The Council on Chiropractic Guidelines and Practice Parameters has recently posted the Best Practices Lower Back Draft Document on their web site, www.ccgpp.org . The New York Chiropractic Council formed a committee of eight to do a comprehensive review of the document utilizing the AGREE instrument. The New York Chiropractic Council has determined that the document will likely negatively impact third party reimbursement and more importantly does not reflect the manner in which the majority of our members and most chiropractors practice. An official position statement has been presented to the CCGPP as well as the Congress of Chiropractic State. The Council's position statement can be viewed by clicking hear, CouncilPositionstatement . If you should have any questions please email Dr. John McAtamney at drjohnmac@aol.com , or Dr. Stephen Simonetti at simochiro@aol.com . As always, the Council is ready to take action on behalf of all New York chiropractors to protect and promulgate our right to provide chiropractic to the citizens of New York State .
Download CCGPP Relevant Documents and PowerPoint Presentations
* Letter to Editor from CCP (Dr. Kent) in response to CCGPP (doc)
* Guideline Letter response from Peter Morgan, President of New York Chiropractic Council (doc)
* Open letter to CCGPP from Thomas Sidoti, D.C. , Chairman of ANJC Literature Search Com . (PDF)
* CCPB Powerpoint Presentation by Dr. Christopher Kent (ppt.)
New York Chiropractic Council Position on the CCGPP Low Back Draft.
The New York Chiropractic Council Board appointed a committee of eight to critique the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) Low Back Draft document. The eight doctors on the committee formed a diverse representation of our organization in terms of geographics and practice style.
The New York Chiropractic Council has determined that the CCGPP Low Back Draft document does not reflect the manner in which our members practice, and if followed, would result in sub standard care for the patients we serve. In fact, according to national and international surveys, the document does not reflect the way most chiropractors practice in all other jurisdictions.
After careful review the New York Chiropractic Council has determined that the Low Back Draft is at best a review of the literature concerning Spinal Manipulative Therapy for lower back pain. The document does not discern whether the SMT is performed by a chiropractor and additionally does not differentiate between SMT performed by other providers and a spinal adjustment performed by a doctor of chiropractic. This Low Back draft is simply not a chiropractic document. The Council's opinion was formed based on the highlights below:
The CCGPP has based most of its conclusions on the Randomized Control Trial, giving those procedures supported by the RTC a Level 1 rating. The fact that most procedures practiced by chiropractors for over one hundred years have not had a Random Control Trial must allow for a different rating system.
Each procedure was taken out of context of the treatment protocols. For example, modalities are rarely if ever used in isolation.
DC's who utilize basic assessments such as static palpation, motion palpation and bilateral weight scale distribution will be suspect to poor evaluation standards. Enclosed is a printout from the American Academy of Orthopedist Surgeons web site, “Back Pain in Children.” Their standards of evaluation include “alignment and mobility of the spine”, “posture” and “x-ray.” Have the American Academy of Orthopedic Surgeons performed RCT's for these standards of practice?
DC's who address vertebral subluxations in persons who happen to have "low back problems" may find themselves in trouble, even if their practice objective is subluxation correction . Subluxation detection and correction is the standard of care in New York by definition of the State Law. Our State law can be reviewed on, www.nysed.gov .
DC's who employ techniques that use x-ray analysis for routine assessment, such as Gonstead, upper cervical, CBP, etc. may be accused of inappropriate use of radiation.
DC's who base care on objective outcomes, rather than symptoms, such as SEMG, thermal scans, quality-of-life assessments, etc may be accused of deviating from "best practices ." Several research papers documenting the validity of SEMG and thermography are enclosed.
DC's who use any form of traction, even for subluxation correction using any named technique protocols, for curve correction or treatment of back pain using flexion/distraction, decompression, or other methods may be accused of "over utilization," rendering "unnecessary" care, or practicing something other than "best practices."
DC's who utilize low force techniques may be denied third party payment entirely and may be exposed to regulatory/disciplinary action.
At our most recent New York State Board meeting a question was posed to the medical doctor who is on the Board. A Board Member asked, “What does the medical community think of Evidence Based Practices?” His response was “they are passé...not highly looked upon by the medical community as effective.” He gave as an example of earaches and the use of antibiotics. He stated, “Little research has been done to support or disprove the effectiveness. Yet the procedures are still performed…, “Plain and simple, the medical community will not have Evidence Based Guidelines.” The questions raised are: (1) are we holding ourselves to a standard higher than other health care providers and (2) are evidenced based guidelines realistic for any providers in health care?
We, the Board of the New York Chiropractic Council take the position of NO SUPPORT in the matter of the CCGPP's recent publishing of the Low Back Draft document, as currently written. We feel for the reasons listed above that this document is unfairly critical of a large segment of the profession and will be detrimental to the practicing chiropractor and the patients we serve. We do concur with the International Chiropractors Association's Critique of the Low Back Draft along with all of their referenced data.
The New York Chiropractic Council recommends that the Low Back Draft be withdrawn at this time.
Regardless of your practice style, you are at risk of being injured by the CCGPP Low Back draft.
