ArticleJournal of manipulative and physiological therapeutics2021
Temporal Trends and Geographic Variations in the Supply of Clinicians Who Provide Spinal Manipulation to Medicare Beneficiaries: A Serial Cross-Sectional Study.
Article in Journal of manipulative and physiological therapeutics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis 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.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Clinician approaches to spinal manipulation for persistent spinal pain after lumbar surgery: systematic review and meta-analysis of individual patient data.Chiropractic & manual therapies · 2023Pooled it
- Association between spinal manipulative therapy and cervical artery dissection in patients with neck pain or headache: a retrospective cohort study.Chiropractic & manual therapies · 2026Article
- Health care epidemiology, characteristics, and regional variation of chiropractic care in Switzerland: a descriptive study using insurance claims data.BMC health services research · 2026Article
- 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
- Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study.PloS one · 2025Article
- Trends in Utilization and Cost of Nonpharmacological Pain Therapies in the United States Under Medicare Part B, 2000-2022.Journal of integrative and complementary medicine · 2024Article
- Article
- Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018.Journal of general internal medicine · 2024Article
- Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study.BMC musculoskeletal disorders · 2024Article
- Dosing of lumbar spinal manipulative therapy and its association with escalated spine care: A cohort study of insurance claims.PloS one · 2024Article
- Article
- Prevalence of opioid and nonopioid pain management therapies among Medicare beneficiaries with musculoskeletal pain conditions from 2016 to 2019.Drug and alcohol dependence · 2023Article
- Article
- Treatment Patterns and Population Characteristics of Nonpharmacological Management of Chronic Pain in the United States' Medicare Population: A Scoping Review.Innovation in aging · 2023Article
- Article
- Article
- Guideline-concordant utilization of magnetic resonance imaging in adults receiving chiropractic manipulative therapy vs other care for radicular low back pain: a retrospective cohort study.BMC musculoskeletal disorders · 2022Article
- Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults.Journal of manipulative and physiological therapeutics · 2021Observational
- Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain.Frontiers in pain research (Lausanne, Switzerland) · 2021Review
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectiveSpinal 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.
methodsMedicare 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.
resultsOf 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.
conclusionChiropractors 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.
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