Chiropractic Spinal Manipulation and Fall Risk in Older Adults With Spinal Pain: Observational Findings From a Matched Retrospective Cohort Study.

Autor:	Trager RJ; Department of Chiropractic Medicine, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA.; Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA.; Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, USA., Burton WM; Osher Center for Integrative Health, Harvard Medical School, Brigham and Women's Hospital, Boston, USA.; Division of Preventive Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, USA., Loewenthal JV; Division of Aging, Harvard Medical School, Brigham and Women's Hospital, Boston, USA., Perez JA; Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, USA., Lisi AJ; Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven, USA.; Section of Biomedical Informatics and Data Science, School of Medicine, Yale University, New Haven, USA., Kowalski MH; Osher Center for Integrative Health, Harvard Medical School, Brigham and Women's Hospital, Boston, USA., Wayne PM; Osher Center for Integrative Health, Harvard Medical School, Brigham and Women's Hospital, Boston, USA.; Division of Preventive Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Oct 24; Vol. 16 (10), pp. e72330. Date of Electronic Publication: 2024 Oct 24 (Print Publication: 2024).
DOI:	10.7759/cureus.72330
Abstrakt:	Introduction: Limited research suggests that spinal manipulative therapy (SMT) might positively influence balance, yet its association with falls remains underexplored. We hypothesized that older adults receiving chiropractic SMT for spinal pain would have a reduced fall risk during 13 months of follow-up compared to matched controls. Methods: We searched >116 million patient records from TriNetX (2013-2023; Cambridge, MA, US) to identify adults aged ≥65 years with spinal pain. After excluding those with major fall risk factors, we formed SMT and non-SMT cohorts, using propensity score matching to control for confounders (e.g., age, sex, comorbidities). Risk ratios (RR) with 95% CIs and p-values were calculated for primary (fall) and secondary (limb fracture) outcomes over 13 months. We explored the cumulative incidence of falls and fractures and negative control outcomes (colonoscopy, vital signs, diabetes, nicotine/tobacco screening). Results: After matching, each cohort had 1,666 patients (mean age 72 years). The SMT cohort had a lower fall rate than the non-SMT cohort (3.8% vs. 5.4%), yielding an RR (95% CI) of 0.71 ((0.52, 0.97); p=0.0319). Cumulative incidences revealed a brief lag in SMT cohort fall incidence. There was no meaningful difference in limb fractures (RR of 1.16 (0.87, 1.54); p=0.3153). Negative control outcomes were similar between cohorts. Conclusions: This study suggests that older adults receiving SMT for spinal pain may have a reduced risk of falls. However, given the observational nature of the study and the lack of significant differences in limb fracture incidence, the clinical significance of these findings remains uncertain. Further research, including randomized controlled trials, is needed to explore injurious falls, care utilization, pain, and costs. Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The University Hospitals Institutional Review Board issued approval STUDY20230244. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This study was not supported by any specific grant. Peter Wayne’s time and resources were supported by general funding from a K24 investigator award from the National Center for Complementary and Integrative Health (#AT009282). The work conducted by RT received support from the Elisabeth Severance Prentiss Foundation (Cleveland, OH) through general funding. This project is also supported by the Clinical and Translational Science Collaborative of Northern Ohio, which is funded by the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Science Award grant, UM1TR004528. The funders were not involved in developing the study protocol or any key decisions. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Trager et al.)
Databáze:	MEDLINE
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