Practicing Chiropractors’ Committee on Radiology Protocols (PCCRP) announced today that the PCCRP Radiographic Guideline was accepted for inclusion at the National Guideline Clearinghouse (NGC). The NGC is a comprehensive database of evidence-based clinical practice guidelines that are accessible via the internet. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.
According to Dr. Deed Harrison (Chair of PCCRP), “The PCCRP guideline is the most comprehensive evaluation of the chiropractic and biomedical literature on the topic of the utilization of X-ray in a Chiropractic setting. PCCRP Contains a thorough review of the reliability, validity, clinical utility and risk-benefit ratio of numerous radiographic views, including all standard views and specialty Chiropractic views like the Nasium, Vertex, and Base Posterior.”
Also, according to Dr. Harrison, “The extent of evidence contained in the PCCRP (nearly 2000 references) robustly refutes the contention that radiography in the Chiropractic profession should be used for Red Flag conditions only (suspected tumor, infection, fracture, etc).”
Some of the key topics that are reviewed in the PCCRP Guideline include:
- Guidelines for the use of radiography in the assessment of subluxation of adults and children;
- Biomechanical definitions for 6 subluxation displacement categories with supporting evidence from the literature;
- Discussion of the risk benefit ratio associated with the use of radiography in Chiropractic practice, including the radiation hormesis vs. the linear no threshold (LNT) theory;
- Comprehensive reviews of the literature on the reliability and validity of measurement of the biomechanical component of the subluxation through line drawing mensuration, as well as the reproducibility of patient positioning for radiographic views;
- Evidence based foundation for video fluoroscopy and digital motion X-ray;
- Reviews and rates the evidence on post-treatment use of radiography, in addition to follow-up radiography to assess the effectiveness of the Chiropractic methods employed and the long-term stability of the improvements achieved;
- Legal issues of Chiropractic radiography usage as determined by the existing State Law.
The PCCRP serves as a clinical guide, specifically for Chiropractors, on the utilization of X-ray, versus adopting/supporting the guidelines written for the use of X-ray in a medical setting. It is anticipated that the PCCRP document will provide supporting evidence which may assist Chiropractors using methods that rely upon X-ray analysis to determine appropriate management and to assess the effectiveness of the care plan for a variety of patient populations.
Although, the PCCRP is officially a sub-committee of the International Chiropractors Association (ICA), the guideline committee members were a diverse group and included individuals such as Dr. Christopher Kent (one of the 5 Principle Investigators) and Dr. Dan Murphy. Of importance, the PCCRP was reviewed and endorsed by numerous Chiropractic political associations, organizations and leaders of Chiropractic Technique Methods:
International Chiropractors Association
World Chiropractic Alliance
Federation of Straight Chiropractors and Organizations (FSCO)
Council on Chiropractic Practice (CCP)
Norway Chiropractic Association,
Ukraine Chiropractic Association
State and Provincial Associations
Arizona Chiropractic Society
Chiropractic Awareness Council of Ontario
Chiropractic Diplomatic Corps
Chiropractic Fellowship of Pennsylvania
Connecticut Chiropractic Council
Massachusetts Chiropractic Society
Michigan Association of Chiropractors (MAC)
Nevada Chiropractic Association
Virginia Society of Chiropractic
Washington State Chiropractic Association
Wyoming Chiropractic Society
If you would like a copy of the PCCRP Guideline you will be able to access these at http://www.ngc.gov/ in the coming weeks or you can contact the ICA at www.chiropractic.org for a printed bound copy.
To learn more about PCCRP, the principle investigators, the esteemed committee members and the international panel of reviewers assembled to guide and facilitate the creation of the guidelines, please visit the PCCRP website at http://www.pccrp.org/.
The International Chiropractors Association (ICA) is very pleased to announce that the landmark 640-page ICA Best Practices and Practice Guidelines have now been accepted for inclusion in the National Guideline Clearinghouse (NGC). The National Guideline Clearinghouse is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.
This important recognition represents the culmination of a three-year effort, involving thousands of hours of study, research and analysis on the part of a team of several dozen doctors of chiropractic from around the world, chaired by Dr. Don Harrison. “We are very excited about the ICA Best Practices being accepted for inclusion by the National Guideline Clearinghouse,” said Dr. Harrison. “To see this ICA Guidelines reach this point is, indeed, historic. It was no simple feat to produce these guidelines. I feel this document and its future revisions will benefit thousands of chiropractors for generations to come, as well as enhance the quality of patient care for countless millions.”
According to the agency’s website, “The NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.” Over 1,400 clinical papers were reviewed by multiple analysts as a basis for the guidelines decisions made by the team, more than utilized by any other guidelines effort in chiropractic’s history.
All levels of evidence were included in an effort to gain a comprehensive and balanced foundation for the guidelines, from the randomized controlled trial to the individual case report. In addition, the draft document was available for review and comment on the Internet for nearly a full year, yielding hundreds of comments and recommendations from doctors of chiropractic worldwide.
The guidelines document and grade the clinical evidence of the efficacy of the chiropractic adjustment for 339 specific health challenges.
“The chiropractic profession owes a tremendous debt of gratitude to Dr. Don Harrison, Dr. Leonard Siskin, Dr. Deed Harrison, Dr. Joseph Betz, Dr. Dwight George, Dr. Stephanie Cheney, Dr. Eric Huntington and many others who devoted their selfless energy and meticulous attention over a period of many years to this project,” said ICA President Dr. Gary L. Walsemann.
The Guidelines text has been published in a limited hardback edition available by contacting ICA at 1-800-423-4690. The full text of the document will also be available on the NGC website in the coming months.
“The level of professionalism and objectivity that went into this process is astounding and reflects a commitment to excellence rare in any professional endeavor,” said Dr. Walsemann. “I believe we can clearly attribute this exceptionally high standard to the Guidelines Committee Chair, Dr. Don Harrison.”
Donald D. Harrison, DC, PhD, MSE, received his DC degree from Western States Chiropractic College in 1979. He received his MSE (Mechanical Engineering) in 1997 and his PhD (Mathematics) in 1998, both from the University of Alabama in Huntsville. He originated CBP Technique in 1980 and is the author of numerous textbooks and clinical manuals and more than 50 articles in peer-reviewed indexed journals. He has served on ICA’s Board of Directors and was ICA’s Chiropractor of the Year in 2006.