Chiropractic Care

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

By Frank M. Painter|February 9, 2025|Chiropractic Care, Medicare|

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

SOURCE: J Manipulative Physiol Ther 2021 (Mar)

James M Whedon • Scott Haldeman • Curtis L Petersen • William Schoellkopf • Todd A MacKenzie • Jon D Lurie

Health Services Research,
Southern California University of Health Sciences,
Whittier, California.

FROM: Davis ~ J Am Board Fam Med. 2015 (Jul)

Objective: Spinal manipulation (SM) is recommended for first-line treatment of patients with low back pain. Inadequate access to SM may result in inequitable spine care for older US adults, but the supply of clinicians who provide SM under Medicare is uncertain. The purpose of this study was to measure temporal trends and geographic variations in the supply of clinicians who provide SM to Medicare beneficiaries.

Methods: Medicare is a US government-administered health insurance program that provides coverage primarily for older adults and people with disabilities. We used a serial cross-sectional design to examine Medicare administrative data from 2007 to 2015 for SM services identified by procedure code. We identified unique providers by National Provider Identifier and distinguished between chiropractors and other specialties by Physician Specialty Code. We calculated supply as the number of providers per 100,000 beneficiaries, stratified by geographic location and year.

Results: Of all clinicians who provide SM to Medicare beneficiaries, 97% to 98% are doctors of chiropractic. The geographic supply of doctors of chiropractic providing SM services in 2015 ranged from 20/100,000 in the District of Columbia to 260/100,000 in North Dakota. The supply of other specialists performing the same services ranged from fewer than 1/100,000 in 11 states to 8/100,000 in Colorado. Nationally, the number of Medicare-active chiropractors declined from 47 102 in 2007 to 45 543 in 2015. The count of other clinicians providing SM rose from 700 in 2007 to 1441 in 2015.

Conclusion: Chiropractors constitute the vast majority of clinicians who bill for SM services to Medicare beneficiaries. The supply of Medicare-active SM providers varies widely by state. The overall supply of SM providers under Medicare is declining, while the supply of nonchiropractors who provide SM is growing.

Keywords: Chiropractic; Manipulation, Spinal; Medicare; Musculoskeletal Manipulations.

From the FULL TEXT Article:

Introduction

Low back pain is highly prevalent in the United States, and management of it can be particularly challenging in the Medicare beneficiary population, which is older and has disabilities and frequently comorbidities. [1, 2]

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Comparative Effectiveness of Cervical vs Thoracic Spinal-thrust Manipulation for Care of Cervicogenic Headache: A Randomized Controlled Trial

By Frank M. Painter|December 26, 2024|Cervicogenic Headache, Chiropractic Care|

Comparative Effectiveness of Cervical vs Thoracic Spinal-thrust Manipulation for Care of Cervicogenic Headache: A Randomized Controlled Trial

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SOURCE: PLoS One 2024 (Mar 29); 19 (3): e0300737 ~ FULL TEXT

OPEN ACCESS

Gopal Nambi • Mshari Alghadier • Mudathir Mohamedahmed Eltayeb • Osama R Aldhafian. et al.

Department of Health and Rehabilitation Sciences,
College of Applied Medical Sciences,
Prince Sattam Bin Abdulaziz University,
Al-Kharj, Saudi Arabia.

Background: There is ample evidence supporting the use of different manipulative therapy techniques for cervicogenic headache (CgH). However, no technique can be singled as the best available treatment for patients with CgH. Therefore, the objective of the study is to find and compare the clinical effects of cervical spine over thoracic spine manipulation and conventional physiotherapy in patients with CgH.

Design, setting, and participants: It is a prospective, randomized controlled study conducted between July 2020 and January 2023 at the University hospital. N = 96 eligible patients with CgH were selected based on selection criteria and they were divided into cervical spine manipulation (CSM; n = 32), thoracic spine manipulation (TSM; n = 32) and conventional physiotherapy (CPT; n = 32) groups, and received the respective treatment for four weeks. Primary (CgH frequency) and secondary CgH pain intensity, CgH disability, neck pain frequency, neck pain intensity, neck pain threshold, cervical flexion rotation test (CFRT), neck disability index (NDI) and quality of life (QoL) scores were measured. The effects of treatment at various intervals were analyzed using a 3 × 4 linear mixed model analysis (LMM), with treatment group (cervical spine manipulation, thoracic spine manipulation, and conventional physiotherapy) and time intervals (baseline, 4 weeks, 8 weeks, and 6 months), and the statistical significance level was set at P < 0.05.

Results: The reports of the CSM, TSM and CPT groups were compared between the groups. Four weeks following treatment CSM group showed more significant changes in primary (CgH frequency) and secondary (CgH pain intensity, CgH disability, neck pain frequency, pain intensity, pain threshold, CFRT, NDI and QoL) than the TSM and CPT groups (p = 0.001). The same gradual improvement was seen in the CSM group when compared to TSM and CPT.

