Journal of Manipulative and Physiological Therapeutics最新文献

{"title":"Relationships Between Trunk Endurance, Low Back Pain Severity and Functional Disability in a United States Veteran Population: A Cross-sectional Retrospective Study.","authors":"Wren M Burton, Alec L Schielke, Robert J Butler, David B Huberman, Matthew H Kowalski, Peter M Wayne, Jeff Teraoka, Robert Vining","doi":"10.1016/j.jmpt.2025.08.001","DOIUrl":"10.1016/j.jmpt.2025.08.001","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to examine the relationships between low back pain (LBP) and trunk endurance (TE) in a United States Veteran population.</p><p><strong>Methods: </strong>Data were collected from the Veterans Affairs Palo Alto Healthcare System electronic health records (01/2019-12/2019) to identify adults aged 18-89 years presenting with nonsurgical LBP for a chiropractic consultation. Coefficient estimates, standard error, and P-values were calculated from multivariable linear regression for primary (LBP severity) and secondary (functional disability) outcomes, controlling for age, sex, and body composition.</p><p><strong>Results: </strong>A total of 85 patients (mean age 53.6 years) were included. Trunk endurance was significantly associated with LBP severity (β: -0.042, P < .001) and Oswestry disability index (ODI) scores (β: -0.334, P < .001) suggesting that participants with greater TE (ie, longer prone bridge (plank) test time) had lower LBP severity and lower functional disability than those with poorer TE.</p><p><strong>Conclusion: </strong>In this sample of Veterans, higher LBP severity and greater functional disability (ODI scores) were associated with reduced TE. Body mass index did not significantly influence these relationships.</p>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Neck Pain Influence on Oculomotor Performance During Near Point Convergence and Fitts's Tasks: a cross-sectional study.","authors":"Michayla M Esteves, Brian MacNeil, Ganesh Tailor, Cheryl M Glazebrook, Michael G Johnson, Steven R Passmore","doi":"10.1016/j.jmpt.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.jmpt.2025.08.005","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to quantify the influence of musculoskeletal dysfunction on oculomotor performance by evaluating oculomotor convergence and volitional gaze performance in participants with chronic neck pain compared with controls.</p><p><strong>Methods: </strong>Twelve participants with chronic neck pain were age/sex matched to 12 asymptomatic participants. All participants completed a series of tests in neutral, trunk rotated right, and trunk rotated left positions. A Royal Air Force ruler was used to measure near point convergence (NPC), a convergence insufficiency (CI) measurement. Oculomotor performance was assessed using an oculomotor Fitts's Law task. Questionnaire data included the neck disability index (NDI) and CI symptom survey (CISS).</p><p><strong>Results: </strong>A significant reduction in NPC was found in participants with neck pain for the neutral and rotated left positions. Movement time increased for targets at farther amplitudes for both groups. Reaction time increased for targets at shorter amplitudes for the symptomatic group, indicating motor planning challenges. Significant correlations were found between CISS and NPC scores, as well as between CISS and NDI scores, indicating CISS scores are associated with convergence performance deficits. Greater NDI scores related to larger CISS scores, correlating to increased CI symptoms.</p><p><strong>Conclusion: </strong>Significant differences between groups were found for NPC suggesting that symptomatic participants have difficulties controlling convergent eye movements compared with asymptomatic participants. Reaction time was found to be longer for index of difficulty at a shorter amplitude for the symptomatic group. Correlations between CISS scores with NPC and NDI scores respectively were found, providing evidence of a relationship between CI and neck disability.</p>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes, Beliefs, and Values of Italian Osteopaths Toward the Management of Patients With Tension-Type Headache: A Categorical Content Analysis.","authors":"Alessio Iacopini, Jorge E Esteves, Giacomo Consorti, Christian Lunghi, Francesco Cerritelli","doi":"10.1016/j.jmpt.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.jmpt.2025.08.009","url":null,"abstract":"<p><strong>Objective: </strong>Tension-type headache (TTH) is among the 20 leading causes of disability worldwide. Due to the difficulty in diagnosis and the variable association of other symptoms, the management of this clinical condition is often unsatisfactory. Osteopathic manipulative treatment combined with exercise, diet, and general relaxation therapies may be valid for TTH. This study investigated osteopaths' common attitudes, beliefs, and values when treating and managing individuals experiencing TTH.</p><p><strong>Methods: </strong>This is a qualitative study using thematic analysis with elements of grounded theory. Osteopaths with expertise in treating patients with primary headache conditions were recruited through purposive sampling methods. Data were gathered from individual, semistructured interviews and transcribed verbatim and then analyzed through thematic analysis. Ten osteopaths who met the inclusion criteria were recruited.