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Utilization of Manipulative Treatment for Spine and Shoulder Conditions Between Different Medical Providers in a Large Military Hospital

      Abstract

      Objective

      To describe the use of manipulative treatment for shoulder and spine conditions among various provider types.

      Design

      Retrospective observational cohort.

      Setting

      Single military hospital.

      Participants

      Consecutive sample of patients (N=7566) seeking care for an initial spine or shoulder condition from January 1 to December 31, 2009.

      Interventions

      Manipulative treatment (eg, manual therapy, spinal and joint manipulation).

      Main Outcome Measure

      Manipulation treatment was identified with procedure billing codes in the medical records. Spine and shoulder conditions were identified by using the International Classification of Diseases, 9th Revision codes. All data were abstracted from the Department of Defense Military Health System Management and Analysis Tool.

      Results

      Of 7566 total patients seeking care, 2014 (26.6%) received manipulative treatment at least once, and 1870 of those received this treatment in a military facility (24.7%). Manipulative treatment was used most often for thoracic conditions and least often for shoulder conditions (50.8% and 24.2% of all patients). There was a total of 6706 unique medical visits with a manipulative treatment procedure (average of 3.3 manipulative treatment procedure visits per patient).

      Conclusions

      Manipulative treatment utilization rates for shoulder and spine conditions ranged from 26.6% to 50.2%. Chiropractors used manipulation the most and physical therapists the least.

      Keywords

      List of abbreviations:

      DC (Doctor of Chiropractic), DO (Doctor of Osteopathy), M2 (Military Health System Management Analysis and Reporting Tool)
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      References

