic Attorneys, as well as a public member. A research commission with several dozen members reports to and is supervised by CCGPP.

Resource Center

Research / vetted papers

CCGPP ARTICLE DIRECTORY

References

  1. "Who is CCGPP and how was it formed?". Council on Chiropractic Guidelines and Practice Parameters. 2008. http://ccgpp.org/. Retrieved 2008-07-08. 

External Links

CCGPP Website