Conclusion: The reports of the current randomized clinical study found that CSM resulted in significantly better improvements in pain parameters (intensity, frequency and threshold) functional disability and quality of life in patients with CgH than thoracic spine manipulation and conventional physiotherapy.

Trial registration: Clinical trial registration: CTRI/2020/06/026092 trial was registered prospectively on 24/06/2020.

From the FULL TEXT Article:

Introduction

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Conservative Management of Cervicogenic Dizziness Associated With Upper Cervical Instability and Postural Orthostatic Tachycardia Syndrome: A Case Report

By Frank M. Painter|December 9, 2024|Cervicogenic Dizziness, Chiropractic Care, Evidence-based Practice|

Conservative Management of Cervicogenic Dizziness Associated With Upper Cervical Instability and Postural Orthostatic Tachycardia Syndrome: A Case Report

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SOURCE: Cureus 2024 (Oct 31); 16 (10): e72765

Robert J Trager • Andres Schuster • Cliff Tao • Gina Zamary

Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, USA.

OPEN ACCESS

Cervicogenic dizziness (CGD) is a disorder in which dizziness arises from cervical spine dysfunction and is diagnosed after excluding other conditions. We present a case of a 27–year-old woman with a six-year history of dizziness, neck and cervicothoracic pain, and occipital-temporal-orbital headaches. The patient also experienced occasional severe, incapacitating episodes of dizziness with vomiting. Previous evaluations, including advanced imaging, had helped rule out central, otolithic, and psychogenic causes of dizziness. Dynamic radiographs revealed signs of lateral instability of C1 while tilt table testing revealed postural orthostatic tachycardia syndrome (POTS). Over eight months, the patient underwent a regimen of gentle manual therapies and cervical stability exercises. The patient’s dizziness substantially improved, as measured by the Dizziness Handicap Inventory (DHI), with scores reducing from 50 (moderate handicap) to 10 (less than mild handicap). This case highlights the importance of considering cervical spine dysfunction and associated conditions like POTS in the differential diagnosis of chronic dizziness. While conservative management including manual therapy appeared effective in this case for CGD with underlying upper cervical instability and POTS, additional research is needed on this topic.

Keywords: case reports; cervical vertebrae; chiropractic; dizziness; headache; joint instability; neck pain; postural orthostatic tachycardia syndrome; rehabilitation.

From the FULL TEXT Article:

Introduction

Dizziness is a non-specific term used to describe various sensations, including lightheadedness, unsteadiness, or a spinning feeling. Its utility as a diagnostic term is limited due to its broad nature, necessitating a thorough assessment of the patient’s history and examination for an accurate diagnosis. [1] Dizziness is typically evaluated based on its timing, associated triggers, and symptom subtypes. For instance, benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, accounting for approximately 24% of cases, presents with brief episodes of rotatory dizziness triggered by head movements. [1, 2] Other subtypes of dizziness may arise from vestibular, vascular, or psychogenic sources, with less frequent causes including Meniere’s disease, vestibular neuritis, and others. [2]

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Association Between Spinal Manipulation, Butalbital Prescription, and Medication Overuse Headache in Adults With Tension-Type Headache: Retrospective Cohort Study

By Frank M. Painter|December 8, 2024|Chiropractic Care, Headache|

Association Between Spinal Manipulation, Butalbital Prescription, and Medication Overuse Headache in Adults With Tension-Type Headache: Retrospective Cohort Study

The Chiro.Org Blog

SOURCE: Health Science Reports 2024 (Nov 29); 7 (12): e70218

Robert J Trager • Timothy J Williamson • Pratheek S Makineni • Lindsay H Morris

Connor Whole Health University Hospitals
Cleveland Medical Center
Cleveland Ohio USA.

Background and aims: Butalbital is an acute headache medication commonly prescribed for tension-type headache (TTH), although discouraged by guidelines due to a risk of medication overuse headache (MOH). Considering spinal manipulative therapy (SMT) may reduce TTH frequency and intensity, we hypothesized adults with TTH receiving chiropractic SMT would be less likely to receive a butalbital prescription over 2 years versus matched controls not receiving SMT. We secondarily compared likelihood of MOH between cohorts.

Methods: We searched a United States medical records database of patients attending academic medical centers for adults with TTH, from 2013 to 2024, excluding those diagnosed with other headaches and seen in inpatient/emergency settings. We divided patients into two cohorts: (1) SMT and (2) non-SMT, using propensity matching to control for demographics and other variables associated with likelihood of butalbital prescription and MOH.

Results: Three thousand one hundred and sixteen patients remained per cohort after matching. The incidence of butalbital prescription was lower in the SMT cohort compared to the non-SMT cohort (SMT: 1.7%; non-SMT: 3.8%), yielding an RR (95% CI) of 0.46 (0.33-0.63; p < 0.001). The incidence of MOH was lower in the SMT cohort versus non-SMT cohort (SMT: 0.5%; non-SMT: 1.2%), yielding an RR (95% CI) of 0.44 (0.25-0.80; p < 0.001).

