The following ratings and categories were utilized in the original 1998 version of the CCP Guidelines and were also utilized in the updating and revision of the 2003 CCP Guidelines:
Established. Accepted as appropriate for use in chiropractic practice for the indications and applications stated.
Investigational. Further study is warranted. Evidence is equivocal, or insufficient to justify a rating of “established.”
Inappropriate. Insufficient favorable evidence exists to support the use of this procedure in chiropractic practice.
Categories of Evidence
E: Expert opinion based on clinical experience, basic science rationale, and/or individual case studies. Where appropriate, this category includes legal opinions.
L: Literature support in the form of reliability and validity studies, observational studies, “pre-post” studies, and/or multiple case studies. Where appropriate, this category includes case law.
C: Controlled studies, including randomized and non-randomized clinical trials of acceptable quality.
Review, Updating and Revision of the 1998 Guidelines
Since the guidelines process is one of continuing evolution, the Council on Chiropractic Practice did not endeavor to develop a set of guidelines and then cease to function. It was decided early in the process that the Council would continue to exist and that new evidence would be considered at periodic intervals to update the model of care defined by the guidelines. It was the decision of the Council on Chiropractic Practice to keep to the five-year recommendation of the National Guideline Clearinghouse for updating and revision. In the spring of 2001 during the Council on Chiropractic Practice’s annual meeting, the Council began the process of updating the 1998 guidelines. One of the first steps was a meeting of technique developers and experts that occurred as part of the same CCP meeting. Additional technique systems that were not involved in the development of the
_________________________________________________________ 22 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision