James M Whedon1, Yunjie Song2, Todd A Mackenzie3, Reed B Phillips4, Timothy G Lukovits5, Jon D Lurie3. 1. Instructor, The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Grantham, NH. Electronic address: james.m.whedon@hitchcock.org. 2. Research Associate, The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Grantham, NH. 3. Associate Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Grantham, NH. 4. President Emeritus, Southern California University of Health Sciences, Whittier, CA. 5. Associate Professor of Neurology, Geisel School of Medicine, Dartmouth College, Grantham, NH.
Abstract
OBJECTIVE: The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain. METHODS: This is a retrospective cohort analysis of a 100% sample of annualized Medicare claims data on 1 157 475 beneficiaries aged 66 to 99 years with an office visit to either a chiropractor or primary care physician for neck pain. We compared hazard of vertebrobasilar stroke and any stroke at 7 and 30 days after office visit using a Cox proportional hazards model. We used direct adjusted survival curves to estimate cumulative probability of stroke up to 30 days for the 2 cohorts. RESULTS: The proportion of subjects with stroke of any type in the chiropractic cohort was 1.2 per 1000 at 7 days and 5.1 per 1000 at 30 days. In the primary care cohort, the proportion of subjects with stroke of any type was 1.4 per 1000 at 7 days and 2.8 per 1000 at 30 days. In the chiropractic cohort, the adjusted risk of stroke was significantly lower at 7 days as compared to the primary care cohort (hazard ratio, 0.39; 95% confidence interval, 0.33-0.45), but at 30 days, a slight elevation in risk was observed for the chiropractic cohort (hazard ratio, 1.10; 95% confidence interval, 1.01-1.19). CONCLUSIONS: Among Medicare B beneficiaries aged 66 to 99 years with neck pain, incidence of vertebrobasilar stroke was extremely low. Small differences in risk between patients who saw a chiropractor and those who saw a primary care physician are probably not clinically significant.
OBJECTIVE: The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain. METHODS: This is a retrospective cohort analysis of a 100% sample of annualized Medicare claims data on 1 157 475 beneficiaries aged 66 to 99 years with an office visit to either a chiropractor or primary care physician for neck pain. We compared hazard of vertebrobasilar stroke and any stroke at 7 and 30 days after office visit using a Cox proportional hazards model. We used direct adjusted survival curves to estimate cumulative probability of stroke up to 30 days for the 2 cohorts. RESULTS: The proportion of subjects with stroke of any type in the chiropractic cohort was 1.2 per 1000 at 7 days and 5.1 per 1000 at 30 days. In the primary care cohort, the proportion of subjects with stroke of any type was 1.4 per 1000 at 7 days and 2.8 per 1000 at 30 days. In the chiropractic cohort, the adjusted risk of stroke was significantly lower at 7 days as compared to the primary care cohort (hazard ratio, 0.39; 95% confidence interval, 0.33-0.45), but at 30 days, a slight elevation in risk was observed for the chiropractic cohort (hazard ratio, 1.10; 95% confidence interval, 1.01-1.19). CONCLUSIONS: Among Medicare B beneficiaries aged 66 to 99 years with neck pain, incidence of vertebrobasilar stroke was extremely low. Small differences in risk between patients who saw a chiropractor and those who saw a primary care physician are probably not clinically significant.
Authors: Donald R Murphy; Michael J Schneider; Stephen M Perle; Christopher G Bise; Michael Timko; Mitchell Haas Journal: Chiropr Man Therap Date: 2016-11-05
Authors: P M Wayne; C Bernstein; M Kowalski; J P Connor; K Osypiuk; C R Long; R Vining; E Macklin; P M Rist Journal: Contemp Clin Trials Commun Date: 2020-01-22
Authors: Cheryl Hawk; Wayne Whalen; Ronald J Farabaugh; Clinton J Daniels; Amy L Minkalis; David N Taylor; Derek Anderson; Kristian Anderson; Louis S Crivelli; Morgan Cark; Elizabeth Barlow; David Paris; Richard Sarnat; John Weeks Journal: J Altern Complement Med Date: 2020-07-30 Impact factor: 2.579