Conclusion: Adults receiving chiropractic SMT had a significantly lower likelihood of butalbital prescription and, tentatively, MOH compared to matched controls not receiving SMT. These findings support current guideline recommendations favoring SMT in TTH care, though future studies should replicate and compare these findings with other nonpharmacologic clinicians and interventions.

Keywords: barbiturates; chiropractic; headache; spinal manipulation.

From the FULL TEXT Article:

Background

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Postgraduate Training Opportunities for Chiropractors: A Description of United States Programs

By Frank M. Painter|October 27, 2024|Chiropractic Care, Chiropractic Education|

Postgraduate Training Opportunities for Chiropractors: A Description of United States Programs

The Chiro.Org Blog

SOURCE: J Chiropractic Education 2024 (Mar 4); 38 (1): 104–114Samuel M Schut

Chiropractic resident at the VA Connecticut Healthcare System
50 Campbell Ave,
West Haven, CT 06516

Samuel M Schut

Chiropractic resident at the VA Connecticut Healthcare System
50 Campbell Ave,
West Haven, CT 06516

Objective: The objective of this study was to describe and compare the current postgraduate training opportunities (PTOs) in the United States (US) for which doctors of chiropractic are eligible, namely, residencies, fellowships, and board certifications.

Methods: An internet search of publicly available English-language websites on Google.com was executed using a cache-cleared private browser and key search phrases. Following webpage data extraction, e-mail and telephone follow-up were completed with officials from institutions offering doctor of chiropractic programs possessing accreditation by the Council on Chiropractic Education (CCE) in the US. Additional programs identified were annotated and incorporated into the data set if they met the inclusion criteria. Descriptive statistics were generated following data aggregation.

Results: Three-hundred internet search results were screened, 70 of which were assessed for eligibility and 47 included for descriptive analysis. Among the 16 CCE-accredited institutions solicited, 13 returned correspondence (81.3% response rate), resulting in the addition of 2 programs to the data set ascertained by the initial web search. There were 49 PTOs for chiropractors. Of programs available, residencies represented 49.0% (24/49) of programs, and fellowships represented 12.2% (6/49) of programs. There were 19 board specialty diplomate programs, constituting 38.8% of PTOs.

Conclusion: This work details preliminary descriptive information on the current state of US-based PTOs for chiropractors.

Keywords: Chiropractic; Education; Fellowships and Scholarships; Internship and Residency.

From the FULL TEXT Article:

INTRODUCTION

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Effect of Chiropractic Care on Low Back Pain for Active-duty Military Members: Mediation Through Biopsychosocial Factors

By Frank M. Painter|October 16, 2024|Acute Low Back Pain, Chiropractic Care, Nonpharmacologic Therapies|

Effect of Chiropractic Care on Low Back Pain for Active-duty Military Members: Mediation Through Biopsychosocial Factors

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SOURCE: PLoS One 2024 (Oct 1); 19 (10): e0310642

Zacariah K. Shannon • Cynthia R. Long • Elizabeth A. Chrischilles • Christine M. Goertz • Robert B. Wallace • Carri Casteel • Ryan M. Carnahan

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA, USA.

FROM: Schneider, Spine 2015

This study evaluates biopsychosocial factors as mediators of the effect of chiropractic care on low back pain (LBP) intensity and interference for active-duty military members. Data from a multi-site, pragmatic clinical trial comparing six weeks of chiropractic care plus usual medical care to usual medical care alone for 750 US active-duty military members with LBP were analyzed using natural-effect, multiple-mediator modeling. Mediation of the adjusted mean effect difference on 12-week outcomes of PROMIS-29 pain interference and intensity by 6-week mediators of other PROMIS-29 physical, mental, and social health subdomains was evaluated. The effect difference on pain interference occurring through PROMIS-29 biopsychosocial factors (natural indirect effect = -1.59, 95% CI = -2.28 to -0.88) was 56% (95% CI = 35 to 96) of the total effect (-2.82, 95% CI = -3.98 to -1.53). The difference in effect on pain intensity occurring through biopsychosocial factors was smaller (natural indirect effect = -0.32, 95% CI = -0.50 to -0.18), equaling 26% (95% CI = 15 to 42) of the total effect (-1.23, 95% CI = -1.52 to -0.88). When considered individually, all physical, mental, and social health factors appeared to mediate the effect difference on pain interference and pain intensity with mental health factors having smaller effect estimates. In contrast with effects on pain interference, much of the effect of adding chiropractic care to usual medical care for US military members on pain intensity did not appear to occur through the PROMIS-29 biopsychosocial factors. Physical and social factors appear to be important intermediate measures for patients receiving chiropractic care for low back pain in military settings. Further study is needed to determine if the effect of chiropractic care on pain intensity for active-duty military occurs through other unmeasured factors, such as patient beliefs, or if the effect occurs directly.

Trial registration registered on clinical trials.gov (NCT01692275)

From the FULL TEXT Article:

Introduction