Abstract
INTRODUCTION: Limited research suggests that spinal manipulative therapy (SMT) might positively influence balance, yet its association with falls remains underexplored. We hypothesized that older adults receiving chiropractic SMT for spinal pain would have a reduced fall risk during 13 months of follow-up compared to matched controls. METHODS: We searched >116 million patient records from TriNetX (2013-2023; Cambridge, MA, US) to identify adults aged ≥65 years with spinal pain. After excluding those with major fall risk factors, we formed SMT and non-SMT cohorts, using propensity score matching to control for confounders (e.g., age, sex, comorbidities). Risk ratios (RR) with 95% CIs and p-values were calculated for primary (fall) and secondary (limb fracture) outcomes over 13 months. We explored the cumulative incidence of falls and fractures and negative control outcomes (colonoscopy, vital signs, diabetes, nicotine/tobacco screening). RESULTS: After matching, each cohort had 1,666 patients (mean age 72 years). The SMT cohort had a lower fall rate than the non-SMT cohort (3.8% vs. 5.4%), yielding an RR (95% CI) of 0.71 ((0.52, 0.97); p=0.0319). Cumulative incidences revealed a brief lag in SMT cohort fall incidence. There was no meaningful difference in limb fractures (RR of 1.16 (0.87, 1.54); p=0.3153). Negative control outcomes were similar between cohorts. CONCLUSIONS: This study suggests that older adults receiving SMT for spinal pain may have a reduced risk of falls. However, given the observational nature of the study and the lack of significant differences in limb fracture incidence, the clinical significance of these findings remains uncertain. Further research, including randomized controlled trials, is needed to explore injurious falls, care utilization, pain, and costs.