To examine patterns of ambulatory care and hospital utilization for people with musculoskeletal disorders (MSDs), including arthritis and related conditions, bone and spinal conditions, trauma and related conditions, and unspecified MSDs.
Administrative data from the Ontario Health Insurance Plan database for ambulatory care physician visits, the National Ambulatory Care Reporting System database for day (outpatient) surgeries and emergency department visits, and the Discharge Abstract Database for hospital discharges were used to examine health care utilization for MSDs in fiscal year 2006-2007. Person visit rates (number of people with physician visits or hospital encounters per population) were calculated.
Overall, 22.3% of Ontario's population (2.8 million persons) saw a physician for an MSD in ambulatory settings. Person visit rates were highest for arthritis and related conditions (107.7 per 1,000 population), followed by trauma and related conditions (89.6 per 1,000 population), unspecified MSDs (71.0 per 1,000 population), and bone and spinal conditions (62.4 per 1,000 population). The majority of visits were to primary care physicians, with 83.2% of those with visits for all MSDs seeing a primary care physician at least once. Overall, 33.0% of people with a physician visit for an MSD saw a specialist, with orthopedic surgeons being the most commonly consulted type of specialist. In hospital settings, person visit rates for MSDs were highest in the emergency department, followed by day surgeries and inpatient hospitalizations.
The findings of our study highlight the magnitude of health care utilization for MSDs and the central role of primary care physicians in the management of these conditions.
To make a preliminary appraisal of the types of unpleasant reactions reported by patients after spinal manipulation and to estimate their frequency.
Standardized interview data collected in a longitudinal survey.
Ten chiropractors collected data on all unpleasant reactions that were reported after a maximum of six visits by ten consecutive patients per chiropractor, with the use of a questionnaire that contained mainly closed-ended questions.
Following 368 treatments in 95 patients, some type of side-effect was reported after 1/3 of treatments. Local or radiating symptoms were most commonly reported (23%). No alarming events were reported. Ninety percent of all reactions were graded by the patients as moderate or slight. They commenced on the day of therapy in 87% of cases, and had disappeared within 24 hours in 83%.
Results from this preliminary study indicate that reactions to spinal manipulation may be relatively common but benign in nature and of short duration. No estimate could be made of rare or serious side-effects.