Effectiveness of chiropractic care in improving sensorimotor function associated with falls risk in older people

Abstract

This thesis assessed whether chiropractic care was effective in improving sensorimotor function that is related to fall risk in community-dwelling older adults over a 12 week period. A pragmatic randomised controlled trial was conducted that compared the effect of chiropractic care to a ‘usual care’ control on proprioception (joint position sense), postural stability (static posturography), a broad measure of sensorimotor function (choice stepping reaction time), multisensory integration (the sound-induced flash illusion), and health-related quality of life (SF-36). Outcomes were assessed at four weeks and 12 weeks after a baseline assessment. Participants in the trial included 60 community dwelling older adults from the Auckland region. Of potential participants screened for eligibility, 92% were eligible. Chiropractic care was provided by 12 chiropractic practices from across Auckland in their usual practice setting, following an approach tailored to the participants’ individual clinical needs. The key findings from the study were that the chiropractic group improved compared to the usual care control group in ankle joint position sense (p=0.045, mean difference across four and 12 week assessments 0.20˚, 95% CI 0.01-0.39˚), and choice stepping reaction time (p=0.01, mean difference at 12 week assessment 118ms, 95% CI 24 to 212ms), and they were also less susceptible to the sound-induced flash illusion (p=0.01, mean difference at 12 week assessment 13.5%, 95% CI 2.9 to 24.0%). Between group differences were also observed in the physical component of health-related quality of life with the chiropractic group improving compared to the control group between the four and 12 week assessments (p=0.047, mean difference 2.4, 95% CI 0.04 to 4.8). Further research is now required to understand the potential mechanisms of action associated with the improvements that were observed in sensorimotor function, multisensory integration, and the physical component of quality of life in the chiropractic group. Future studies are also required to investigate whether chiropractic care may play a role in preventing falls in older people.