</p><p><strong>Results: </strong>Four main themes were generated from data analysis: (1) osteopathy and its alternative perspective on patients' perception of osteopathic intervention; (2) osteopaths' clinical decision making regarding the selection of treatment approaches; (3) the person's management through an individualized case treatment model; (4) a person-centered approach, setting the treatment in a particular environment to achieve the fulfillment of an individual's potential.</p><p><strong>Conclusion: </strong>The present study highlights that this sample of osteopaths endorse a person-centered renewed approach. The participants regularly assess the clinical conditions and disabilities associated with TTH to tailor their treatment approach. These osteopaths consider that these tailored treatment approaches directed at improving and promoting the individual's wellbeing alongside a reduction of their symptoms should be the main aim of osteopathic treatment.</p>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Rehabilitative Home Exercise Adherence Among Older Adults With Chronic Back Pain: Secondary Analysis of a Randomized Trial.","authors":"Michele J Maiers, Mary L Forte","doi":"10.1016/j.jmpt.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.jmpt.2025.08.004","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to assess the association between baseline factors and adherence to rehabilitative home exercise (RHE) after 12 weeks of chiropractic spinal manipulation (CSM) plus RHE instruction, and whether adherence was associated with improvement in back-related disability in adults ≥65 years with chronic low back pain (CLBP).</p><p><strong>Methods: </strong>This secondary analysis used randomized trial data collected in 2010 through 2013 from community-dwelling older adults with CLBP and disability in a metropolitan area in the upper mid-west United States. We defined adherence as exercising ≥ 4 days/week, and clinically meaningful disability improvement as ≥ 30% reduction in Oswestry Disability Index (ODI). Baseline factors (demographic, low back, activity, function) associated with adherence and change in disability were tested with chi-square and logistic regression.</p><p><strong>Results: </strong>Among 176 participants, mean age was 71.1 years, 59.7% were female, and median back pain duration was 13.5 years. Baseline average back pain and ODI were moderate. Over 12 weeks of treatment, median CSM visits was 11; RHE instruction was 4. Over half the participants (56.3%) reported RHE adherence of ≥ 4x/week at 12 weeks. No baseline factors were associated with 12-week RHE adherence (all P > .05), and adherence was not associated with change in ODI. Only adherence at 4 weeks was positively associated with 12-week adherence (P < .001).</p><p><strong>Conclusions: </strong>Among this sample of older adults with CLBP, baseline patient characteristics did not predict adherence to home exercise recommendations. Further, adherence was not associated with clinically meaningful change in disability.</p>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability and Validity of Telehealth Spinal Examination Components: A Systematic Review.","authors":"Frank M Bucki, Victoria A Bensel, Clarice H Wallert, Brittney N Walters","doi":"10.1016/j.jmpt.2025.08.008","DOIUrl":"https://doi.org/10.1016/j.jmpt.2025.08.008","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to systematically review the literature on the reliability or validity of telehealth spine examination components.</p><p><strong>Methods: </strong>MEDLINE database from inception to May 17, 2022. Subject headings include virtual, telerehabilitation, telehealth, telemedicine, spine, spinal, neurologic, cervical, thoracic, lumbar, back, and examination. Studies not done synchronously, lacked comparisons to in-person, involved non-spine pathologies, or lacked reliability/validity were excluded. Reliability and validity data were captured using Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. Quality and risk of bias were assessed with Quality Appraisal Tool for Studies of Diagnostic Reliability and the Scottish Intercollegiate Guidelines Network diagnostic accuracy checklist.</p><p><strong>Results: </strong>Six studies, with sample sizes of 11 to 100, were included. In 2 studies, Quality Appraisal Tool for Studies of Diagnostic Reliability was low, and the remaining were moderate to high. Two validity studies had high Scottish Intercollegiate Guidelines Network methodologic quality. Two studies suggested high validity and/or reliability for inspection, cranial nerve testing, pain localization, range of motion, deep neck flexion endurance, Lhermitte sign, and cervical spine neuroforaminal compression. Five studies suggested reliability for inspection, lower extremity muscle testing, pain localization, straight leg raise, Sorensen test, 5 repetitive sit-to-stand test, Lasègue test, reverse Lasègue test, Adams test, and pain on heel strike and poor postural inspection reliability.</p><p><strong>Conclusion: </strong>This review found that components of telehealth spine examinations, such as those done in physical therapy or chiropractic clinical settings, were valid or reliable and provided support for clinical use.</p>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Costs and Utilization Between Provider Types for Back and Neck Pain: A Cross-Sectional Study.","authors":"Forest S Kim, David J Kahle, Neil S Fleming, Michael Gallaugher, Tanner Houston, Sonish Lamsal, Rodney X Sturdivant","doi":"10.1016/j.jmpt.2024.09.013","DOIUrl":"https://doi.org/10.1016/j.jmpt.2024.09.013","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to compare treatment expenditures and utilization of licensed doctors of chiropractic or doctors of physical therapy working for Airrosti (AP) compared with non-AP providers (NAP) comprising 5 different provider types.