Transcript Council on Chiropractic Guidelines and Practice

Using CCGPP to Build a Strong and Profitable
Practice
“WHAT is CCGPP?”
“The Commission”
•
•
The Commission is the scientific
arm of the organization (i.e. the
researchers)
“The Clinical Compass”
•
Is the “process” for translating
evidence into knowledge.
•
Includes the various strategies
of the DIER process
(Dissemination,
Implementation, Evaluation,
Revision).
•
Products: Seminars, products,
webinars, articles, websites,
various versions of the literature
syntheses recommendations.
Products: Literature syntheses,
guidelines, inclusion in the
National Guideline
Clearinghouse.
“WHY CCGPP?”
The CCGPP's mission is to provide
consistent and widely adopted chiropractic
practice information, to perpetually
distribute and update this data as is
necessary, so that consumers and others
have reliable information on which to base
informed health care decisions.
“Council on Chiropractic Guidelines and Practice
Parameters (CCGPP)”
CCGPP was also delegated to examine all
existing guidelines, parameters, protocols
and best practices in the United States and
other nations with a chiropractic lens.
Participation and process have been as
transparent as possible and a major goal is to
represent a diverse cross-section of the
profession on the projects that CCGPP has
been involved in.
“Council on Chiropractic Guidelines and Practice
Parameters (CCGPP)”
CCGPP was charged with developing guidelines
regarding the most common conditions treated by
chiropractic physicians.
Condition-based care is consistent with that found
throughout the healthcare industry today, thus the
focus of CCGPP’s efforts.
“Council on Chiropractic Guidelines and Practice
Parameters (CCGPP)”
Since its inception, CCGPP has had tremendous success
fulfilling its mission. In addition to over 12
Chapters/Literature Syntheses produced, CCGPP has
also completed and published multiple guidelines which
now appear in the National Guideline Clearinghouse.
“Council on Chiropractic Guidelines and Practice
Parameters (CCGPP)”
Step 1:
Be Aware of Available
Resources
CCGPP Website Information
http://www.ccgpp.org
1.
A wealth of information is available on the
CCGPP website at www.ccgpp.org.
2.
All completed literature syntheses and consensus
guidelines have been published in
www.jmptonline.org, and
3.
submitted for inclusion in the National Guideline
Clearinghouse at www.guideline.gov.
“Council on Chiropractic Guidelines and Practice
Parameters (CCGPP)”
Myofascial Trigger
Points
10. Tendinopathy
11. Wellness
12. What Constitutes
Evidence.
9.
1.
2.
3.
4.
5.
6.
7.
8.
Acute Low Back Pain
Chronic Spine Pain
Terminology
Lumbar
Lower Extremity
Nonmusculoskeletal
Fibromyalgia
Methodology
13.
14.
Thoracic and
Upper extremity
chapters Completed:
In Process
“Council on Chiropractic Guidelines and Practice
Parameters (CCGPP)”
Cervical and
16. Diagnostic Imaging reports have been
issued.
15.
Be Aware of Available Resources
Top Four Papers
Plus
Published Chapters
CCGPP Website Information
http://www.ccgpp.org
 Delphi Acute Low Back Guideline:

CHIROPRACTIC MANAGEMENT OF LOW BACK
DISORDERS: REPORT FROM A CONSENSUS
PROCESS, JMPT Oct 2008, Globe, Morris, Whalen,
Farabaugh, Hawk, DC,
CCGPP Website Information
http://www.ccgpp.org
 Delphi Chronic Care Guideline:

Management of Chronic Spine-Related Conditions:
Consensus Recommendations of a Multidisciplinary
Panel: JMPT September 2010, Farabaugh, Dehen,
Hawk.
CCGPP Website Information
http://www.ccgpp.org
 Terminology Paper:

Consensus Terminology for Stages of Care: Acute,
Chronic Recurrent and Wellness, JMPT August 2010,
Dehen, Whalen, Farabaugh, Hawk. (Published
July/August 2010)
CCGPP Website Information
http://www.ccgpp.org
NEW CHAPTER:

Effort spearheaded by Drs. Carl Cleveland III and Jay
Triano. Principle investigator(s): Brian Budgell, DC,
PhD

