Trager Robert J, Burton Wren M, Loewenthal Julia V, Perez Jaime A, Lisi Anthony J, Kowalski Matthew H, Wayne Peter M
Department of Chiropractic Medicine, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA.
Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA.
Cureus. 2024 Oct 24;16(10):e72330. doi: 10.7759/cureus.72330. eCollection 2024 Oct.
Limited research suggests that spinal manipulative therapy (SMT) might positively influence balance, yet its association with falls remains underexplored. We hypothesized that older adults receiving chiropractic SMT for spinal pain would have a reduced fall risk during 13 months of follow-up compared to matched controls.
We searched >116 million patient records from TriNetX (2013-2023; Cambridge, MA, US) to identify adults aged ≥65 years with spinal pain. After excluding those with major fall risk factors, we formed SMT and non-SMT cohorts, using propensity score matching to control for confounders (e.g., age, sex, comorbidities). Risk ratios (RR) with 95% CIs and p-values were calculated for primary (fall) and secondary (limb fracture) outcomes over 13 months. We explored the cumulative incidence of falls and fractures and negative control outcomes (colonoscopy, vital signs, diabetes, nicotine/tobacco screening).
After matching, each cohort had 1,666 patients (mean age 72 years). The SMT cohort had a lower fall rate than the non-SMT cohort (3.8% vs. 5.4%), yielding an RR (95% CI) of 0.71 ((0.52, 0.97); p=0.0319). Cumulative incidences revealed a brief lag in SMT cohort fall incidence. There was no meaningful difference in limb fractures (RR of 1.16 (0.87, 1.54); p=0.3153). Negative control outcomes were similar between cohorts.
This study suggests that older adults receiving SMT for spinal pain may have a reduced risk of falls. However, given the observational nature of the study and the lack of significant differences in limb fracture incidence, the clinical significance of these findings remains uncertain. Further research, including randomized controlled trials, is needed to explore injurious falls, care utilization, pain, and costs.
有限的研究表明，脊柱推拿疗法（SMT）可能对平衡有积极影响，但其与跌倒的关联仍未得到充分探索。我们假设，与匹配的对照组相比，接受脊椎按摩师SMT治疗脊柱疼痛的老年人在13个月的随访期间跌倒风险会降低。
我们在TriNetX（2013 - 2023年；美国马萨诸塞州剑桥）中搜索了超过1.16亿份患者记录，以识别年龄≥65岁且患有脊柱疼痛的成年人。在排除那些有主要跌倒风险因素的人后，我们形成了SMT组和非SMT组，并使用倾向评分匹配来控制混杂因素（如年龄、性别、合并症）。计算了13个月内主要（跌倒）和次要（肢体骨折）结局的风险比（RR）及95%置信区间（CI）和p值。我们探讨了跌倒和骨折的累积发生率以及阴性对照结局（结肠镜检查次数、生命体征、糖尿病、尼古丁/烟草筛查）。
匹配后，每组有1666名患者（平均年龄72岁）。SMT组的跌倒率低于非SMT组（3.8%对5.4%），RR（95%CI）为0.71（（0.52，0.97）；p = 0.0319）。累积发生率显示SMT组跌倒发生率有短暂滞后。肢体骨折方面无显著差异（RR为1.16（0.87，1.54）；p = 0.3153）。两组的阴性对照结局相似。
本研究表明，接受SMT治疗脊柱疼痛的老年人跌倒风险可能降低。然而，鉴于该研究的观察性质以及肢体骨折发生率缺乏显著差异，这些发现的临床意义仍不确定。需要进一步的研究，包括随机对照试验，以探讨意外伤害性跌倒、医疗护理利用情况、疼痛和成本。