</p><p><strong>Methods: </strong>This study was a retrospective, claims-based, cross-sectional study using 5 years of claims and enrollment data from the state of Texas. We compared licensed doctors of chiropractic or doctors of physical therapy working for Airrosti to NAP. Episodes of care for back and neck pain were formed using 90-day clean periods. We utilized propensity scores using inverse probability weighting to control for selection bias. We examined the association of provider type with total costs per episode and 5 different measures of utilization: numbers of visits, length of episode, hospitalization, use of advanced diagnostic imaging, and use of surgery.</p><p><strong>Results: </strong>Included were 645 799 unique patient episodes of care. Orthopedic specialists, physiatrists, and physical therapists had higher costs and utilization than AP, except for lower visits for orthopedic specialists. Primary care providers had lower costs and utilization than AP, except for hospitalizations, in which no difference was found. AP were most similar to chiropractors in terms of costs and utilization; however, AP had higher use of advanced diagnostic imaging compared with chiropractors. Chiropractors had more visits and longer episodes than AP. Standard deviations for average episode cost, episode length, and number of visits were greater for all provider types compared with AP, except for primary care providers.</p><p><strong>Conclusion: </strong>In the sample studied, providers using standardized treatment pathways had reduced variation and costs for patients with spinal pain. We hypothesize that adherence to treatment pathways that align with recommended clinical practice guidelines that discourage the use of diagnostic imaging and surgery as a first step for treating lower back and neck pain may have resulted in the significant cost and utilization differences found between AP and NAP.</p>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Cognitive Impairment and Spinal Pain in the Older Adult Population in the United States: A Cross-Sectional Study.","authors":"Haiou Yang, Scott Haldeman, Eric L Hurwitz, Patricia A Tavares, Bart N Green, Hannah Dale, Katie de Luca","doi":"10.1016/j.jmpt.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.jmpt.2025.07.001","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to explore the association between cognitive impairment and spinal pain in the older population in the United States.</p><p><strong>Methods: </strong>We undertook a secondary analysis of cross-sectional data from the 1999 to 2000 and 2001 to 2002 National Health and Nutrition Examination Survey. The pooled data included a representative sample (n = 2975) of older adults (aged 60-85 years) in the United States. Cognitive impairment was assessed through the Digit Symbol Substitution Test. Spinal pain was defined with a multisite definition, including both nonspecific low back pain and neck pain present in the past 3 months. To account for the complex sampling design, logistic regression was performed using Taylor linearized variance estimation to compute weighted measures of associations.</p><p><strong>Results: </strong>For older adults with spinal pain, the proportion of cognitive impairment increased with age, from 32.64% in the 60 to 64 age group to 93.83% in the 80 to 84 age group, which was also statistically significantly higher than the general population group and the group without spinal pain (P < .001). After controlling for demographic characteristics, socioeconomic status, and general health status, older adults with spinal pain had significantly increased odds of cognitive impairment (odds ratio 1.76, 95% confidence interval: 1.12, 2.79). Vulnerable subgroups (older, female, and less education) were identified.</p><p><strong>Conclusion: </strong>There was a significant association between cognitive impairment and spinal pain in the older adult population in the United States. Within this population, there were vulnerable subgroups for which spinal pain and cognitive impairment had a greater impact, namely people who are older, female, and those with less education.</p>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Local Vibration Therapy on ERK1/2-Mediated Schwann Cell Proliferation in Rats With Sciatic Nerve Injury.","authors":"Lu Yin, Yangbo Hou, Qingjuan Guo, Feiran Zhao, Yun An, Guohui Zhang, Shujie Ma, Xiao Chen, Juntao Yan","doi":"10.1016/j.jmpt.2024.09.014","DOIUrl":"https://doi.org/10.1016/j.jmpt.2024.09.014","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to investigate the effect of local vibration therapy on the activation of the extracellular signal-regulated kinase (ERK1/2) signaling pathway and the proliferation of Schwann cell with the goal of promoting remyelination after sciatic nerve injury (SNI).</p><p><strong>Methods: </strong>Experimental Sprague Dawley rats were divided into the sham group, SNI group, vibration group, and U0126 inhibitor group, with 8 rats in each group. The rats in the vibration and U0126 inhibitor groups received local vibration intervention for 21 consecutive days from the 7th day after operation. We used the sciatic nerve functional index to assess behavioral recovery in rats and performed immunofluorescence staining and Western blotting to assess the effects of SC proliferation and expression of myelin protein in the injured sciatic nerve.