Clinical Compass

Clinical Compass The Clinical Compass (CCGPP) exists to translate existing knowledge into effective, evidence - based chiropractic practice.

The Clinical Compass is powered by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). Our mission is to gather and evaluate existing evidence-based practice information; to facilitate the development of new information where existing evidence is lacking; and to distribute and assist in implementation of evidence-based practice information that is relevant to the chiropractic profession.

What does the evidence actually tell us about spinal manipulative therapy in older adults?Older adults experience a sign...
08/31/2026

What does the evidence actually tell us about spinal manipulative therapy in older adults?

Older adults experience a significant burden from spine-related conditions, yet this population has historically been underrepresented in clinical research.

That's what makes this systematic review worth a closer look.

Researchers examined 7 randomized controlled trials involving 1,226 participants ages 55–94, evaluating spinal manipulative therapy (SMT) for:
• Chronic low back pain
• Chronic neck pain
• Lumbar spinal stenosis

Over the next several weeks, we'll break down what the review found—including where SMT demonstrated benefit, where the evidence was less clear, and what the findings may mean for clinicians treating older adults.

Because evidence-informed care isn't about asking whether a treatment simply "works."

It's about asking: For whom? For what condition? Compared to what? And with what level of certainty?

Follow along as we translate the research into meaningful clinical conversations. Check out the paper here: https://pubmed.ncbi.nlm.nih.gov/42238484/

Behind every paper are researchers asking important questions, analyzing the evidence, and helping move healthcare forwa...
08/28/2026

Behind every paper are researchers asking important questions, analyzing the evidence, and helping move healthcare forward.

As we close out this month's series, we'd like to recognize and thank Farabaugh et al. for their systematic review examining chiropractic care and healthcare utilization for spine-related musculoskeletal pain.

Their work gave us the opportunity to explore important conversations around cost, opioid utilization, imaging, downstream interventions, patient-centered care, and the role of conservative management within the broader healthcare system.

Research is what gives evidence-informed practice its foundation—and we are grateful to the authors who dedicate their time and expertise to advancing that evidence.

To the authors: thank you for your contribution to the literature and for helping move the conversation forward.

And thank you to everyone who followed along, asked questions, and joined the discussion this month.

Evidence. Education. Empowerment.

As we wrap up this month's featured paper, here's the one takeaway worth remembering:The initial management pathway may ...
08/26/2026

As we wrap up this month's featured paper, here's the one takeaway worth remembering:

The initial management pathway may influence everything that follows.

Farabaugh et al.'s systematic review highlights an important concept: the decisions made early in a patient's healthcare journey can shape downstream utilization, costs, and the overall care pathway.

But this isn't simply about reducing healthcare spending.

It's about delivering effective, patient-centered care while avoiding unnecessary escalation whenever appropriate.

High-value care doesn't mean doing less.

It means providing the right care, at the right time, for the right patient—guided by the best available evidence and informed through shared decision-making.

When high-quality care and high-value care align, patients, clinicians, and healthcare systems all benefit.

Thank you for following along with this month's Research Translation series. We hope it sparked new conversations, challenged assumptions, and encouraged reflection on how evidence can inform everyday clinical practice.

Every study has limitations.And that's exactly how science is supposed to work.Farabaugh et al.'s systematic review incl...
08/24/2026

Every study has limitations.

And that's exactly how science is supposed to work.

Farabaugh et al.'s systematic review included 44 studies, most of which were retrospective cohort studies using large healthcare databases.

That means these studies can identify associations, but they cannot establish cause and effect.

So why do these findings matter?

Because when a large body of evidence repeatedly points in the same direction, consistent patterns begin to emerge. Those patterns don't prove causation—but they do warrant thoughtful consideration and continued investigation.

Evidence-informed practice isn't about accepting every study at face value.

It's about critically evaluating the strengths, acknowledging the limitations, and integrating the best available evidence with clinical expertise and patient values.

That's how research moves practice forward.

💬 Discussion FridayWhen it comes to rising spine care costs, which downstream intervention do you think has the greatest...
08/21/2026

💬 Discussion Friday

When it comes to rising spine care costs, which downstream intervention do you think has the greatest impact?

