{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T15:36:08Z","timestamp":1784734568323,"version":"3.55.0"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T00:00:00Z","timestamp":1704412800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>The objective of this study was to evaluate the relationship between three distinct spinal manipulative therapy dose groups and escalated spine care by analyzing insurance claims from a cohort of patients with low back pain.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We compared three distinct spinal manipulative therapy dose groups (low = 1 SMT visits, moderate = 2\u201312 SMT visits, high = 13+ SMT visits), to a control group (no spinal manipulative therapy) regarding the outcome of escalated spine care. Escalated spine care procedures include imaging studies, injection procedures, emergency department visits, surgery, and opioid medication use. Propensity score matching was performed to address treatment selection bias. Modified Poisson regression modeling was used to estimate the relative risk of spine care escalation among three spinal manipulative therapy doses, adjusting for age, sex, retrospective risk score and claim count.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>83,025 claims were categorized into 11,114 unique low back pain episodes; 8,137 claims had 0 spinal manipulative therapy visits, with the remaining episodes classified as low dose (n = 404), moderate dose (n = 1,763) or high dose (n = 810). After propensity score matching, 5,348 episodes remained; 2,454 had 0 spinal manipulative therapy visits with the remaining episodes classified as low dose (n = 404), moderate dose (n = 1,761), or high dose (n = 729). The estimated relative risk (vs no spinal manipulative therapy) for any escalated spine care was 0.45 (95% confidence interval 0.38, 0.55, <jats:italic>p &lt;0<\/jats:italic>.<jats:italic>001<\/jats:italic>), 0.58 (95% confidence interval 0.53, 0.63, <jats:italic>p &lt;0<\/jats:italic>.<jats:italic>001<\/jats:italic>), and 1.03 (95% confidence interval 0.95, 1.13, <jats:italic>p = 0<\/jats:italic>.<jats:italic>461<\/jats:italic>) for low, moderate, and high dose spinal manipulative therapy groups, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>For claims associated with initial episodes of low back pain, low and moderate dose spinal manipulative therapy groups were associated with a 55% and 42% reduction, respectively, in the relative risk of any escalated spine care.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0283252","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T18:41:22Z","timestamp":1704480082000},"page":"e0283252","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Dosing of lumbar spinal manipulative therapy and its association with escalated spine care: A cohort study of insurance claims"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8134-4697","authenticated-orcid":true,"given":"Brian R.","family":"Anderson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Whedon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia M.","family":"Herman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,1,5]]},"reference":[{"issue":"14","key":"pone.0283252.ref001","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1001\/jama.2018.0158","article-title":"The State of US Health, 1990\u20132016: Burden of Diseases, Injuries, and Risk Factors Among US States","volume":"319","author":"US Burden of Disease Collaborators","year":"2018","journal-title":"JAMA"},{"issue":"6","key":"pone.0283252.ref002","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.berh.2010.10.002","article-title":"The Epidemiology of low back pain","volume":"24","author":"D Hoy","year":"2010","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"3","key":"pone.0283252.ref003","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1001\/archinternmed.2008.543","article-title":"The rising prevalence of chronic low back pain","volume":"169","author":"JK Freburger","year":"2009","journal-title":"Arch Intern Med"},{"issue":"10","key":"pone.0283252.ref004","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1007\/s00296-019-04430-5","article-title":"Health-care utilisation for low back pain: a systematic review and meta-analysis of population-based observational studies","volume":"39","author":"GK Beyera","year":"2019","journal-title":"Rheumatol Int"},{"issue":"2","key":"pone.0283252.ref005","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1002\/acr.20064","article-title":"Health care utilization for musculoskeletal disorders.","volume":"62","author":"C MacKay","year":"2010","journal-title":"Arthritis Care Res"},{"key":"pone.0283252.ref006","first-page":"2020","article-title":"Creating a priority list of non-communicable diseases to support health research funding decision-making","volume":"1","author":"S Babashahi","journal-title":"Health Policy. 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