%0 Journal Article %J J Manipulative Physiol Ther %D 2014 %T Chiropractic use in the Medicare population: prevalence, patterns, and associations with 1-year changes in health and satisfaction with care. %A Paula A Weigel %A Jason Hockenberry %A Frederic D Wolinsky %K Aged %K Aged, 80 and over %K Female %K Humans %K Male %K Manipulation, Chiropractic %K Medicare %K Patient Satisfaction %K Time Factors %K Treatment Outcome %K United States %X

OBJECTIVE: The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.

METHODS: Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.

CONCLUSION: This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

%B J Manipulative Physiol Ther %V 37 %P 542-51 %8 2014 Oct %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/25233887 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/25233887?dopt=Abstract %R 10.1016/j.jmpt.2014.08.003 %0 Journal Article %J J Manipulative Physiol Ther %D 2014 %T The comparative effect of episodes of chiropractic and medical treatment on the health of older adults. %A Paula A Weigel %A Jason Hockenberry %A Suzanne E Bentler %A Frederic D Wolinsky %K Activities of Daily Living %K Aged, 80 and over %K Back Pain %K Episode of Care %K Female %K Humans %K Male %K Manipulation, Chiropractic %K Treatment Outcome %X

OBJECTIVES: The comparative effect of chiropractic vs medical care on health, as used in everyday practice settings by older adults, is not well understood. The purpose of this study is to examine how chiropractic compares to medical treatment in episodes of care for uncomplicated back conditions. Episodes of care patterns between treatment groups are described, and effects on health outcomes among an older group of Medicare beneficiaries over a 2-year period are estimated.

METHODS: Survey data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old were linked to participants' Medicare Part B claims under a restricted Data Use Agreement with the Centers for Medicare and Medicaid Services. Logistic regression was used to model the effect of chiropractic use in an episode of care relative to medical treatment on declines in function and well-being among a clinically homogenous older adult population. Two analytic approaches were used, the first assumed no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: Episodes of care between treatment groups varied in duration and provider visit pattern. Among the unadjusted models, there was no significant difference between chiropractic and medical episodes of care. The propensity score results indicate a significant protective effect of chiropractic against declines in activities of daily living (ADLs), instrumental ADLs, and self-rated health (adjusted odds ratio [AOR], 0.49; AOR, 0.62; and AOR, 0.59, respectively). There was no difference between treatment types on declines in lower body function or depressive symptoms.

CONCLUSION: The findings from this study suggest that chiropractic use in episodes of care for uncomplicated back conditions has protective effects against declines in ADLs, instrumental ADLs, and self-rated health for older Medicare beneficiaries over a 2-year period.

%B J Manipulative Physiol Ther %V 37 %P 143-54 %8 2014 Mar-Apr %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/24636108 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24636108?dopt=Abstract %R 10.1016/j.jmpt.2013.12.009 %0 Journal Article %J J Manipulative Physiol Ther %D 2013 %T Chiropractic use and changes in health among older medicare beneficiaries: a comparative effectiveness observational study. %A Paula A Weigel %A Jason Hockenberry %A Suzanne E Bentler %A Frederic D Wolinsky %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Cohort Studies %K Databases, Factual %K Disability Evaluation %K Female %K Geriatric Assessment %K Humans %K Low Back Pain %K Male %K Manipulation, Chiropractic %K Medicare %K Mobility Limitation %K Musculoskeletal Diseases %K Patient Satisfaction %K Quality of Life %K Risk Assessment %K Sex Factors %K Treatment Outcome %K United States %X

OBJECTIVE: The purpose of this study was to investigate the effect of chiropractic on 5 outcomes among Medicare beneficiaries: increased difficulties performing activities of daily living (ADLs), instrumental ADLs (IADLs), and lower body functions, as well as lower self-rated health and increased depressive symptoms.

METHODS: Among all beneficiaries, we estimated the effect of chiropractic use on changes in health outcomes among those who used chiropractic compared with those who did not, and among beneficiaries with back conditions, we estimated the effect of chiropractic use relative to medical care, both during a 2- to 15-year period. Two analytic approaches were used--one assumed no selection bias, whereas the other adjusted for potential selection bias using propensity score methods.

RESULTS: Among all beneficiaries, propensity score analyses indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, and depressive symptoms, although there were increased risks associated with chiropractic for declines in lower body function and self-rated health. Propensity score analyses among beneficiaries with back conditions indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, lower body function, and depressive symptoms, although there was an increased risk associated with chiropractic use for declines in self-rated health.

CONCLUSION: The evidence in this study suggests that chiropractic treatment has comparable effects on functional outcomes when compared with medical treatment for all Medicare beneficiaries, but increased risk for declines in self-rated health among beneficiaries with back conditions.

%B J Manipulative Physiol Ther %V 36 %P 572-84 %8 2013 Nov-Dec %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/24636108 %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/24144425?dopt=Abstract %R 10.1016/j.jmpt.2013.08.008 %0 Journal Article %J Journal of Manipulative & Physiological Therapeutics %D 2012 %T Chiropractic episodes and the co-occurrence of chiropractic and health services use among older Medicare beneficiaries. %A Paula A Weigel %A Jason Hockenberry %A Suzanne E Bentler %A Kaskie, Brian %A Frederic D Wolinsky %K Age Factors %K Aged %K Aged, 80 and over %K Chiropractic %K Combined Modality Therapy %K Episode of Care %K Female %K Geriatric Assessment %K Health Care Surveys %K Health Services %K Humans %K Incidence %K Insurance Claim Reporting %K Low Back Pain %K Medicare Part B %K Musculoskeletal Diseases %K Primary Health Care %K Retrospective Studies %K Sex Factors %K Treatment Outcome %K United States %X

OBJECTIVE: The purpose of this study was to define and characterize episodes of chiropractic care among older Medicare beneficiaries and to evaluate the extent to which chiropractic services were used in tandem with conventional medicine.

METHODS: Medicare Part B claims histories for 1991 to 2007 were linked to the nationally representative survey on Assets and Health Dynamics among the Oldest Old baseline interviews (1993-1994) to define episodes of chiropractic sensitive care using 4 approaches. Chiropractic and nonchiropractic patterns of service use were examined within these episodes of care. Of the 7447 Assets and Health Dynamics among the Oldest Old participants, 971 used chiropractic services and constituted the analytic sample.

RESULTS: There were substantial variations in the number and duration of episodes and the type and volume of services used across the 4 definitions. Depending on how the episode was constructed, the mean number of episodes per chiropractic user ranged from 3.74 to 23.12, the mean episode duration ranged from 4.7 to 28.8 days, the mean number of chiropractic visits per episode ranged from 0.88 to 2.8, and the percentage of episodes with co-occurrent use of chiropractic and nonchiropractic providers ranged from 4.9% to 10.9% over the 17-year period.

CONCLUSION: Treatment for back-related musculoskeletal conditions was sought from a variety of providers, but there was little co-occurrent service use or coordinated care across provider types within care episodes. Chiropractic treatment dosing patterns in everyday practice were much lower than that used in clinical trial protocols designed to establish chiropractic efficacy for back-related conditions.

%B Journal of Manipulative & Physiological Therapeutics %V 35 %P 168-175 %G eng %N 3 %R 10.1016/j.jmpt.2012.01.011