Older Patients, Stroke Risk and Manipulation
Study reinforces low risk, comparable to primary care.
By Editorial Staff
The first population-based study in the United States to evaluate stroke risk following spinal manipulation – and the first involving older adults – suggests that "[c]hiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain. For patients who saw a chiropractic physician, the adjusted probability of any type of stroke was lower than those who saw a primary care physician at days 1 through 24 after office visit, but higher at days 25 to 30, but these temporal associations are of doubtful clinical significance."1
JMPT Editor-in-Chief Claire Johnson, DC, MSEd, underscored the value of the study findings for chiropractic practitioners and the profession: "This new study offers additional information that will help practitioners inform older patients about the safety of chiropractic manipulation. Keeping in mind that there are different types of stroke and that we must always be alert for stroke signs, this study suggests older patients with neck pain can be reassured that manipulation is an unlikely cause of vertebrobasilar stroke."
Published as an open-access paper in the February 2015 issue of JMPT, the study reviewed Medicare administrative data on beneficiaries ages 66-99 with neck pain who utilized either chiropractic or primary (medical) care exclusively for one or more visits in 2007. Eligible beneficiaries had at least one allowed Medicare B claim that year for a chiropractic office visit with spinal manipulation or a primary care office visit for evaluation and management. Beneficiaries with one or more visits to both provider types were excluded.
The study authors pointed out that although Medicare does not require the manipulation site to be specified, the site must be related to the patient's complaint. Thus, all patients presenting with neck pain should have received cervical spine manipulation.
Select observations / recommendations made by the investigators appear as follows:
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