        • Chou R.
        • Qaseem A.
        • Snow V.
        • et al.
        Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society.
        Ann Intern Med. 2007; 147: 478-491
        • Bronfort G.
        • Haas M.
        • Evans R.
        • Leininger B.
        • Triano J.
        Effectiveness of manual therapies: the UK evidence report.
        Chiropr Osteopat. 2010; 18: 3
        • Koes B.W.
        • van Tulder M.
        • Lin C.-W.C.
        • Macedo L.G.
        • McAuley J.
        • Maher C.
        An updated overview of clinical guidelines for the management of non-specific low back pain in primary care.
        Eur Spine J. 2010; 19: 2075-2094
        • Paige N.M.
        • Miake-Lye I.M.
        • Booth M.S.
        • et al.
        Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis.
        JAMA. 2017; 317: 1451-1460
        • Peek A.L.
        • Miller C.
        • Heneghan N.R.
        Thoracic manual therapy in the management of non-specific shoulder pain: a systematic review.
        J Man Manip Ther. 2015; 23: 176-187
        • Southerst D.
        • Yu H.
        • Randhawa K.
        • et al.
        The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
        Chiropr Man Ther. 2015; 23: 30
        • Carlesso L.C.
        • Macdermid J.C.
        • Gross A.R.
        • Walton D.M.
        • Santaguida P.L.
        Treatment preferences amongst physical therapists and chiropractors for the management of neck pain: results of an international survey.
        Chiropr Man Ther. 2014; 22: 11
        • Francke A.L.
        • Smit M.C.
        • de Veer A.J.
        • Mistiaen P.
        Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.
        BMC Med Inform Decis Mak. 2008; 8: 38
        • Mulley A.G.
        Inconvenient truths about supplier induced demand and unwarranted variation in medical practice.
        BMJ. 2009; 339: b4073
      1. Ancillary laboratory and radiology for the MHS Data Repository (MDR) (version 1.06.01). Defense Health Agency.
        (Available at:)
        • Benchimol E.I.
        • Smeeth L.
        • Guttmann A.
        • et al.
        The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement.
        PLoS Med. 2015; 12: e1001885
        • Langan S.M.
        • Cook C.
        • Benchimol E.I.
        Improving the reporting of studies using routinely collected health data in physical therapy.
        J Orthop Sports Phys Ther. 2016; 46: 126-127
        • Chou R.
        • Huffman L.H.
        • American Pain Society
        • American College of Physicians
        Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.
        Ann Intern Med. 2007; 147: 492-504
        • Vincent K.
        • Maigne J.-Y.
        • Fischhoff C.
        • Lanlo O.
        • Dagenais S.
        Systematic review of manual therapies for nonspecific neck pain.
        Joint Bone Spine. 2013; 80: 508-515
        • Page M.J.
        • Green S.
        • McBain B.
        • et al.
        Manual therapy and exercise for rotator cuff disease.
        Cochrane Database Syst Rev. 2016; : CD012224
        • Camarinos J.
        • Marinko L.
        Effectiveness of manual physical therapy for painful shoulder conditions: a systematic review.
        J Man Manip Ther. 2009; 17: 206-215
        • Johnson S.M.
        • Kurtz M.E.
        Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession.
        Acad Med. 2001; 76: 821-828
        • Roberge R.J.
        • Roberge M.R.
        Overcoming barriers to the use of osteopathic manipulation techniques in the emergency department.
        West J Emerg Med. 2009; 10: 184-189
        • Fraser J.J.
        • Glaviano N.R.
        • Hertel J.
        Utilization of physical therapy intervention among patients with plantar fasciitis in the United States.
        J Orthop Sports Phys Ther. 2017; 47: 49-55
        • Haik M.N.
        • Alburquerque-Sendín F.
        • Silva C.Z.
        • Siqueira-Junior A.L.
        • Ribeiro I.L.
        • Camargo P.R.
        Scapular kinematics pre- and post-thoracic thrust manipulation in individuals with and without shoulder impingement symptoms: a randomized controlled study.
        J Orthop Sports Phys Ther. 2014; 44: 475-487
        • Sueki D.G.
        • Cleland J.A.
        • Wainner R.S.
        A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications.
        J Man Manip Ther. 2013; 21: 90-102
        • McDevitt A.
        • Young J.
        • Mintken P.
        • Cleland J.
        Regional interdependence and manual therapy directed at the thoracic spine.
        J Man Manip Ther. 2015; 23: 139-146
        • Staud R.
        • Price D.D.
        • Robinson M.E.
        • Vierck Jr., C.J.
        Body pain area and pain-related negative affect predict clinical pain intensity in patients with fibromyalgia.
        J Pain. 2004; 5: 338-343
        • Visser E.J.
        • Ramachenderan J.
        • Davies S.J.
        • Parsons R.
        Chronic widespread pain drawn on a body diagram is a screening tool for increased pain sensitization, psycho-social load, and utilization of pain management strategies.
        Pain Pract. 2016; 16: 31-37
        • Mansfield K.E.
        • Sim J.
        • Croft P.
        • Jordan K.P.
        Identifying patients with chronic widespread pain in primary care.
        Pain. 2017; 158: 110-119
        • Fritz J.M.
        • Childs J.D.
        • Wainner R.S.
        • Flynn T.W.
        Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs.
        Spine (Phila Pa 1976). 2012; 37: 2114-2121
        • Childs J.D.
        • Fritz J.M.
        • Flynn T.W.
        • et al.
        A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study.
        Ann Intern Med. 2004; 141: 920-928
        • Fritz J.M.
        • Childs J.D.
        • Flynn T.W.
        Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention.
        BMC Fam Pract. 2005; 6: 29

      Linked Article

      • Correction
        Archives of Physical Medicine and RehabilitationVol. 99Issue 8
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          The article by Rhon, Greenlee and Fritz, Utilization of Manipulative Treatment for Spine and Shoulder Conditions Between Different Medical Providers in a Large Military Hospital, published in Archives of Physical Medicine and Rehabilitation 2018; 99: 72–81 ( https://doi.org/10.1016/j.apmr.2017.06.010 ), contained errors in the abstract. The value of 1870 is an error. The first sentence of the Results section should have read “and 1883 of those received this treatment in a military facility (24.7%).”
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