title: Chiropractic use in the Medicare population: prevalence, patterns, and associations with 1-year changes in health and satisfaction with care.
abstract: OBJECTIVE
  The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.
  
  
  METHODS
  Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.
  
  
  RESULTS
  The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.
  
  
  CONCLUSIONS
  This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.
authors.affiliation: Research Associate, Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA. Electronic address: Paula-Weigel@uiowa.edu.
authors.forename: Paula A M
authors.initials: PA
authors.lastname: Weigel
authors.affiliation: Assistant Professor, Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Hockenberry
authors.affiliation: Professor, John W. Colloton Chair of Health Management and Policy, Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA.
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data*; D006278:Medicare; D017060:Patient Satisfaction; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Activities of Daily Living; Chiropractic; Medicare; Patient Satisfaction