Forte Mary L, Maiers Michele
Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, Bloomington, Minnesota.
Center for Healthcare Innovation and Policy, Northwestern Health Sciences University, Bloomington, Minnesota.
J Manipulative Physiol Ther. 2019 Jul;42(6):450-460. doi: 10.1016/j.jmpt.2018.12.003. Epub 2019 Jul 16.
The purpose of this cross-sectional study was to compare functional limitations and comorbidity prevalence between older adult users and nonusers of chiropractic and osteopathic (DC/DO) manipulation to inform provider training.
We conducted a secondary analysis of the 2012 National Health Interview Survey data. Adults age 65 or older who responded to the survey were included. Descriptive statistics are reported for adults who used DC/DO manipulation (vs nonusers) regarding function, comorbidities, musculoskeletal complaints, and medical services. Weighted percentages were derived using SAS and compared with χ tests.
The DC/DO users were more often female, overweight or obese, and of white race than nonusers. More DC/DO users reported arthritis (55.3% vs 47.0%, <0.01) or asthma (15.0% vs 10.0%, P < .01) than nonusers; hypertension (61.9% vs 55.5%, P = .02) and diabetes (20.3% vs 15.7%, P = .02) were more prevalent in nonusers; and other comorbidities were comparable. The DC/DO users reported more joint pain/stiffness (55.7% vs 44.8%), chronic pain (19.8% vs 14.2%), low back pain (27.8% vs 18.4%), low back with leg pain (18.8% vs 10.6%), and neck pain (24.2% vs 13.1%) than nonusers (all P < .01). Functional limitations affected two-thirds overall, but DC/DO users reported more difficulties stooping and bending; other limitations were comparable. One in 9 reported activities of daily living or instrumental activities of daily living limitations; nonusers were more affected. Surgery was more common among DC/DO users (26.1% vs 19.3%, <0.01); emergency room visits were comparable.
Differences existed between older adult manipulation users and nonusers, especially surgical utilization, musculoskeletal complaints, and comorbidities; functional differences were modest. Our findings highlight areas for provider training and awareness regarding comorbidity burden and management needs in older patients who may simultaneously use manipulation and medical care for musculoskeletal complaints.
本横断面研究的目的是比较老年整脊疗法和骨病疗法（DC/DO）使用者与非使用者之间的功能限制和共病患病率，以为提供者培训提供信息。
我们对2012年美国国家健康访谈调查数据进行了二次分析。纳入了年龄在65岁及以上且对调查做出回应的成年人。报告了使用DC/DO手法治疗的成年人（与非使用者相比）在功能、共病、肌肉骨骼疾病主诉和医疗服务方面的描述性统计数据。使用SAS得出加权百分比，并与χ检验进行比较。
与非使用者相比，DC/DO使用者女性更多，超重或肥胖，且为白人。与非使用者相比，更多的DC/DO使用者报告患有关节炎（55.3%对47.0%，P<0.01）或哮喘（15.0%对10.0%，P<0.01）；高血压（61.9%对55.5%，P = 0.02）和糖尿病（20.3%对15.7%，P = 0.02）在非使用者中更为普遍；其他共病情况相当。与非使用者相比，DC/DO使用者报告有更多的关节疼痛/僵硬（55.7%对44.8%）、慢性疼痛（19.8%对14.2%）、腰痛（27.8%对18.4%）、腰腿痛（18.8%对10.6%）和颈痛（24.2%对13.1%）（所有P<0.01）。功能限制总体上影响了三分之二的人，但DC/DO使用者报告在弯腰和弯曲方面有更多困难；其他限制相当。九分之一的人报告有日常生活活动或工具性日常生活活动受限；非使用者受影响更大。手术在DC/DO使用者中更为常见（26.1%对19.3%，P<0.01）；急诊室就诊情况相当。
老年手法治疗使用者和非使用者之间存在差异，特别是在手术利用率、肌肉骨骼疾病主诉和共病方面；功能差异不大。我们的研究结果突出了提供者培训以及对可能同时使用手法治疗和医疗护理来处理肌肉骨骼疾病主诉的老年患者共病负担和管理需求的认识方面的重点领域。
