Original article
Chiropractic care amongst people with multiple sclerosis: A survey of MS therapy centres in the UK

https://doi.org/10.1016/j.clch.2009.03.005Get rights and content

Summary

Objective

Many of the musculoskeletal symptoms associated with multiple sclerosis (MS) can be managed with physical therapy. Chiropractors are well placed to deliver this, but the extent of their involvement in the team management of multiple sclerosis in the UK is unknown. The present study investigates the level of awareness and use of chiropractic by people with MS in the UK.

Methods

A retrospective cross sectional postal survey design was employed, utilising a structured, self-administered questionnaire and convenience sampling of individuals aged over 18 years with a definitive diagnosis of MS who were members of UK MS Therapy Centres.

Results

Ninety-one per cent of respondents had used complementary therapy modalities of some kind, with physiotherapy being the most popular (52%), followed by massage (44%), then chiropractic (42%). Of those that had used chiropractic, 68% used it to manage their MS symptoms and most would recommend it to others with MS. Just under half had consulted their General Practitioner for approval prior to receiving the treatment, with 79% obtaining support. Of those who did not use chiropractic, 78% cited lack of knowledge about chiropractic as the main reason. All of the MS therapy centres contacted during this study offered physiotherapy and massage, but none offered chiropractic.

Conclusions

There is moderate uptake of chiropractic by people with MS in the UK together with a willingness to recommend it. Further awareness of the potential benefits of chiropractic amongst stakeholders may help its integration into the team management of MS.

Introduction

Multiple sclerosis (MS) is an inflammatory demyelinating condition of the central nervous system (CNS), producing a large variety of symptoms, and progressive functional impairment, which varies widely with each individual. Commonly reported symptoms include: mobility challenges, fatigue, pain, visual disturbances or blindness, impaired cognition, and problems with bowel and bladder function. This long-term, chronic neurological disorder is sometimes benign, frequently remitting, but often progressive with gradually increasing disability. The damage caused by MS can occur anywhere in the CNS and, as a result, symptoms can be extremely diverse, with a gradual loss of function a common result.1 Symptoms can come and go quite unpredictably, and no two people experience them in exactly the same way. Most of the symptoms of MS can be effectively managed, and complications avoided, with regular care by a neurologist and allied health professionals.1, 2

Between three and seven people per 100,000 globally are diagnosed with MS each year and, in the UK, prevalence is approximately 100–120 per 100,000. In all, 85,000 people in the UK are currently estimated to have MS.3

Usually diagnosed between the age of 20 and 40, MS tends to affect people at a crucial stage in their lives when they are establishing their careers, setting up home and having a family. Awareness of the treatment options available to manage a chronic neurological illness lasting upwards of 30 years is clearly important both for those with MS and those involved in their healthcare.

Sensible symptom management is recognised as a key factor for optimising quality of life for most people with MS.4 Positive outcomes for physiotherapy and neurorehabilitative interventions for a number of specific MS impairments have been reported.7, 8, 9, 10, 11 It would seem that chiropractic may potentially fit well into this overall model of care, particularly for management of musculoskeletal symptoms.14 As many as 85% of those with MS are reported to use Complementary and Alternative Medicine (CAM) at some stage over the course of their disease5, with half the GP practices in England now providing access to CAM in some form.6 In 2003, chiropractic was the second most frequently used CAM modality cited by those with MS in the USA.12 There is, however, no comparable information for those with MS in the UK. Such information is vital for the rational delivery of healthcare services and for decisions relating to the dissemination of healthcare information so that informed choices can be made. The purpose of this study was therefore to scope the level of awareness and utilisation of chiropractic amongst people with MS in the UK.

Section snippets

Materials and methods

A retrospective, cross sectional postal survey design, with a structured, self-administered questionnaire was used. The main themes explored were the number of people who use chiropractic, the frequency of its use in comparison with other forms of treatment and the extent of General Practitioner support for using chiropractic, as experienced by MS patients.

After obtaining institutional Research and Ethics approval, a list of 30 National MS Therapy Centres was obtained from the UK Multiple

Results

A total of 231 completed questionnaires were returned. The sample was predominantly female, aged between 31 and 65 with a mean age of 43, and a mean age at onset of MS of 37 (Table 1). These results compare favourably with the UK national average where the ratio of female to male is 2:1 and average age at onset of between 20 and 40 years.1, 2

A total of 210/231 (91%) of all respondents had used rehabilitation and CAM modalities of some kind. Physiotherapy was the most popular (52%), followed by

Discussion

The aim of this survey was to act as a preliminary investigation of whether people with MS utilise chiropractic, and what factors may influence this. The method was chosen so as to be as easy to implement as possible for the participating MS therapy centres; therefore, sample selection was pragmatic, rather than strictly controlled. In this sample of respondents with MS who were recruited via 8 UK MS therapy centres, 42% had chosen to receive chiropractic care. This level of utilisation of

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