continued from page 21 4. Systematic reviews for older adults — efficacy and safety
Status: Manuscripts in revision (spinal manipulation efficacy and safety for older adults; submissions May 27 and July 28, 2025; revisions submitted September 17 and September 25, 2025)
Why it matters: Older adults represent a growing patient demographic with unique needs — frailty, polypharmacy, comorbidity, and different risk profiles. The twin reviews (efficacy and safety) represent an evidence-based push to answer two core questions simultaneously: does spinal manipulation help older adults, and is it safe when used in this population?
Implication for Washington clinics: If these manuscripts substantiate efficacy with acceptable safety profiles, they will be central to Medicare conversations, geriatric collaborations, and primary care integration strategies for seniors.
5. Older Adults Clinical Practice Guideline Status: Delphi round 1 pending
Why it matters: Moving beyond systematic reviews, the guideline will aim to translate evidence into specific clinical recommendations — force selection, dosing, comorbidity screening, and referral thresholds.
Implication for Washington clinics: A clinical practice guideline specifically for older adults will be an essential tool for charting appropriate care plans and communicating expected outcomes to patients and families.
6. Evidence-synthesis stakeholder priorities and consensus project
Status: Study in progress (Delphi round 1)
Why it matters: This stakeholder-informed effort will prioritize evidence synthesis topics that matter most to clinicians, payers, and patients — ensuring that research investments produce maximal clinical and policy return.
Implication for Washington clinics: Being attentive to these priorities will help clinicians leverage clinical questions into local research collaborations or quality improvement projects that attract funding or policy attention.
Publications & productivity: Translating work into citable evidence
Quantities matter — but so does venue. The quarter saw Clinical Compass–generated work and broader field productivity across respected journals, including Systematic Reviews, Neurological Sciences, Journal of Manipulative and Physiological Therapeutics,
22 www .ch ir oh ealth.or g
JOR Spine, Pain Medicine, and more. The Commission’s own letter on vertebral artery dissection reporting was published in Neurological Sciences, and a critical commentary on a recent migraine meta-analysis was accepted in Systematic Reviews.
Notable trends in the quarter’s publications include:
• Increased attention to safety reporting and the methodological rigor of case reports and series that attribute cerebrovascular events to spinal manipulation.
• Growth in observational and cohort studies that examine outcomes such as opioid use disorder and postoperative care — important areas for payer and regulatory interest.
• A broader multi-disciplinary footprint, with chiropractic investigators participating on multi-author efforts in spine surgery, pain medicine, and aging research.
For the practicing chiropractor, this represents both opportunity and obligation: opportunity to cite peer-reviewed evidence when advocating for coverage or interdisciplinary collaboration; obligation to keep clinical documentation in step with evidence- based recommendations so research findings can be operationalized in day-to-day care.
Evidence Center growth and rapid responses: Influencing policy in real time
One of the most consequential parts of the memo is the Evidence Center activity. Membership grew (annual membership change +30, +16.8% as of June 2025), and usage metrics indicate steady month-to-month increases. But numbers alone underestimate the real value: the Evidence Center supplied curated literature and testimony that directly influenced policy outcomes.
Two rapid-response examples are illustrative: Oregon — Headache Coverage
Clinical Compass provided articles and testimony related to the dosage of spinal manipulation for headaches. The Oregon Health Evidence Review Commission received Clinical Compass materials; the HERC later approved coverage of chiropractic services as a treatment for headaches. That is a concrete policy win where literature translated directly into coverage expansion for patients.
Oregon — Safety Testimony
Commission leadership presented to the Oregon HERC on the safety of chiropractic care regarding vertebral artery dissection and cervicogenic headache. The presentation was received well and helped shape the commission’s approach to evaluating coverage while preserving safe practice parameters. Other rapid-response engagements included assistance with state-level insurance limitations (Virginia, pediatric coverage), evidence for
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