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The guidelines reflect the consensus of the panel, which gave final approval to the recommendations.

Rationale and Importance of the Guideline

These guidelines for vertebral subluxation were developed because the Council and its constituents recognized the need for guidelines that deal specifically with the vertebral subluxation and its management. Other guidelines have been developed that address a myriad of conditions and symptoms reported to be amenable to chiropractic intervention and/or spinal manipulation.60-62 These other guidelines blur the boundaries regarding care for the amelioration of various pain syndromes and at the same time blur the boundaries regarding the interventions used to affect a response. In addition, none of these guidelines have been updated since its original dissemination and one of them, the Mercy Guidelines, is approaching a decade since publication.

One of the rationales for the development of a guideline specifically addressing the clinical entity of vertebral subluxation is to bring clarity to the issue of what entities, conditions, disorders, or symptoms chiropractors deal with and the procedures they use. Clarity is considered an attribute of good practice guidelines by the Institute of Medicine.63 An example of the clarity portrayed in the CCP Guides would be the distinction between the terms adjustment and manipulation. While a manipulation may be used by a host of health care providers to affect joint function, only the chiropractor uses the adjustment to reduce or correct vertebral subluxation. The CCP guides do not address the use of a chiropractic adjustment for any other clinical situation.

The importance of this distinction cannot be overemphasized since the profession of chiropractic entails many types of providers and the profession enjoys a broad scope in most if not all jurisdictions. Because of this latitude in scope of practice there are differing styles of practice based on the extent of the implementation of procedures and management by individual chiropractors. Some practitioners choose to practice at the extreme limits of their practice scope. This means that chiropractors in Oregon, for example, may choose to diagnose and treat gynecological problems because their scope allows for it and they desire to do so, or they may elect to strictly limit their practice to the detection and correction of vertebral subluxation.

It is the opinion of the Council that it would be prudent for those interested in the applications of gynecological diagnosis and management for example, to consult guidelines that address these issues as opposed to expecting that chiropractic guidelines address all conditions and disorders that a particular scope allows.


_________________________________________________________ Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision

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