Stroke

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

By Frank M. Painter|January 30, 2015|Chiropractic Care, Stroke|

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

SOURCE: J Manipulative Physiol Ther. 2015 (Feb); 38 (2): 93–101 ~ FULL TEXT

James M. Whedon, DC, MS, Yunjie Song, PhD, Todd A. Mackenzie, PhD,
Reed B. Phillips, DC, PhD, Timothy G. Lukovits, MD, Jon D. Lurie, MD, MS

The Dartmouth Institute for Health Policy & Clinical Practice,
Dartmouth College,
Grantham, NH.
james.m.whedon@hitchcock.org

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).

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Risk of Traumatic Injury Associated with Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66-99

By Frank M. Painter|December 12, 2014|Chiropractic Care, Stroke|

Risk of Traumatic Injury Associated with Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66-99

The Chiro.Org Blog

SOURCE: Spine (Phila Pa 1976). 2014 (Dec 9) [Epub ahead of print]

James M Whedon, DC, MS; Todd A Mackenzie, PhD;
Reed B Phillips, DC, PhD; Jon D Lurie, MD, MS

The Dartmouth Institute for Health Policy and Clinical Practice,
Lebanon, NH

Southern California University of Health Sciences,
Whittier, CA

Study Design. Retrospective cohort study

Objective. In older adults with a neuromusculoskeletal complaint, to evaluate risk of injury to the head, neck or trunk following an office visit for chiropractic spinal manipulation, as compared to office visit for evaluation by primary care physician

Summary of Background Data. The risk of physical injury due to spinal manipulation has not been rigorously evaluated for older adults, a population particularly vulnerable to traumatic injury in general.

Methods. We analyzed Medicare administrative data on Medicare B beneficiaries aged 66-99 with an office visit in 2007 for a neuromusculoskeletal complaint. Using a Cox proportional hazards model, we evaluated for adjusted risk of injury within 7 days, comparing two cohorts: those treated by chiropractic spinal manipulation vs. those evaluated by a primary care physician. We used direct adjusted survival curves to estimate the cumulative probability of injury. In the chiropractic cohort only, we used logistic regression to evaluate the effect of specific chronic conditions on likelihood of injury.

Results. The adjusted risk of injury in the chiropractic cohort was lower as compared to the primary care cohort (hazard ratio 0.24; 95% CI 0.23-0.25). The cumulative probability of injury in the chiropractic cohort was 40 injury incidents per 100,000 subjects, as compared to 153 incidents per 100,000 subjects in the primary care cohort. Among subjects who saw a chiropractic physician, the likelihood of injury was increased in those with a chronic coagulation defect, inflammatory spondylopathy, osteoporosis, aortic aneurysm and dissection, or long-term use of anticoagulant therapy.

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Changes in Vertebral Artery Blood Flow Following Various Head Positions and Cervical Spine Manipulation

By Frank M. Painter|January 25, 2014|Spinal Manipulation, Stroke, Vertebral Artery|

Changes in Vertebral Artery Blood Flow Following Various Head Positions and Cervical Spine Manipulation

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2014 (Jan); 37 (1): 22–31

Jairus J. Quesnele, DC, John J. Triano, DC, PhD,
Michael D. Noseworthy, PhD, Greg D. Wells, PhD

Chiropractor, Private Practice,
Division of Graduate Studies, Clinical Sciences,
Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada

OBJECTIVE: The objective of the study was to investigate the cerebrovascular hemodynamic response of cervical spine positions including rotation and cervical spine manipulation in vivo using magnetic resonance imaging technology on the vertebral artery (VA).

METHODS: This pilot study was conducted as a blinded examiner cohort with 4 randomized clinical tasks. Ten healthy male participants aged 24 to 30 years (mean, 26.8 years) volunteered to participate in the study. None of the participants had a history of disabling neck, arm, or headache pain within the last 6 months. They did not have any current or history of neurologic symptoms. In a neutral head position, physiologic measures of VA blood flow and velocity at the C1-2 spinal level were obtained using phase-contrast magnetic resonance imaging after 3 different head positions and a chiropractic upper cervical spinal manipulation. A total of 30 flow-encoded phase-contrast images were collected over the cardiac cycle, in each of the 4 conditions, and were used to provide a blood flow profile for one complete cardiac cycle. Differences between flow (in milliliters per second) and velocity (in centimeters per second) variables were evaluated using repeated-measures analysis of variance.