COST: $60,000
New Chapter:
Formerly the “Subluxation Chapter”
RENAMED to:
“Determining the Site of Care: What is the Evidence
Regarding the Primary Methods Used to Locate the
Site of Treatment Used by Chiropractors: a
Proposed Formal Literature Systhesis.”
Project Goal:
•
This chapter will provide the evidence related to the
rationale basis of performing spinal manipulation on
a particular spine site.
“Council on Chiropractic Guidelines and Practice
Parameters (CCGPP)”
Step 2:
Highlights of the Chronic
Pain Guideline
“Chronic Care Recommendations”
“Council on Chiropractic Guidelines and Practice
Parameters (CCGPP)”

Comment: Not every patient who suffers a flare-up of their
symptoms needs ongoing care for an extended period of
time. The consensus panel recommend up to four visits after
TW, followed by re-evaluation to determine the need for
care or ability to discontinue care and transition that patient
to home/self care. If further care is indicated based upon
TW and re-evaluation, the panel recommended up to 4
visits per month, to be re-evaluated minimally every 12
visits. See Table 5 for more information on dosaging.

“Patient recovery patterns vary depending on degrees of exacerbations.
Mild exacerbation episodes may be manageable with 1-6 office visits within
a chronic care treatment plan. There is not a linear effect between the
intensity of exacerbation and time to recovery.25 Moderate and severe
exacerbation episodes within a chronic care treatment plan require acute
care recommendations and case management.” (Page 6-7 Scheduled
ongoing chronic pain management treatment planning. See Table 5)

Comment: It is important to recognize the difference between those
patients who need ongoing “scheduled” care versus those patients who
suffer acute exacerbations of their chronic pain. Acute exacerbations
often require increase care as described in Table 5.

Chronic care goals are to:
1.
2.
3.
4.
5.
6.
7.

Minimize lost time on the job
Support patient's current level of function/ADL
Pain control/relief to tolerance
Minimize further disability
Minimize exacerbation frequency and severity
Maximize patient satisfaction
Reduce and/or minimize reliance on medication
(Page 7. Chronic Care Goals)

Comment: Remember that once a case has progressed to a
state of maximal medical improvement with the patient
unable to return to a pre-accident state, no advancement or
improvement in visual analog (VAS) or outcome assessment
(OAT) scores is expected, and ongoing care may be
necessary. The goals of ongoing care are significantly
different than that of acute care where one could expect an
improvement VAS or OAT scores.

“The management for chronic pain patients ranges from home-directed
self-care to episodic care to scheduled ongoing care.” (Page 3 Definition of
“Chronic Pain Patients”)

Comment: Chronic pain management includes a population of patients
who require “scheduled ongoing care”, which represents a deviation
from historically limiting recommendations which supported chronic
spine care (spinal manipulation) rendered only in episodes.

“…these patients may be expected to progressively deteriorate as
demonstrated by previous treatment withdrawals.” (Page 3 Definition of
“Chronic Pain Patients”. Also see Page 5 Clinical Re-evaluation)

Comment: Therapeutic withdrawal (TW) is included as part of proper
case management. Without a TW there is no way to determine the
stability of the spine and whether or not a patient requires ongoing care.
HOWEVER, TW can include an abrupt discontinuation of care, OR a
gradual withdrawal. AND, there is no defined time frame for TW. One
cannot pre-determine when the patient’s condition will decline, or how
long it will remain stable, therefore it would be improper to require a
defined time from for TW.

“Ongoing care may be inappropriate when it interferes with other
appropriate care or when the risk of supportive care outweighs its benefits,
that is, physician dependence, somatization, illness behavior, or secondary
gain. However, when the benefits outweigh the risks, ongoing care may
be both medically necessary and appropriate.” (Page 3 Application of
Chronic Pain Management)

Comment: In the past treatment was often denied due to concerns over
physician dependency resulting in over reliance on less effective, less
safe, and more invasive medical care. This guideline emphasizes that
the benefits of spinal manipulation and other types of care rendered by
chiropractic physicians often outweighs the risk commonly associated
with standard medical management.

“Once documented as persistent or recurrent, these chronic
presentations should not be categorized as “acute” or
uncomplicated.” (Page 3 Application of Chronic Pain
Management)

Comment: In the past care was often denied based upon
guidelines that were based on “uncomplicated” patients,
which is simply not the case with the chronic pain population
of patients.

