Examining Vertebrobasilar Artery Stroke in Two Canadian Provinces

Boyle, Eleanor; Côté, Pierre; Grier, Alexander R.; Cassidy, J. David

doi:10.1097/brs.0b013e31816454e0

Cited by 41 publications

(16 citation statements)

References 4 publications

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“…However, patients presenting to a hospital with symptoms of stroke and a recent history of visiting a chiropractor may be subjected to a more aggressive workup for VBS, and consequent bias towards increased diagnosis of VBS. 7 Therefore, because diagnostic misclassification in the chiropractic cohort is more likely to result in more claims for VBS rather than fewer, we are confident that our results do not significantly underestimate the risk of VBS stroke in this study population. The results for the chiropractic cohort reflect the risk of stroke following chiropractic spinal manipulation, not that following all clinical encounters with chiropractors, who routinely screen patients for contraindications to spinal manipulation and withhold manipulation from those perceived as being at risk.…”

Section: Discussionmentioning

confidence: 60%

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Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

Whedon

Song

MacKenzie

et al. 2015

Journal of Manipulative and Physiological Therapeutics

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Objective The purpose of this study was to quantify risk of stroke following chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66–99 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 66–99 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 following 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 two cohorts. Results The proportion of subjects with stroke of any type in the chiropractic cohort was 1.2 per 1,000 at 7 days, and 5.1 per 1,000 at 30 days. In the primary care cohort, the proportion of subjects with stroke of any type was 1.4 per 1,000 at 7 days, and 2.8 per 1,000 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% CI 0.33–0.45), but at 30 days, a slight elevation in risk was observed for the chiropractic cohort (hazard ratio 1.10; 95% CI 1.01–1.19). Conclusions Among Medicare B beneficiaries aged 66–99 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.

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Section: Discussionmentioning

confidence: 60%

“…al., who found that marked increases in the rates of VBS in two Canadian provinces in 2000 were unassociated with increased utilization of chiropractic services. 7 …”

Section: Introductionmentioning

confidence: 99%

Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

Whedon

Song

MacKenzie

et al. 2015

Journal of Manipulative and Physiological Therapeutics

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“…Adverse events Seven systematic reviews [24,25,28,29,210-213] and seven primary studies [214-220] were identified specifically concerning adverse events of manual therapy. Mild-to-moderate adverse events of transient nature (e.g., worsening symptoms, increased pain, soreness, headache, dizziness, tiredness, nausea, vomiting) were relatively frequent.…”

Section: Resultsmentioning

confidence: 99%

Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report

et al. 2014

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BackgroundThis systematic review updated and extended the "UK evidence report" by Bronfort et al. (Chiropr Osteopath 18:3, 2010) with respect to conditions/interventions that received an 'inconclusive’ or 'negative’ evidence rating or were not covered in the report.MethodsA literature search of more than 10 general medical and specialised databases was conducted in August 2011 and updated in March 2013. Systematic reviews, primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included. Study quality was assessed using standardised instruments, studies were summarised, and the results were compared against the evidence ratings of Bronfort. These were either confirmed, updated, or new categories not assessed by Bronfort were added.Results25,539 records were found; 178 new and additional studies were identified, of which 72 were systematic reviews, 96 were randomised controlled trials, and 10 were non-randomised primary studies. Most 'inconclusive’ or 'moderate’ evidence ratings of the UK evidence report were confirmed. Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases (manipulation/mobilisation [with exercise] for rotator cuff disorder; spinal mobilisation for cervicogenic headache; and mobilisation for miscellaneous headache). In addition, evidence was identified on a large number of non-musculoskeletal conditions not previously considered; most of this evidence was rated as inconclusive.ConclusionsOverall, there was limited high quality evidence for the effectiveness of manual therapy. Most reviewed evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity. Areas requiring further research are highlighted.

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“…Despite some respondent's concerns, current evidence also suggests that chiropractic care is not causally related to serious adverse events, specifically vertebrobasilar artery stroke [15,16]; however, efforts are currently underway to better establish the risks associated with spinal manipulation [17]. Diversity within the chiropractic profession has been previously reported [18,19], and some practitioners have concluded that "for every chiropractor there is an equal and opposite chiropractor" [20].…”

Section: Resultsmentioning

confidence: 99%

Attitudes towards chiropractic: an analysis of written comments from a survey of north american orthopaedic surgeons

et al. 2011

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BackgroundThere is increasing interest by chiropractors in North America regarding integration into mainstream healthcare; however, there is limited information about attitudes towards the profession among conventional healthcare providers, including orthopaedic surgeons.MethodsWe administered a 43-item cross-sectional survey to 1000 Canadian and American orthopaedic surgeons that inquired about demographic variables and their attitudes towards chiropractic. Our survey included an option for respondants to include written comments, and our present analysis is restricted to these comments. Two reviewers, independantly and in duplicate, coded all written comments using thematic analysis.Results487 surgeons completed the survey (response rate 49%), and 174 provided written comments. Our analysis revealed 8 themes and 24 sub-themes represented in surgeons' comments. Reported themes were: variability amongst chiropractors (n = 55); concerns with chiropractic treatment (n = 54); areas where chiropractic is perceived as effective (n = 43); unethical behavior (n = 43); patient interaction (n = 36); the scientific basis of chiropractic (n = 26); personal experiences with chiropractic (n = 21); and chiropractic training (n = 18). Common sub-themes endorsed by surgeon's were diversity within the chiropractic profession as a barrier to increased interprofessional collaboration, endorsement for chiropractic treatment of musculoskeletal complaints, criticism for treatment of non-musculoskeletal complaints, and concern over whether chiropractic care was evidence-based.ConclusionsOur analysis identified a number of issues that will have to be considered by the chiropractic profession as part of its efforts to further integrate chiropractic into mainstream healthcare.

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Examining Vertebrobasilar Artery Stroke in Two Canadian Provinces

Cited by 41 publications

References 4 publications

Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report

Attitudes towards chiropractic: an analysis of written comments from a survey of north american orthopaedic surgeons

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