Christopher Kent

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

Good afternoon. My name is Christopher Kent. I’m a chiropractor and I’m president of the Council on Chiropractic Practice. The Council on Chiropractic Practice is a nonprofit apolitical organization, committed primarily to the development and distribution of clinical practice guidelines. The clinical practice approach that we elected to use was evidence based. An evidence based clinical practice is defined by Saket(?) as the use of the current best evidence in making decisions about the care of individual patients. It is not restricted to randomized trials and net analyses. It involves tracking down the best external evidence with which to answer our clinical questions. This concept was embraced by the Association of Chiropractic Colleges in their position paper, which states chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on subluxation. A subluxation is a complex of functional and/or structural and/or pathological auricular changes that compromise neural integrity and may influence organ system function and general health. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence. And, indeed, that was the challenge.

How can we acquire this evidence because much of it was not available on computer databases? Much of this evidence is not available in . . . journals. Some of it is privately published and some of it is simply passed on by word of mouth. So we used the following methodology. We began with a comprehensive computer and manual review of literature, using such databases as Index, Medicos, Mathis . . . etc. We had a technique forum, where we invited developers of chiropractic techniques to present oral evidence and any written support for their procedures, and the panel members had an opportunity to question these individuals. We then held an open forum because we found the practitioner acceptance of clinical practice guidelines was very poor unless they were actively involved in this practice. So to involve them in our process, we held an open forum where anyone who wished could present oral testimony, could present written evidence, and could interact with the panel.

The panel itself was multidisciplinary in character. It consisted primarily of chiropractors, but also included medical physicians, basic scientists, attorneys, and a consumer member. The important thing to remember in the guideline development process, in my opinion, is that it must be open. It must examine the best available clinical evidence, not placing itself in a sort of epistemological straightjacket by limited the work to randomized clinical trials. And it must be designed to empower the individual clinician by providing the best available information and not serve as a replacement for clinical judgment or a default to a cookbook type clinical approach. I’ve provided copies of the guidelines to the various panel members, as well as some resources, and thank you very much for your time.

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