“Prognostic factors that may provide a partial basis for the
necessity for chronic pain management of spine-related
conditions after MTI has been achieved include:” (Page 3-4
Prognostic Factors.)

Comment: Documentation should include prognostic
factors which may help explain the presence or potential for
chronic pain.

“Other factors or comorbidities not listed above may
adversely affect a given patient's prognosis and management.
These should be documented in the clinical record and
considered on a case-by-case basis. Each of the following
factors may complicate the patient's condition, extend
recovery time, and result in the necessity of ongoing care:
(Page 4 Prognostic Factors.)

Comment: Documentation should include comorbidities
which may help explain the presence or potential for chronic
pain.

“Individual factors from this list may adequately explain the
condition chronicity, complexity and instability in some cases.
However, most chronic cases that require ongoing care are
characterized by multiple complicating factors.” (Page 5
Complicating Factor. See table 2.)

Comment: Documentation should include comorbidities
which may help explain the presence or potential for chronic
pain.

“…the Council on Chiropractic Guidelines and Practice
Parameters (CCGPP) conducted a formal consensus process
with a multidisciplinary panel of experts…” (Page 2
Chiropractic Management)

Comment: This guideline includes input from not only
chiropractic physicians, but also MDs, PT, MT, psychologist,
and LAc.

“Those recommendations also held true for the management of chronic
LBP, with the judicious addition of one or more interventions, such as back
exercises, behavioral therapy, acupuncture, yoga, massage therapy,
multidisciplinary rehabilitation, and adjunctive or strong opioid
analgesics.4,9” (Page 2 Chiropractic Management)

Comment: Current guidelines, including CCGPP and ODG, include a
multimodal approach to the treatment of spine pain, which includes
spinal manipulation.

“A number of prognostic variables have been identified as
increasing the risk of transition from acute/subacute to chronic
nonspecific spine-related pain.” (Page 5 Risk Factors)

Comment: Documentation should include risk factors
which may help explain the presence or potential for chronic
pain.

“The diagnosis should never be used exclusively to determine need for care (or lack
thereof). The diagnosis must be considered with the remainder of case
documentation to assist the physician or reviewer in developing a comprehensive
clinical picture of the condition/patient under treatment.” (Page 5 Diagnosis)

Comment: Too often ongoing care is denied due to the diagnosis. For example,
the diagnosis of “sprain/strain” alone does not portray the potential complexities
of a case that need to be considered when determining medical necessity or
causation. In addition to prognostic factors, comorbidities, complicating factors,
and risk factors, the neurological principles (receptive field enlargement,
neuroplasticity, and neurologicl wind-up) related to chronic pain help explain the
development of chronic pain even when the diagnosis is as seemingly simple as
sprain/strain.

“Clinical information obtained during re-evaluation that may
be used to document the necessity of chronic pain
management for persistent or recurrent spine-related
conditions includes, but is not limited to:” (Page 5 Clinical Reevaluation Information. See Table 3)

Comment: Documentation should include clinical
information which may help explain the presence or
potential for chronic pain.

“A variety of functional and physiological changes may occur in
chronic conditions. Therefore, a variety of treatment
procedures, modalities, and recommendations may be applied
to benefit the patient. These include but are not limited to the
items indicated in Table 4.” (Page 6 Chronic Pain
Management Components. See Table 4)

Comment: Due to the complexities associated with chronic pain, a
variety of treatments may be necessary, including passive and active
therapies and recommendations. In more complicated cases a
multimodal treatment regimen is preferred. In less complicated chronic
cases home exercise alone may be all that is necessary to control pain.
Other cases may require spinal manipulation only, or NSAIDs only.
Remember, each case is unique and patient preferences must be
considered as well as the response to care and the other issues
mentioned throughout this paper.