⬜ Advanced imaging
⬜ Opioid prescriptions
⬜ Specialist referrals
⬜ Surgery
⬜ Emergency department utilization

There isn't always a single right answer. Each of these can play an important role in patient care when clinically appropriate—but unnecessary utilization can increase costs and expose patients to additional risks.

What's your perspective?

Cast your vote in the comments, and tell us why you chose your answer. We'd love to hear how you think healthcare systems can improve value while ensuring patients receive the right care at the right time.

Some of the most important conversations in healthcare begin with a simple question."Do I need an MRI?""Will I need surg...
08/20/2026

Some of the most important conversations in healthcare begin with a simple question.

"Do I need an MRI?"
"Will I need surgery?"
"Should I take medication?"

Patients deserve answers that are guided by the best available evidence—not fear, assumptions, or habit.

Evidence-informed care means helping patients understand their options, including conservative approaches that may be appropriate based on their clinical presentation and personal goals.

When patients are informed, they can actively participate in decisions about their care. That's the foundation of shared decision-making.

It's not about telling patients what to do—it's about ensuring they have the knowledge to make decisions that align with the evidence and their values.

Every conversation is an opportunity to build trust, improve understanding, and support better healthcare decisions.

The conversation around spine care isn't just about pain.It's also about public health.One of the strongest and most con...
08/19/2026

The conversation around spine care isn't just about pain.

It's also about public health.

One of the strongest and most consistent findings in Farabaugh et al.'s systematic review was lower opioid utilization among patients who initiated care with chiropractors. Across multiple studies, these patients were less likely to fill opioid prescriptions.

While this review cannot determine cause and effect, the consistency of these findings raises an important question:

How might the initial care pathway influence downstream treatment decisions?

In the midst of an ongoing opioid crisis, those questions matter.

Every healthcare decision has the potential to shape what comes next—not only for an individual patient, but across the healthcare system.

Research like this reminds us that spine care decisions extend beyond symptom management. They may also play an important role in supporting safer, evidence-informed care pathways.

MYTH: Lower-cost care means lower-quality care.FACT: High-value care isn't about doing less—it's about doing what's nece...
08/18/2026

MYTH: Lower-cost care means lower-quality care.

FACT: High-value care isn't about doing less—it's about doing what's necessary.

One of the most important findings from Farabaugh et al.'s systematic review is that lower downstream healthcare costs were often associated with fewer potentially unnecessary interventions, not less care.

That distinction matters.

Value-based care doesn't ask, "What's the cheapest option?"

It asks:
✔️ Is this intervention necessary?
✔️ Is it supported by the evidence?
✔️ Will it improve outcomes for this patient, at this time?

Sometimes the highest-quality care involves additional testing or referral. Other times, it's a careful examination, patient education, reassurance, and conservative management.

The goal is never less care. The goal is the right care, at the right time, for the right patient.

Advanced imaging has transformed healthcare.But more imaging isn't always better.For many episodes of spine pain, an MRI...
08/17/2026

Advanced imaging has transformed healthcare.

But more imaging isn't always better.

For many episodes of spine pain, an MRI or CT scan performed early in the course of care doesn't change treatment—and may not improve outcomes.

Farabaugh et al.'s systematic review found that patients who initiated care with chiropractors were less likely to undergo advanced imaging.

The takeaway isn't that imaging should be avoided. When clinically indicated, advanced imaging is an essential part of patient care.

The question is simply: Will this test change management today?

Sometimes, the highest-value care isn't ordering another scan—it's performing a thorough clinical evaluation, recognizing when imaging is (and isn't) indicated, and providing patients with evidence-informed reassurance.

High-value care means using the right test, for the right patient, at the right time.

Forty-four studies. One consistent message.Farabaugh et al.'s systematic review found that patients who received chiropr...
08/10/2026

Forty-four studies. One consistent message.

Farabaugh et al.'s systematic review found that patients who received chiropractic care were consistently associated with:

✔️ Lower overall healthcare costs
✔️ Lower opioid utilization
✔️ Fewer downstream interventions, including advanced imaging, injections, and surgery

These findings reinforce an important principle in healthcare: value isn't just about reducing costs—it's about delivering the right care at the right time while avoiding unnecessary escalation.

As healthcare continues to shift toward value-based care, evidence like this helps inform conversations about where conservative care fits within the broader healthcare system.

📖 Research should do more than sit on a shelf. It should guide better clinical decisions.

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