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Does case misclassification threaten the validity of studies investigating the relationship between neck manipulation and vertebral artery dissection stroke? Yes

Overview of attention for article published in Chiropractic & Manual Therapies, November 2016
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • Among the highest-scoring outputs from this source (#44 of 543)
  • High Attention Score compared to outputs of the same age (93rd percentile)
  • High Attention Score compared to outputs of the same age and source (93rd percentile)

Mentioned by

blogs
3 blogs
twitter
14 tweeters
facebook
2 Facebook pages

Citations

dimensions_citation
3 Dimensions

Readers on

mendeley
33 Mendeley
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Title
Does case misclassification threaten the validity of studies investigating the relationship between neck manipulation and vertebral artery dissection stroke? Yes
Published in
Chiropractic & Manual Therapies, November 2016
DOI 10.1186/s12998-016-0123-x
Pubmed ID
Authors

Jessica K. Paulus, David E. Thaler

Abstract

For patients and health care providers who are considering spinal manipulative therapy of the neck, it is crucial to establish if it is a trigger for cervical artery dissection and/or stroke, and if it is, the magnitude of the risk. We discuss the biological plausibility of how neck manipulation could cause cervical artery dissection. We also discuss how case misclassification threatens the validity of influential published studies that have investigated the relationship between neck manipulation and dissection. Our position is supported by the fact that the largest epidemiologic studies of neck manipulation safety with respect to neurological outcomes have relied on International Classification of Diseases-9 codes for case identification. However, the application of these codes in prior studies failed to identify dissections (rather than strokes in general) and so conclusions from those studies are invalid. There are several methodological challenges to understanding the association between neck manipulation and vertebral artery dissection. Addressing these issues is critical because even a modest association between neck manipulation and cervical artery dissection could translate into a significant number of avoidable dissections given the widespread use of neck manipulation by providers from various backgrounds. We believe that valid case classification, accurate measurement of manipulative procedures, and addressing reverse causation bias should be top priorities for future research.

Twitter Demographics

The data shown below were collected from the profiles of 14 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 33 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Sweden 1 3%
Australia 1 3%
Unknown 31 94%

Demographic breakdown

Readers by professional status Count As %
Researcher 8 24%
Student > Doctoral Student 4 12%
Student > Master 4 12%
Student > Bachelor 4 12%
Other 3 9%
Other 5 15%
Unknown 5 15%
Readers by discipline Count As %
Medicine and Dentistry 17 52%
Nursing and Health Professions 4 12%
Agricultural and Biological Sciences 2 6%
Biochemistry, Genetics and Molecular Biology 1 3%
Neuroscience 1 3%
Other 0 0%
Unknown 8 24%

Attention Score in Context

This research output has an Altmetric Attention Score of 35. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 15 September 2022.
All research outputs
#967,974
of 22,691,736 outputs
Outputs from Chiropractic & Manual Therapies
#44
of 543 outputs
Outputs of similar age
#20,075
of 311,111 outputs
Outputs of similar age from Chiropractic & Manual Therapies
#1
of 15 outputs
Altmetric has tracked 22,691,736 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 95th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 543 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 14.0. This one has done particularly well, scoring higher than 91% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 311,111 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 93% of its contemporaries.
We're also able to compare this research output to 15 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 93% of its contemporaries.