“Although the visit frequency and duration of supervised
treatment vary, and are influenced by the rate of recovery
toward MTI values and the individual's ability to self-manage
the recurrence of complaints, a reasonable therapeutic trial for
managing patients requiring ongoing care is up to 4 visits after
a therapeutic withdrawal. See Table 5 for a summary of
dosaging and reevaluation recommendations.” (Page 6.
Chronic pain management treatment planning/dosaging.
See table 5)

“It is important for the reader to recognize that these
guidelines are intended to be flexible and may need to be
modified. They are not standards of care. Adherence to them is
voluntary. Alternative practices are possible and may be
preferable under certain clinical conditions. The ultimate
judgment regarding the propriety of any specific procedure
must be made by the practitioner in light of individual
circumstances presented by each patient.” (Page 7.
Discusssion)

Comment: It is important to again emphasize that every case is unique,
and each physician must recommend treatment based upon those
individual circumstances. It would be improper for the treating
physician or any consultant to recommend denial of treatment based
upon sole diagnostic test/findings, or based upon research alone.

In an evidence-based, condition-based, value-based healthcare
environment, it remains very critical to recognize the importance of
guidelines, in combinations with research, clinical decision-making, and
patient values, in addition to the process and progress of care and all the
issues mentioned in this paper.
“Council on Chiropractic Guidelines and Practice
Parameters (CCGPP)”
Step 3:
Contents of Published
Guidelines…Examples
American College of Physicians
Diagnosis and Treatment of Low Back
Pain: A Joint Clinical Practice Guideline
from the American College of
Physicians and the American Pain
Society
2 October 2007 | Volume 147 Issue 7 |
Pages 478-491
American College of Physicians
Recommendation 7: For patients who do not
improve with self-care options, clinicians should
consider the addition of nonpharmacologic
therapy with proven benefits—for acute low back
pain, spinal manipulation; for chronic or
subacute low back pain, intensive
interdisciplinary rehabilitation, exercise
therapy, acupuncture, massage therapy, spinal
manipulation, yoga, cognitive-behavioral
therapy, or progressive relaxation (weak
recommendation, moderate-quality)
CCGPP Website Information
http://www.ccgpp.org
 Delphi Acute Low Back Guideline:

CHIROPRACTIC MANAGEMENT OF LOW BACK
DISORDERS: REPORT FROM A CONSENSUS
PROCESS, JMPT Oct 2008, Globe, Morris, Whalen,
Farabaugh, Hawk, DC,
1.
Strong evidence supports the use of spinal manipulation
to reduce symptoms and improve function in patients
with acute and subacute low back pain.
2. There is good evidence that the use of exercise in
conjunction with manipulation is likely to speed and
improve outcomes as well as minimize episodic
recurrence.
3.
There is fair evidence for the use of manipulation for patients
with low back pain and radiating leg pain, sciatica or
radiculopathy, however, manipulation in combination with
other common forms of therapy may be of clinical value.
4.
Cases with high severity of symptoms may benefit by referral
for co-management of symptoms with medication.
5.
Strong evidence supports the use of spinal manipulation
/mobilization to reduce symptoms and improve function in
patients with chronic low back pain.
Stage of
Condition
Frequency
Duration
Re-evaluate
after:
Acute
3x weekly
2-4 weeks
2-4 weeks
Sub-acute
3x weekly
2-4 weeks
2-4 weeks
Chronic
2-3 x weekly
2-4 weeks
2-4 weeks
Recurrent/Flar 1-3x weekly
e-up
1-2 weeks
1-2 weeks
Stage of
Condition
Frequency
Duration
Re-evaluate
after:
Acute
2-3x weekly
2-4 weeks
4-12
treatments
Sub-acute
2-3x weekly
2-4 weeks
4-12
treatments
Chronic
1-3 x weekly
2-4 weeks
2-12
treatments
Recurrent/Flar 1-3x weekly
e-up
1-2 weeks
1-6 treatments
“ROM is commonly used by practitioners for a
variety of reasons. It has not been shown to
be a valid functional outcome measure;
however, it may be used as part of
determining an impairment rating, or to
determine whether a patient responded
positively to a single treatment session.”
CHIROPRACTIC MANAGEMENT OF
UPPER EXTREMITY PAIN
Team Lead
Thomas Souza, DC
Dean of Academic Affairs
Palmer Chiropractic College
San Jose, CA 95134
 Upper extremity pain, shoulder pain, elbow
pain, and wrist pain
 Chronicity range: acute, subacute, chronic and
recurrent
Evaluation:
Rating A: Evaluation: Questionnaires, physical examinations
(rotator cuff-full/partial tears, instability, ROM)
Manipulation/Mobilization
Rating B: Mobilization
Rating D: Manipulation/HVLA
Conservative Non-Manipulation:
Rating: B - for exercise for roator cuff disorders and
impingement syndrome
Rating: A - for ultrasound for calcific tendinitis

