Several years ago the Foundation for Vertebral Subluxation (FVS) embarked on an ambitious effort to develop a clinical practice guideline/best practices project that would search, gather, compile and review the scientific literature going as far back as January 1998.
This Chapter on the chiropractic care of children was peer reviewed and approved by 196 chiropractors from several countries and included chiropractors specializing in pediatric and maternal care such as Diplomates and others certified in such care.
The Best Practices document, developed through the Foundation's Best Practices Initiative (CLICK HERE for more on the Best Practices Initiative) includes a Recommendation statement as follows:
RECOMMENDATION
Rating: Established
Evidence: E, L
Since vertebral subluxation may affect individuals at any age, chiropractic care may be indicated at any time after birth. As with any age group, however, care must be taken to select adjustment methods most appropriate to the patient’s stage of development and overall spinal integrity. Parental education by the chiropractor concerning the importance of evaluating children for the presence of vertebral subluxation is encouraged as are public health initiatives geared toward screening of children for vertebral subluxation beginning at birth
Joel Alcantara DC, Ph.D (C) who is the Director of Research of the International Chiropractic Pediatric Association (ICPA) and part of the Foundation's research team is the lead author of the document with the rest of the team including:
Joel Alcantara, DC, Joey D. Alcantara, DC, Junjoe Alcantara, DC, Christopher Kent DC, JD, Matthew McCoy DC, MPH, Christie Kwon DC, MS, MPH, Anquonette Stiles DC, MPH, Jeanne Ohm DC, Veronica Gutierrez DC, Andrew Rupp DC, Shannon O’Brien DC, Anne Bishop DC, Stacey Rainey DC, Bethany Carilli DC, Hui Zhen Lim DC, Gabriel Hrebien BA, Justin Bedrosian DC, Suzzanne M. Candelaria-Perez BSc, DC, Christopher Long DC.
The document is dedicated to the memory of Jeanne Ohm DC who dedicated her life to pediatric and maternal chiropractic care and led the ICPA until her passing. Dr. Ohm was a very hands on participant in the evolution and development of the pediatric guideline from the very beginning.
The Foundation saw a crucial need to develop this project because other practice guidelines that included the management of vertebral subluxation were about to become outdated including the Council on Chiropractic Practice's (CCP) Vertebral Subluxation in Chiropractic Practice and the International Chiropractors Association's Best Practices document.
The Foundation's project covers twelve topic areas:
- History and chiropractic examination
- Instrumentation
- Radiographic and other imaging
- Clinical impression, assessment and recordkeeping
- Reassessment and outcomes assessment
- Modes of adjustive care
- Duration of care for correction of vertebral subluxation
- Chiropractic care for children
- Maternal chiropractic care
- Vertebral subluxation and well being
- Behavioral and mental health issues
- Patient safety, privacy and advocacy
The Foundation established a Guideline's Committee with experts in guidelines and best practices development, Project Managers, and a team of researchers who established the methodology and then search, gathered and organized the literature over a period of several years. Anquonette Stiles DC, MPH, a Fellow with the Foundation for Vertebral Subluxation, has been overseeing the project
The Project Manager developed training modules for the researchers responsible for searching and gathering the literature in order to establish continuity. This continuity is necessary for an ongoing best practices project that includes Fellowship students in order to develop the infrastructure for an ongoing best practices initiative.
Guidelines and best practices development within the subluxation focused faction of chiropractic has historically been hampered by a lack of interest, funding and talent since guideline development first came into being in the late 80's and early 1990's. Making the task even more challenging is the need to update best practices every five years. Reconvening committees, panels and training the next set of researchers to update the literature and recommendations only serves to delay or stop the process. This initiative creates an ongoing process with an ideally seamless team so that the related literature is updated regularly and then the recommendations can be updated as the evidence changes.
This initiative is currently housed at Sherman College of Chiropractic and is overseen and funded by the Foundation. One of the goals of the project is to train students and others in the development of best practices as the related attitudes, knowledge and skills for such endeavors is in short supply within the faction of the profession that manages vertebral subluxation.
The project involved establishing a database, reviewing the literature, establishing a writing team, developing draft documents of those reviews and circulating the reviews through the Guidelines Committee which developed recommendations based on the reviews. Once a draft document including recommendations is complete the document is released for peer review with those reviewers asked to provide comments and references. This is the process followed for each of the topic areas.
The Foundation is currently preparing the publication of its best practices document on maternal chiropractic care with documents on radiography and instrumentation also in development.
CLICK Here for more on that document
