Back pain amongst 8,910 young Australian women: a longitudinal analysis of the use of conventional providers, complementary and alternative medicine (CAM) practitioners and self-prescribed CAM

Use of massage therapy by mid-aged and older Australian women

BACKGROUND

Massage is a widely acceptable and popular form of complementary medicine (CM) among Australian women. While there is some research that reports on massage use in younger women, there is minimal research exploring massage use in the treatment of chronic illness in older women. This study provides an estimate of the prevalence of massage use, as well as identifying the characteristics significantly associated with consultation with a massage therapist, for mid-age and older Australian women.

METHODS

A cross-sectional sub-study was conducted on a sample of women drawn from the 45 and Up Study; a large cohort study of adults aged 45 years and over. Data from 1795 women were included in the analyses and massage use was compared against measures of demographics, health status and health care utilisation.

RESULTS

A total of 174 (7.7%) women consulted with a massage therapist in the previous 12 months. Women were more likely to consult a massage therapist if they have tertiary level education (O.R. = 1.67; 95% C.I.: 1.04, 2.65; p = 0.031), private health insurance (O.R. = 6.37; 95% C.I.: 4.41, 9.19; p < 0.001) and/or osteoarthritis (O.R. = 1.72; 95% C.I.: 1.19, 2.48; p = 0.004). They were also more likely to consult a massage therapist if they have a poorer health-related quality of life (HRQoL) (O.R. = 1.14; 95% C.I.: 1.04, 1.27; p = 0.007).

CONCLUSION

Older, tertiary-level educated Australian women with private health insurance were more likely to use massage therapy, as were women with osteoarthritis specifically. Women with lower HRQoL were found to be more likely to use massage therapy in the treatment of their chronic illness. This research provides insight into the determinants of massage use among ageing women and is useful for governments in consideration of accessibility to holistic healthcare when developing public policy for healthcare in Australia.

Spinal manipulative therapy in older adults with chronic low back pain: an individual participant data meta-analysis

PURPOSE

Many systematic reviews have reported on the effectiveness of spinal manipulative therapy (SMT) for low back pain (LBP) in adults. Much less is known about the older population regarding the effects of SMT.

OBJECTIVE

To assess the effects of SMT on pain and function in older adults with chronic LBP in an individual participant data (IPD) meta-analysis.

SETTING

Electronic databases from 2000 until June 2020, and reference lists of eligible trials and related reviews.

DESIGN AND SUBJECTS

Randomized controlled trials (RCTs) which examined the effects of SMT in adults with chronic LBP compared to interventions recommended in international LBP guidelines.

METHODS

Authors of trials eligible for our IPD meta-analysis were contacted to share data. Two review authors conducted a risk of bias assessment. Primary results were examined in a one-stage mixed model, and a two-stage analysis was conducted in order to confirm findings.

MAIN OUTCOMES AND MEASURES

Pain and functional status examined at 4, 13, 26, and 52 weeks.

RESULTS

10 studies were retrieved, including 786 individuals, of which 261 were between 65 and 91 years of age. There is moderate-quality evidence that SMT results in similar outcomes at 4 weeks (pain: mean difference [MD] - 2.56, 95% confidence interval [CI] - 5.78 to 0.66; functional status: standardized mean difference [SMD] - 0.18, 95% CI - 0.41 to 0.05). Second-stage and sensitivity analysis confirmed these findings.

CONCLUSION

SMT provides similar outcomes to recommended interventions for pain and functional status in the older adult with chronic LBP. SMT should be considered a treatment for this patient population.

Axial Spondyloarthritis in the Chiropractic Care Setting: A Systematic Literature Review

ABSTRACT

Diagnosis of axial spondyloarthritis (axSpA), an immune-mediated inflammatory disease, is commonly associated with chronic inflammatory back pain (IBP) and often occurs years after initial onset of clinical symptoms. Recognition of IBP is important for timely referral of patients with suspected axSpA to a rheumatologist. Patients with all types of back pain are treated in chiropractic care, but the proportion of patients with undiagnosed axSpA is unknown. This systematic literature review investigated the presence of axSpA in patients treated by chiropractors and identified the chiropractor's role in axSpA diagnosis, referral, and management. A PubMed search was conducted using the following search strings: "chiropract*" AND ("sacroiliac" OR "back pain" OR "spondyloarthritis" OR "ankylosing spondylitis"); English language, since 2009; and (chiropractic OR chiropractor) AND (ankylosing spondylitis OR axial spondyloarthritis), with no date limits. Of 652 articles identified in the searches, 27 met the inclusion criteria. Although back pain was identified as a common reason for patients seeking chiropractic care, there was no mention of axSpA, ankylosing spondylitis, or the distinction between mechanical and IBP. Data from relevant articles suggested that the majority of patients seeking chiropractic care have lower back pain, whereas no articles reported axSpA in this patient population. The near absence of any identified articles on axSpA in chiropractic care may be due to underrecognition of axSpA, resulting in delayed rheumatology referral and appropriate management. Better awareness and increased use of validated screening tools could reduce diagnostic delay of axSpA in chiropractic care.

