RISK OF VERTEBROBASILAR STROKE AND CHIROPRACTIC CARE Results of a Population-Based Case-Control and Case-Crossover Study (Reprinted from Spine, vol 33, pg S176-S183, 2008)

被引：36

作者：

Cassidy, J. David ^{[1
,2
,3
,4
]}

Boyle, Eleanor ^{[1
,2
]}

Cote, Pierre ^{[1
,2
,3
,4
,5
]}

He, Yaohua ^{[1
,2
]}

Hogg-Johnson, Sheilah ^{[3
,5
]}

Silver, Frank L. ^{[6
,7
]}

Bondy, Susan J. ^{[3
]}

机构：

[1] Toronto Western Hosp, Univ Hlth Network Rehabil Solut, CREIDO, Toronto, ON M5T 2S8, Canada

[2] Toronto Western Res Inst, Div Heath Care & Outcomes Res, Toronto, ON, Canada

[3] Univ Toronto, Dept Publ Hlth Sci Management & Evaluat, Toronto, ON, Canada

[4] Univ Toronto, Dept Hlth Policy Management & Evaluat, Toronto, ON, Canada

[5] Inst Work & Hlth, Toronto, ON, Canada

[6] Toronto Western Hosp, Univ Hlth Network Stroke Program, Toronto, ON M5T 2S8, Canada

[7] Univ Toronto, Dept Med, Fac Med, Div Neurol, Toronto, ON, Canada

来源：

JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS | 2009年 / 32卷 / 02期

基金：

加拿大健康研究院;

关键词：

vertebrobasilar stroke; case control studies; case crossover studies; chiropractic; primary care; complications; neck pain; CERVICAL ARTERY DISSECTION; NECK PAIN; BACK-PAIN; MANIPULATION; SASKATCHEWAN; DISABILITY; DISORDERS; THERAPY; EVENTS; DESIGN;

D O I：

10.1016/j.jmpt.2008.11.020

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Study Design: Population-based, case-control and case-crossover study. Objective: To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke. Summary of Background Data: Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke. Methods: Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls. Results: There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke. Conclusion: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care. (J Manipulative Physiol Ther 2009;32:S201-S208)

引用

页码：S201 / S208

页数：8

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