Temporal Trends and Geographic Variations in the Supply of Clinicians Who Provide Spinal Manipulation to Medicare Beneficiaries: A Serial Cross-Sectional Study

Whedon, James M.; Haldeman, Scott; Petersen, Curtis L.; Schoellkopf, William J.; MacKenzie, Todd A.; Lurie, Jon D.

doi:10.1016/j.jmpt.2021.02.002

Cited by 18 publications

(17 citation statements)

References 23 publications

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“…The CPT codes 98940, 98941 and 98 942 for CSMT were included in the ‘CSMT’ cohort and excluded in the ‘other care’ cohort. These 9894* codes are almost exclusively used by chiropractors in the USA 45. Patients in the CSMT cohort were required to receive CSMT on the date of index date of diagnosis of LDH or LSR (ie, the first instance of the diagnosis in the medical record), while those in the cohort receiving other care could not receive CSMT on the index date of diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data

et al. 2022

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ObjectivesChiropractic spinal manipulative therapy (CSMT) and lumbar discectomy are both used for lumbar disc herniation (LDH) and lumbosacral radiculopathy (LSR); however, limited research has examined the relationship between these therapies. We hypothesised that adults receiving CSMT for newly diagnosed LDH or LSR would have reduced odds of lumbar discectomy over 1-year and 2-year follow-up compared with those receiving other care.DesignRetrospective cohort study.Setting101 million patient US health records network (TriNetX), queried on 24 October 2022, yielding data from 2012 query.ParticipantsAdults age 18–49 with newly diagnosed LDH/LSR (first date of diagnosis) were included. Exclusions were prior lumbar surgery, absolute indications for surgery, trauma, spondylolisthesis and scoliosis. Propensity score matching controlled for variables associated with the likelihood of discectomy (eg, demographics, medications).InterventionsPatients were divided into cohorts according to receipt of CSMT.Primary and secondary outcome measuresORs for lumbar discectomy; calculated by dividing odds in the CSMT cohort by odds in the cohort receiving other care.ResultsAfter matching, there were 5785 patients per cohort (mean age 36.9±8.2). The ORs (95% CI) for discectomy were significantly reduced in the CSMT cohort compared with the cohort receiving other care over 1-year (0.69 (0.52 to 0.90), p=0.006) and 2-year follow-up (0.77 (0.60 to 0.99), p=0.040). E-value sensitivity analysis estimated the strength in terms of risk ratio an unmeasured confounding variable would need to account for study results, yielding point estimates for each follow-up (1 year: 2.26; 2 years: 1.92), which no variables in the literature reached.ConclusionsOur findings suggest receiving CSMT compared with other care for newly diagnosed LDH/LSR is associated with significantly reduced odds of discectomy over 2-year follow-up. Given socioeconomic variables were unavailable and an observational design precludes inferring causality, the efficacy of CSMT for LDH/LSR should be examined via randomised controlled trial to eliminate residual confounding.

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Section: Methodsmentioning

confidence: 99%

Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data

et al. 2022

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“…It has been established in a Medicare population that chiropractors administer 97% to 98% of all SMT services in the United States. 33 There is a high likelihood this finding would translate to other patient populations. Without additional clinical information, the distinction between high vs low value care cannot be determined.…”

Section: Limitationsmentioning

confidence: 97%

Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims

Anderson

McClellan²

2021

Journal of Manipulative and Physiological Therapeutics

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“…These codes are relatively specific to the chiropractic profession in the USA. 37 The non-CSMT cohort was considered an active-comparator as these patients were actively engaged in the healthcare system for evaluation and/or treatment of rLBP. 56…”

Section: Eligibility Criteria Inclusionsmentioning

confidence: 99%

Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA

et al. 2022

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ObjectivesAlthough chiropractic spinal manipulative therapy (CSMT) and prescription benzodiazepines are common treatments for radicular low back pain (rLBP), no research has examined the relationship between these interventions. We hypothesise that utilisation of CSMT for newly diagnosed rLBP is associated with reduced odds of benzodiazepine prescription through 12 months’ follow-up.DesignRetrospective cohort study.SettingNational, multicentre 73-million-patient electronic health records-based network (TriNetX) in the USA, queried on 30 July 2021, yielding data from 2003 to the date of query.ParticipantsAdults aged 18–49 with an index diagnosis of rLBP were included. Serious aetiologies of low back pain, structural deformities, alternative neurological lesions and absolute benzodiazepine contraindications were excluded. Patients were assigned to cohorts according to CSMT receipt or absence. Propensity score matching was used to control for covariates that could influence the likelihood of benzodiazepine utilisation.Outcome measuresThe number, percentage and OR of patients receiving a benzodiazepine prescription over 3, 6 and 12 months’ follow-up prematching and postmatching.ResultsAfter matching, there were 9206 patients (mean (SD) age, 37.6 (8.3) years, 54% male) per cohort. Odds of receiving a benzodiazepine prescription were significantly lower in the CSMT cohort over all follow-up windows prematching and postmatching (p<0.0001). After matching, the OR (95% CI) of benzodiazepine prescription at 3 months was 0.56 (0.50 to 0.64), at 6 months 0.61 (0.55 to 0.68) and 12 months 0.67 (0.62 to 0.74). Sensitivity analysis suggested a patient preference to avoid prescription medications did not explain the study findings.ConclusionsThese findings suggest that receiving CSMT for newly diagnosed rLBP is associated with reduced odds of receiving a benzodiazepine prescription during follow-up. These results provide real-world evidence of practice guideline-concordance among patients entering this care pathway. Benzodiazepine prescription for rLBP should be further examined in a randomised trial including patients receiving chiropractic or usual medical care, to reduce residual confounding.

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Temporal Trends and Geographic Variations in the Supply of Clinicians Who Provide Spinal Manipulation to Medicare Beneficiaries: A Serial Cross-Sectional Study

Cited by 18 publications

References 23 publications

Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data

Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data

Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims

Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA

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