Recommendation: Chiropractors should consider
mobilization approaches to the glenohumeral joinst
or cervical spine for patients with shoulder pain.
Although, there is no literature support for or
against high-velocity, low-amplitude adjusting of
the shoulder, based on expert opinion, we
recommend its use with the cautions stated in the
main text of the document.
 Brantingham JW, Globe G, Pollard H, Hicks M,
Korporaal C, Hoskins W. Manipulative therapy for lower
extremity conditions: expansion of literature review. J
Manipulative Physiol Ther. 2009 Jan;32(1):53-71.
Manipulative therapy of lower extremity conditions:
Summary of Clinical Practice Recommendations from the
Commission of the Council on Chiropractic Guidelines and
Practice Parameters
NGC: Summary of Clinical Practice
Recommendations

Rating B: Fair evidence for manipulative therapy of the
knee and/or full kinetic chain combined with multimodal
or exercise therapy for knee osteoarthritis.

Rating B: Fair evidence for manipulative therapy of the
knee and/or full kinetic chain combined with multimodal
or exercise therapy for Patellofemoral Pain Syndrome.
NGC: Summary of Clinical Practice
Recommendations

Rating B: Fair evidence for manipulative therapy of the
ankle and/or foot combined with multimodal or exercise
therapy for Ankle Inversion Sprain.
Myofascial trigger points and
myofascial pain syndrome
2. Fibromyalgia
3. Tendinopathy
1.

Vernon H, Schneider M. Chiropractic management of
myofascial trigger points and myofascial pain
syndrome: a systematic review of the literature.
J Manipulative Physiol Ther. 2009 Jan;32(1):14-24.

NGC: Chiropractic management of myofascial trigger
points and myofascial pain syndrome: Summary of
Clinical Practice Recommendations from CCGPP
NGC: Summary of Clinical Practice Recommendations
Conclusion and strength of evidence rating:
Conservative non-manipulation
Rating A: laser therapies. There is strong evidence that
laser therapy (various types of lasers) is effective in the
treatment of MTrPs and MPS.
NGC: Summary of Clinical Practice Recommendations
Rating B: TENS, magnets, and acupuncture.
There is moderately
strong evidence that TENS is effective in the short-term relief of
pain at MTrPs. There is moderately strong evidence that magnet
therapy is effective in the relief of pain at MTrP and in MPS. There is
moderately strong evidence that a course of deep acupuncture to
MTrPs is effective in the treatment of MTrPs and MPS for up to 3
mo.
Conclusion and strength of evidence rating: Manipulation/
mobilization
Rating
B: short-term relief. There is moderately strong evidence to
support the use of some manual therapies (manipulation, ischemic
pressure) in providing immediate relief of pain at MTrPs.
Rating
C: long-term relief. There is limited evidence to support the
use of some manual therapies in providing long-term relief of pain at
MTrPs.

Schneider M, Vernon H, Ko G, Lawson G, Perera J.
Chiropractic management of fibromyalgia syndrome: a
systematic review of the literature. J Manipulative
Physiol Ther. 2009 Jan;32(1):25-40.

NGC: Chiropractic management of fibromyalgia
syndrome: Summary of Clinical Practice
Recommendations from the Commission of the Council
on Chiropractic Guidelines and Practice Parameters
NGC: Summary of Clinical Practice Recommendations

Strong evidence supports aerobic exercise and cognitive
behavioral therapy.

Moderate evidence supports massage, muscle strength
training, acupuncture, and spa therapy (balneotherapy).

Limited evidence supports spinal manipulation,
movement/body awareness, and vitamins, herbs, and
dietary modification.
NGC: Summary of Clinical Practice Recommendations
Conclusions: Presently there is no single therapy or intervention that can be
considered a cure for FMS.
Combinations of therapies appear to be most helpful, and future research
seems to be looking toward strategies by which to find sub-groups of FMS
patients who might respond better to certain therapies.

Current literature (since 2006) provide evidence that FMS is
not a peripheral disorder of the soft tissues, but rather a
disorder of aberrant pain processing and central
sensitization.