Massage therapy utilisation by Australian women: Prevalence and determinants

OBJECTIVES

Massage is a popular form of health care used among women, yet little is known about the characteristics of women who use massage therapy and the rationale for its use. This study reports the prevalence and characteristics of young and middle-aged Australian women who consulted a massage therapist.

DESIGN

The study analysed data from the Australian Longitudinal Study on Women's Health; a nationally-representative sample of Australian women. The data from 7,993 young, and 9,102 middle-aged women were included in the analyses and massage use was compared against measures of health status, health care utilisation, and demographics.

RESULTS

Prevalence of consultation with a massage therapist in the previous 12 months was 42.4% in young women and 25.2% in middle-aged women. Women who consulted a massage therapist were more likely to consult other complementary medicine practitioners and/or use self-prescribed complementary medicine. Both young and middle-aged women were more likely to consult a massage therapist if they experienced musculoskeletal problems; however less likely, with chronic disease such as diabetes and hypertension.

CONCLUSION

Despite large numbers of young and middle-aged Australian women consulting a massage therapist, no Australian studies investigate the prevalence of massage consultations and report correlations with characteristics relevant to demographic, health status and health service data. Our findings highlight the need for further investigation of women's choices relevant to the use of massage therapy. Such research could shape the future of women's health care by providing insight into women's decision making around massage therapy, conventional treatment and healthcare utilisation.

Course of Back Pain in the Canadian Population: Trajectories, Predictors, and Outcomes

OBJECTIVE

To identify and describe back pain trajectory groups and to compare indicators of health status, medication, and health care use in these groups.

METHODS

A representative sample (n = 12,782) of the Canadian population was followed-up from 1994/1995 to 2010/2011. Participants were interviewed biannually and provided data on sociodemographic (e.g., education) and behavior-related (e.g., physical activity) factors, depression, comorbidities, pain, disability, medication use (e.g., opioids), and health care use (e.g., primary care visits). We used group-based trajectory analysis to categorize participants according to patterns in the course of their back pain during the 16-year follow-up period and compared indicators of pain, disability, medication, and health care use in the trajectory groups.

RESULTS

A total of 45.6% of the participants reported back pain at least once during follow-up. Of those, we identified 4 trajectories: persistent (18.0%), developing (28.1%), recovery (20.5%), and occasional (33.4%). The persistent and developing groups were characterized as having pain that prevented activities, disability, depression, and comorbidities. There were significant differences in the patterns of medication and health care use across the groups, with a general trend of most to least health care and medication use in the persistent, developing, recovering, and occasional groups. Those in the recovery group had an increasing trajectory reflecting opioid and antidepressant use.

CONCLUSION

Approximately 1 in 5 people with back pain experience a persistent pain trajectory with an associated increase in pain, disability, and health care use. Further research is needed to determine whether the groups identified represent different diagnoses, which may provide insight into the selection of stratified treatment and aid in designing early prevention and management strategies in the population.

The clinical factors associated with benefit finding of complementary medicine use in patients with back pain: A cross-sectional study with cluster analysis

BACKGROUND

Complementary and alternative medicine (CAM) use has been increasing.

OBJECTIVE

To identify the factors associated with perceived benefit from CAM methods in back problems.

METHODS

The study was conducted on patients who practiced any CAM methods due to complaints of back pain. Social-demographic properties, details of CAM methods employed were questioned. Severity of pain was measured by visual analog scale (VAS); benefits were evaluated by the Likert scale. Hierarchical cluster analysis was used to discover relationships among variables.

RESULTS

In total, 500 patients (265 female, 235 male) were included in the study. Mostly used methods were herbal therapy (32%), balneotherapy (31%), cupping (19.4%) and massage-manipulation (19.2%). Of patients, 355 (71%) were satisfied. The variables associated with benefit finding were female gender, age, chronicity and severity of pain, high educational level, upper middle income status, use as a result of recommendation, dissatisfaction with conventional methods, residence in an urban area, non-herbal method use, being married, and social insurance (p < 0.005).

CONCLUSION

The majority of patients using CAM perceived benefits; in particular, women living in urban areas, highly educated, aged more than 40, who suffer from severe chronic back pain, may be more inclined to go to CAM therapists.