RESULTS: The side-to-side difference between ipsilateral and contralateral VA velocities was not significant for either velocities (P = .14) or flows (P = .19) throughout the conditions. There were no other interactions or trends toward a difference for any of the other blood flow or velocity variables.

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Stroke Numbers Are Up Worldwide

By Frank M. Painter|October 24, 2013|Clinical Decision-making, Stroke|

Stroke Numbers Are Up Worldwide

The Chiro.Org Blog

SOURCE: MedPage Today ~ Oct 23, 2013

By Todd Neale, Senior Staff Writer

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

The overall burden of stroke in terms of absolute numbers of people affected around the world is growing, especially in younger age groups and in low-to-middle-income countries, a global study showed.

In 2010, there were 16.9 million people who had a first stroke, 33 million stroke survivors, and 5.9 million people who died from a stroke — increases of 68%, 84%, and 26% respectively since 1990, according to Valery Feigin, MD, of the Auckland University of Technology in New Zealand, and colleagues.

Major Points:

Despite declining rates of nonfatal and fatal stroke, the overall burden of stroke in terms of absolute numbers of people affected around the world is growing, especially in low-to-middle-income countries, a study found.

Note that another analysis showed that hemorrhagic — and not ischemic — stroke accounted for the majority of the worldwide burden of deaths and disability-adjusted life years lost due to stroke.

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The Quality of Reports on Cervical Arterial Dissection Following Cervical Spinal Manipulation

By Frank M. Painter|March 27, 2013|Evidence-based Medicine, Spinal Manipulation, Stroke|

The Quality of Reports on Cervical Arterial Dissection Following Cervical Spinal Manipulation

The Chiro.Org Blog

SOURCE: PLoS ONE 2013 (Mar 20); 8 (3): e59170

Shari Wynd, Michael Westaway, Sunita Vohra, Greg Kawchuk

Texas Chiropractic College,
Pasadena, Texas, United States of America.

Background Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.

Purpose 1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and
2) assess the quality of these reports.

Methods A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.

Results Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.

Conclusions This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.

Copyright: © 2013 Wynd et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: Greg Kawchuk receives salary support from the Canada Research Chairs program. Sunita Vohra receives salary support from Alberta Innovates-Health Solutions. Training support for Shari Wynd was provided by the Alberta Canadian Institutes of Health Research (CIHR) Training Program in Bone and Joint Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

From the Full-Text Article:

Introduction

In the area of harms reporting, one topic that has received significant attention is cervical spinal manipulation therapy (cSMT), an intervention most often administered by chiropractors [1, 2] to treat musculoskeletal complaints of the head and neck [3] including headaches [4]. If harms are associated with cSMT, they most commonly involve additional head and neck pain [2]. While these adverse events tend to be self-limiting [2], more serious adverse events have been reported such as neurovascular sequelae and stroke. More specifically, injuries such as cervical artery dissection (CAD), whether vertebral, internal carotid, or vertebrobasilar, have been reported to be associated with cSMT [5-7]. Although this subset of adverse events appears to occur infrequently [1, 8, 9], understanding the relation between CADs, stroke and cSMT is important given the medical [7], societal [1], economic [9], and legal [8] implications of any event leading to cerebrovascular compromise.

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ECG for Eyes Sorts Strokes from Vertigo

By Frank M. Painter|March 6, 2013|Stroke, Vertigo|

ECG for Eyes Sorts Strokes from Vertigo

The Chiro.Org Blog

SOURCE: MedPage Today ~ March 05, 2013

By Crystal Phend, Senior Staff Writer, MedPage Today

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

A new device, described as an ECG for the eye, appears to accurately distinguish stroke from other causes of dizziness in the emergency department.

Note that the bedside device feeds webcam video from goggles mounted with an accelerometer to computer software that looks for abnormal corrective eye movements when the head turns.

A device described as an ECG for the eye accurately distinguishes stroke from other causes of dizziness in the emergency department (ED), a small proof-of-concept study showed.

When tested on 12 patients in the ED for acute vestibular symptoms, the device picked out all six vertebrobasilar strokes that were subsequently diagnosed with MRI, David Newman-Toker, MD, PhD, of the Johns Hopkins Hospital, and colleagues reported online in Stroke.

The bedside device feeds webcam video from goggles mounted with an accelerometer to computer software that looks for abnormal corrective eye movements when the head turns. (more…)

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