</p><p><strong>Results: </strong>The sciatic nerve functional index of rats in the vibration group was significantly increased on the 21st and 28th day after surgery compared to that of those the SNI group; on the 28th day after injury, p-ERK1/2 was significantly activated and Schwann cell proliferation was induced in the vibration group, but U0126 inhibitor group showed no significant difference effect in Schwann cell proliferation. The expression of myelin basic protein secreted by Schwann cell was significantly upregulated in the vibration group compared to the SNI group, but myelin basic protein expression was not significantly different in the U0126 group.</p><p><strong>Conclusion: </strong>The results showed that local vibration therapy after SNI accelerated Schwann cell proliferation through activation of the ERK1/2 signaling pathway, and effectively promoted myelin repair in a rat model.</p>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of 2 Training Protocols on Aspects of Pain in Older Women With Chronic Low Back Pain: A Randomized Clinical Trial.","authors":"Poliana de Jesus Santos, José Carlos Aragão-Santos, Thainá Souza Santos, Marcos Raphael Pereira-Monteiro, Josimari Melo DeSantana, Elyson Ádan Nunes Carvalho, Marzo Edir Da Silva-Grigoletto","doi":"10.1016/j.jmpt.2024.09.012","DOIUrl":"https://doi.org/10.1016/j.jmpt.2024.09.012","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to compare the effects of 16 weeks of functional versus dual-task training on aspects of pain in older women with chronic nonspecific low back pain.</p><p><strong>Methods: </strong>This randomized clinical trial included 38 participants aged 60 to 79 years divided into 2 groups: functional training (FT) and dual-task training (DT). We assessed pressure pain threshold (PPT), temporal summation of pain, conditioned pain modulation (CPM), trunk instability, isometric strength, and endurance of trunk muscles before and 16 weeks after training. Generalized mixed models were used to compare the groups over time, adopting P ≤ .05. Additionally, the effect size (Cohen's d) was calculated.</p><p><strong>Results: </strong>Functional training and DT promoted statistically significant increases in PPT (d = 1.82 and 1.10, respectively) and CPM (d = 1.60 and 1.13, respectively). Only FT promoted a statistically significant increase in PPT (d = 1.23). Functional training was superior to DT in PPT and CPM (P < .05). Functional training and DT increased the maximum isometric strength of trunk extensors (d = 2.14 and 2.12, respectively; P < .05), without statistically significant differences between groups. Only DT showed a statistically significant improvement in the endurance of extensors and lateral flexors of the trunk (d = 0.77; d = 0.69).</p><p><strong>Conclusion: </strong>Both FT and DT were effective in promoting increased pain pressure threshold, improvement of CPM, and trunk function in older women with chronic nonspecific low back pain, however, without effects on temporal summation of pain and trunk stability. These indicators show that the proposed training may promote pain attenuation and increased trunk function.</p>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Observational Study of the Safety of Chiropractic vs Medical Care Among Older Adults With Neck Pain.","authors":"James M Whedon, Brian Anderson, Todd A Mackenzie, Leah Grout, Steffany Moonaz, Jon D Lurie, Scott Haldeman","doi":"10.1016/j.jmpt.2025.07.002","DOIUrl":"10.1016/j.jmpt.2025.07.002","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to evaluate the risk of selected adverse outcomes for older adults with a new episode of neck pain (NP) receiving chiropractic care compared to those receiving primary medical care with Prescription Drug Therapy (PDT) or primary care without medication.</p><p><strong>Methods: </strong>Through analysis of Medicare claims data, we designed a retrospective cohort study including 291 604 patients with a new office visit for NP in 2019. We developed 3 mutually exclusive exposure groups: the Chiropractic Manipulative Therapy (CMT) group received spinal manipulative therapy from a chiropractor with no primary care visits; the PDT group visited primary care and filled an analgesic prescription within 7 days without chiropractic care, and the Primary Care Only (PCO) group visited primary care without chiropractic care or analgesic prescriptions. We analyzed possible complications, including adverse drug events, vertebrobasilar insufficiency, and other selected adverse outcomes, calculating incidence rate ratios over 24 months using Poisson regression with robust standard errors and inverse propensity weighing to balance the exposure groups regarding patient characteristics.</p><p><strong>Results: </strong>Among 291 604 patients, 182 596 (63%) received chiropractic care. For CMT vs PDT, the rate for any measured adverse outcome was 20% lower; for CMT vs PCO, the rate was 14% lower, and for PDT vs PCO, the rate was 6% higher. PDT had the highest risk of any measured adverse outcome.</p><p><strong>Conclusion: </strong>For Medicare Part B beneficiaries with new onset NP, management with chiropractic care was associated with lower rates of adverse events than primary medical care. The PDT group had the highest risk of any measured adverse outcome.</p>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}