Pfefer MT, Cooper SR, Uhl NL. Chiropractic Management
of tendinopathy: a literature synthesis.J Manipulative
Physiol Ther. 2009 Jan;32(1):41-52.

NGC: Chiropractic management of tendinopathy:
Summary of Clinical Practice Recommendations from the
Commission of the Council on Chiropractic Guidelines and
Practice Parameters
NGC: Summary of Clinical Practice Recommendations

Rating A: nothing

Rating B: Ultasound, Eccentric exercise

Rating C: Manipulation/mobilization, friction
massage, acupuncture, surgery, topical
NSAIDs.
BEST PRACTICES: CHIROPRACTIC MANAGEMENT OF
PREVENTION AND HEALTH PROMOTION;
NONMUSCULOSKELETAL CONDITIONS; AND CONDITIONS
OF
THE ELDERLY, CHILDREN AND PREGNANT WOMEN
Team Lead
Cheryl Hawk, DC, PhD, CHES
Vice President of Research and Scholarship
Cleveland Chiropractic College
Kansas City and Los Angeles
1.
Chiropractic Care for Non-musculoskeletal
Conditions
2.
Wellness, Health Promotion and Disease
Prevention
3.
Special Populations: Children
4.
Special Populations: Pregnant Women
5.
Special Populations: Older Adults

Rating C: Asthma, infantile colic, Otitis media,
cervicogenic vertigo, dysmenorrhea

Rating I: other non-musculoskeletal conditions

Rating A: Counseling tobacco
users to quit

Rating A: Counseling sedentary patients to
engage in physical activity

Rating I: Spinal manipulation for health
promotion
“Council on Chiropractic Guidelines and Practice
Parameters (CCGPP)”
Step 4:
Fighting Back
“Proper Use of Guideline”

All guidelines serve merely as background information to
assist doctors in the clinical decision-making process.

A guideline serves as a “compass” for care, not a cookbook
for care.

Guidelines should never be used punitively, or as
prescriptions for care.

Each patient is unique and treatment recommendations
must be based on the specific factors pertaining to the
individual case.

Guidelines are only one piece of evidence to consider when
considering the medical necessity of care. Other pieces of
evidence include:
1. research,
2. clinical experience/decision-making,
3. patient values,
4. risk stratification,
5. process of care,
6. response to care,
7. documentation, etc.
Guidelines are not cookbooks with rigid dosages for treatment.

Most, if not all, guidelines like Mercy, ACOEM, ODG,
Milliman and Roberston, etc., are based upon the acute, noncomplicated patient.

Each case is unique and may present with many
complications that should be reported and considered to
help clarify why treatment may have extended beyond the
natural healing time, or expected recovery time, compared
to a non-complicated, mild, acute case.

Any reviewer/consultant who recommends a denial based
upon his/her belief that a guideline was exceeded should
volunteer his/her rationale, and/or be challenged to produce
the page, paragraph, and sentence in the guideline being
referenced indicating were the POR/DC exceeded the
guideline.

Additionally, exceeding the guideline is NOT the issue in
chronic pain management.

“Why were expected treatment parameters exceeded” IS
the question.

Reviewer: Must consider complicating factors, versus the
generic “treating non-allowed conditions”.

Pain versus Pathology

Numerous studies suggest that one CANNOT accurately rely
upon diagnostic tests to determine the presence or absence
of pain.

Therefore, how can a consultant viewing nothing more than
a radiology report conclude that pain is generated from nonallowed diagnoses?




State the reason for the appeal
Stick to the facts
Avoid emotion/Keep it professional!
Do not attached the reviewer, but do attack
his/her inaccurate statements.
1. “I wish to file an appeal to the denial for the following
reasons:”
2. “Consulted stated…..”
3. “Response:……”
4. End with a brief case summary

We need funding, from both the field doctors
and corporate sponsors, in order to fund the
Clinical Compass, the Rapid Response Team
and future research projects.

Our mission is to generate a pool of funds
which can be granted to the colleges to fund
research projects and “fill in the gaps” which
have been identified through the CCGPP
process thus far.

