Evidence map›Paper›PMID 26907615›Full record

Observational studyJournal of manipulative and physiological therapeutics2016

The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities.

William B Weeks, Brent Leininger, James M Whedon, Jon D Lurie, Tor D Tosteson, Rand Swenson, Alistair J O'Malley, Christine M Goertz

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of manipulative and physiological therapeutics, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 2 pooled it
2.8field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 42 citations in OpenAlex.

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  18. Spinal manipulative therapy for low back pain-time for an update.Canadian family physician Medecin de famille canadien · 2017
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

William B WeeksProfessor, The Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; Director, Health Services and Clinical Research, Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, IA. Electronic address: wbw@dartmouth.edu.
Brent LeiningerAssistant Professor, Integrative Health and Wellbeing Research Program, Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN.
James M WhedonInstructor, The Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; Director, Health Services Research, Southern California University of Health Sciences, Whittier, CA.
Jon D LurieAssociate Professor, The Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Tor D TostesonProfessor, The Geisel School of Medicine at Dartmouth, Department of Biomedical Data Science, Lebanon, NH.
Rand SwensonProfessor, The Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Alistair J O'MalleyProfessor, The Geisel School of Medicine at Dartmouth, Department of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Christine M GoertzVice Chancellor, Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, IA.
Dartmouth Institute for Health Policy and Clinical Practice · USPalmer College of Chiropractic · USDartmouth College · USUniversity of Minnesota · US

Funding

Translational Engineering in Cancer (TEC)P30CA023108 · NCI · DARTMOUTH COLLEGE · PI Fred W Kolling IV · 1985 to 2026
$91.3M
Effect of chiropractic on costs of Medicare patients with multiple comorbiditiesR21AT008287 · NCCIH · DARTMOUTH COLLEGE · PI WEEKS, WILLIAM B · 2013 to 2014
$435k
Cost effectiveness of spinal manipulative therapy for seniors with neck painF32AT007507 · NCCIH · UNIVERSITY OF MINNESOTA · PI LEININGER, BRENT · 2012 to 2014
$214k
NCCIH NIH HHS F32 AT007507NCCIH NIH HHS F32AT007507NCCIH NIH HHS R21 AT008287NCCIH NIH HHS R21AT008287NCI NIH HHS P30 CA023108
6 · The paper itself

Abstract

objectiveThe purpose of this study was to determine whether use of chiropractic manipulative treatment (CMT) was associated with lower healthcare costs among multiply-comorbid Medicare beneficiaries with an episode of chronic low back pain (cLBP).

methodsWe conducted an observational, retrospective study of 2006 to 2012 Medicare fee-for-service reimbursements for 72326 multiply-comorbid patients aged 66 and older with cLBP episodes and 1 of 4 treatment exposures: chiropractic manipulative treatment (CMT) alone, CMT followed or preceded by conventional medical care, or conventional medical care alone. We used propensity score weighting to address selection bias.

resultsAfter propensity score weighting, total and per-episode day Part A, Part B, and Part D Medicare reimbursements during the cLBP treatment episode were lowest for patients who used CMT alone; these patients had higher rates of healthcare use for low back pain but lower rates of back surgery in the year following the treatment episode. Expenditures were greatest for patients receiving medical care alone; order was irrelevant when both CMT and medical treatment were provided. Patients who used only CMT had the lowest annual growth rates in almost all Medicare expenditure categories. While patients who used only CMT had the lowest Part A and Part B expenditures per episode day, we found no indication of lower psychiatric or pain medication expenditures associated with CMT.

conclusionsThis study found that older multiply-comorbid patients who used only CMT during their cLBP episodes had lower overall costs of care, shorter episodes, and lower cost of care per episode day than patients in the other treatment groups. Further, costs of care for the episode and per episode day were lower for patients who used a combination of CMT and conventional medical care than for patients who did not use any CMT. These findings support initial CMT use in the treatment of, and possibly broader chiropractic management of, older multiply-comorbid cLBP patients.

Indexed as

AgedAged, 80 and overChronic PainComorbidityFemaleHealth ExpendituresHumansLow Back PainMaleManipulation, ChiropracticMedicarePropensity ScoreRetrospective StudiesUnited StatesChiropracticManipulationMedicarePropensity ScoreRetrospective Studies

Identifiers

PMID26907615
PMCPMC4834378
OpenAlexW2278210163

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.