ArticleJournal of manipulative and physiological therapeutics2015
Risk of stroke after chiropractic spinal manipulation in medicare B beneficiaries aged 66 to 99 years with neck pain.
Article in Journal of manipulative and physiological therapeutics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Adverse events among older adults receiving chiropractic spinal manipulation and related treatments: an updated systematic review.Chiropractic & manual therapies · 2026Pooled it
- Reporting of adverse events associated with spinal manipulation in randomised clinical trials: an updated systematic review.BMJ open · 2023Pooled it
- Multimodal chiropractic care for migraine: A pilot randomized controlled trial.Cephalalgia : an international journal of headache · 2021Trial
- The Benefits ofJournal of alternative and complementary medicine (New York, N.Y.) · 2020Trial
- Association between spinal manipulative therapy and cervical artery dissection in patients with neck pain or headache: a retrospective cohort study.Chiropractic & manual therapies · 2026Article
- Neck pain patient with a final diagnosis of bilateral vertebral artery tears: A case report.Journal of chiropractic medicine · 2026Article
- Selective criticism confounds objective evaluation of case report on spinal manipulation and vertebral artery dissection.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Comparative Cost Analysis of Neck Pain Treatments for Medicare Beneficiaries.Archives of physical medicine and rehabilitation · 2025Article
- Patterns of initial treatment and subsequent care escalation among medicare beneficiaries with neck pain: a retrospective cohort study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Plausible Mechanisms of Causation of Immediate Stroke by Cervical Spine Manipulation: A Narrative Review.Cureus · 2024Review
- Review
- An Adult Patient With Acute Ischemic Stroke and Carotid Stenosis Presenting to a Chiropractor: A Case Report.Cureus · 2023Article
- Demographic and psychometric predictors associated with engagement in risk-associated alternative healthcare behaviours.PloS one · 2023Article
- The Effects of Four Weeks of Chiropractic Spinal Adjustments on Blood Biomarkers in Adults with Chronic Stroke: Secondary Outcomes of a Randomized Controlled Trial.Journal of clinical medicine · 2022Article
- Association between cervical artery dissection and spinal manipulative therapy -a medicare claims analysis.BMC geriatrics · 2022Article
- Full-Coverage Chiropractic in Medicare: A Proposal to Eliminate Inequities, Improve Outcomes, and Reduce Health Disparities Without Increasing Overall Program Costs.Journal of chiropractic humanities · 2020Review
- Proposing a new algorithm for premanipulative testing in physical therapy practice.Journal of physical therapy science · 2020Review
- Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline.Journal of alternative and complementary medicine (New York, N.Y.) · 2020Article
- The Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) trial: Study rationale, design and intervention validation.Contemporary clinical trials communications · 2020Article
- A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review.Annals of medicine · 2019Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveThe 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.
methodsThis 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.
resultsThe 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).
conclusionsAmong Medicare B beneficiaries aged 66 to 99 years 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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.