Many thanks to our corporate supporters:
 ChiroCode Institute, Lamont Leavitt, and late D.
Henry Leavitt
 Core Products and President Philip Mattison who
recently committed up to $10,000 in the form of a
matching donation. He will donate $1 for every
dollar donated by the profession, up to $10,000!
Core Products will provide a free pillow per $100 donated
to the CCGPP. This “product rebate” will be capped at a
total of 500 pillows and will equate to a potential of
$50,000 raised by the profession. Doctors pay only freight
on pillows earned.
Core Products will provide a 10% discount on ALL
products available through the Core Website for anyone
who signs up for a recurring $84/mo for 12 month
“membership” to CCGPP.

ACA:

“The profession and ACA are is indebted to CCGPP for its
invaluable assistance in gathering the information we have
needed to approach insurance companies and regulators to
effectively advocate for the profession. In our work with
insurers, in this time when there is an increased focus on
quality care based upon evidence, we find that the message
we share must be undergirded by research. It is the
yardstick used to drive policy change, so to facilitate
change that results in favorable adjudication, we must
wield the sword of evidence skillfully.”

ACA:

“The responses from CCGPP have shown that the
profession is ready to boldly defend itself with the evidence
and are framed in a tone that encourages collaborative
dialog. In addition, the resources provided have not only
assisted our current battles, but have gone on to prove
helpful in many other similar situations. As for service, we
have found CCGPP to exceed our expectations with regard
to timely response, comprehensiveness of the objective
data, and professionalism of reporting. CCGPP is playing a
vital role in helping the chiropractic profession and we hope
it will for a very long time to come.”
Is now a positive
chiropractic information
website!

Special thanks to Dr. Rob Sheely and the ACA
Addendum Resources
Topic:
Background and Methodology

What constitutes evidence for best practice?
 Triano JJ.
J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):637-43.

Literature syntheses for the Council on Chiropractic
Guidelines and Practice Parameters: methodology.
 Triano JJ.
J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):645-50.
Topic:
Low back and leg complaints

Chiropractic management of low back pain and low back-related leg
complaints: a literature synthesis.


Lawrence DJ, Meeker W, Branson R, Bronfort G, Cates JR, Haas M, Haneline
M, Micozzi M, Updyke W, Mootz R, Triano JJ, Hawk C.
J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):659-74.
Chiropractic management of low back disorders: report from a
consensus process.

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on
Chiropractic Guidelines and Practice Parameter.
J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8.
Topic:
Lower Extremity Conditions
• Manipulative therapy for lower extremity conditions:
expansion of literature review.
Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C,
Hoskins W. J Manipulative Physiol Ther. 2009 Jan;32(1):53-71.
• Manipulative therapy of lower extremity conditions:
Summary of Clinical Practice
Recommendations from the Commission of the Council on
Chiropractic Guidelines and Practice Parameters
Topic:
Tendinopathy
Chiropractic management of tendinopathy: a literature
synthesis.
Pfefer MT, Cooper SR, Uhl NL. J Manipulative Physiol
Ther. 2009 Jan;32(1):41-52.
Chiropractic management of tendinopathy: Summary of
Clinical Practice
Recommendations from the Commission of the Council on
Chiropractic Guidelines and Practice Parameters
Topic:
Fibromyalgia
Chiropractic management of fibromyalgia syndrome: a
systematic review of the literature.
Schneider M, Vernon H, Ko G, Lawson G, Perera J. J
Manipulative Physiol Ther. 2009 Jan;32(1):25-40.
Chiropractic management of fibromyalgia syndrome:
Summary of Clinical Practice
Recommendations from the Commission of the Council on
Chiropractic Guidelines and Practice Parameters
Topic:
Myofascial trigger points and myofascial
pain syndrome
Chiropractic management of myofascial trigger points and
myofascial pain syndrome: a systematic review of the
literature.
Vernon H, Schneider M J Manipulative Physiol Ther. 2009
Jan;32(1):14-24.
Chiropractic management of myofascial trigger points and
myofascial pain syndrome: Summary of Clinical Practice
Recommendations from the Commission of the Council on
Chiropractic Guidelines and Practice Parameters
Topic:
Nonmusculoskeletal conditions/Wellness
Chiropractic care for nonmusculoskeletal conditions: a
systematic review with implications for whole systems
research.
Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW.
J Altern Complement Med. 2007 Jun;13(5):491-512.

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