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Health policy and outcome research
Carotid and Vertebral A. Dissection
(Stroke. 2001;32:1054.)
© 2001 American Heart Association, Inc.
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Original Contributions
Chiropractic Manipulation and Stroke
A Population-Based Case-Control Study
Deanna M. Rothwell, MSc; Susan J. Bondy, PhD; J. Ivan Williams, PhD
From the Institute for Clinical Evaluative Sciences (D.M.R., S.J.B.,
J.I.W.); Departments of Public Health Sciences (S.J.B., J.I.W.), Family and
Community Medicine (J.I.W.), and Continuing Education (J.I.W.), University
of Toronto; and Sunnybrook and Women’s College Health Sciences Centre
(J.I.W.), Toronto, Ontario, Canada.
Background and Purpose—Several reports have linked chiropractic manipulation
of the neck to dissection or occlusion of the vertebral artery. However,
previous studies linking such strokes to neck manipulation consist primarily
of uncontrolled case series. We designed a population-based nested
case-control study to test the association.
Methods—Hospitalization records were used to identify vertebrobasilar
accidents (VBAs) in Ontario, Canada, during 1993–1998. Each of 582 cases was
age and sex matched to 4 controls from the Ontario population with no
history of stroke at the event date. Public health insurance billing records
were used to document use of chiropractic services before the event date.
Results—Results for those aged <45 years showed VBA cases to be 5 times more
likely than controls to have visited a chiropractor within 1 week of the VBA
(95% CI from bootstrapping, 1.32 to 43.87). Additionally, in the younger age
group, cases were 5 times as likely to have had 3 visits with a cervical
diagnosis in the month before the case’s VBA date (95% CI from
bootstrapping, 1.34 to 18.57). No significant associations were found for
those aged 45 years.
Conclusions—While our analysis is consistent with a positive association in
young adults, potential sources of bias are also discussed. The rarity of
VBAs makes this association difficult to study despite high volumes of
chiropractic treatment. Because of the popularity of spinal manipulation,
high-quality research on both its risks and benefits is recommended.
Editorial Comment
A Population-Based Case-Control Study
Marie-Germaine Bousser, MD, Guest Editor
Service de Neurologie, Hôpital Lariboisière, Paris, France,
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*******************************************************
Douglas M. White, PT, OCS
Physical Therapist, Consultant
191 Blue Hills Parkway
Milton, MA USA 02186
P: 617.696.1974
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http://DouglasWhite.tripod.com
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