The influence of communication and information sources upon decision-making around complementary and alternative medicine use for back pain among Australian women aged 60-65 years

This study examined factors influencing decision-making on complementary and alternative medicine (CAM) use for back pain and back pain sufferers' communication about CAM use. A cross-sectional postal survey was conducted in 2011/2012 as a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH). The sample contained 1620 women from the 1945-1951 cohort of the ALSWH, aged 60-65 years who were eligible for the sub-study, as they had experienced back pain during 12 months prior to the survey. Of these, 1310 (80.9%) returned completed questionnaires. A significant proportion of women consulted a CAM practitioner (76%, n = 1001) and/or had self-prescribed CAM treatment (75%, n = 985). Of the women who used CAM for their back pain, 20% consulted their general practitioner (GP) prior to using CAM and 34% always informed their GP following CAM use. Forty-three per cent of the women were influenced by their doctors, 39% by friends/colleagues, 36% by family/relatives, 33% by their partner, 30% by a CAM practitioner, 20% by a pharmacist, 16% by a book/magazine, 11% by mass media, 10% by an allied health worker and 6% by the Internet. Our results show that information sources used by women for their decision-making on CAM use differed according to the symptoms. While non-professional information sources (e.g. family/relatives) positively influenced women in their decision to use CAM for a range of back pain-related symptoms (e.g. headaches/migraines), doctors and allied health workers (e.g. nurses) negatively influenced women in their decision to consult a CAM practitioner for a range of back pain-related symptoms (e.g. headaches/migraines, neck pain). Women seek information from a wide range of professional and non-professional sources with regard to their decision-making around CAM use for back pain. Back pain care providers need to ensure effective communication with their back pain patients regarding safe, effective and co-ordinated back pain care options.

Outcomes of a pilot study in chiropractic practices in Western Australia

BACKGROUND

This paper reports the quantitative outcomes of a mixed-methods pilot study of the characteristics and demographics of chiropractic practices and patients in Western Australia.

METHODS

This was a mixed-methods data transformation model (qualitative to quantitative) pilot study. A non-random sample of chiropractic practices across Western Australia was recruited and data collected anonymously from consecutive new patients using an online platform. Data covered practice and patient demographics and characteristics, alongside quality of life measures. A descriptive quantitative analysis characterised the sample, and the patient population was stratified by main reason for presentation to compare characteristics according to the presence of secondary complaints. Odds ratios were calculated to estimate the odds of a secondary complaint for various combinations of main complaints, from univariate logistic regression models.

RESULTS

Of the 539 registered practitioners in WA in July 2014, 33 agreed to participate, from 20 different practices. Ten participating practices provided data on 325 adult new patients. The recruited practices (metropolitan n = 8, regional n = 2) had a positive response rate of 79.7 % (n = 301 metropolitan and n = 24 regional patients), mean age 36.3 years (range 18-74) (53.2 % female). Spinal problems were reported as the main reason for consultation by 67 % and as secondary reasons by 77.2 % of patients. People presented primarily for health maintenance or a general health check in 11.4 %, and as a secondary reason 14.8 %. There were 30 % of people below societal norms for the SF-12 Physical Component Score (mean 47.19, 95 % CI; 46.27-48.19) and 86 % for the Mental Component Score (mean 36.64, 95 % CI; 35.93-37.65), Pain Impact Questionnaire mean scores were 54.60 (95 % CI; 53.32-55.88).

CONCLUSIONS

Patients presented to chiropractors in Western Australia with a fairly wide range of conditions, but primarily spinal and musculoskeletal-related problems. A significant proportion of patients had associated, or found to be at risk of, depression. Consequently, there are responsibilities and opportunities for chiropractors with respect to providing care services that include health promotion and well-being education related to musculoskeletal/spinal and mental health. This pilot study supports the feasibility of a future confirmatory study where the potential role of chiropractors in spinal/musculoskeletal health management may be explored.

TRIAL REGISTRATION

ACTRN12616000434493: Australian New Zealand Clinical Trials Registry (ANZCTR), Registered 5 April 2016, First participant enrolled 01 July 2014 Retrospectively Registered.

Severity of back pain may influence choice and order of practitioner consultations across conventional, allied and complementary health care: a cross-sectional study of 1851 mid-age Australian women

BACKGROUND

Back pain is a common, disabling and costly disorder for which patients often consult with a wide range of health practitioners. Unfortunately, no research to date has directly examined the association between the severity of back pain and back pain sufferers' choice of whom and in what order to consult different health practitioners.

METHODS

This is a sub-study of the large nationally representative Australian Longitudinal Study on Women's Health (ALSWH). The mid-age cohort women (born 1946-51, n = 13,715) of the ALSWH were recruited from the Australian national Medicare database in 1996. These women have been surveyed six time, with survey 6 being conducted in 2010 (n = 10,011). Mid-age women (n = 1851) who in 2010 had sought help from a health care practitioner for their back pain were mailed a self-report questionnaire targeting their previous 12 months of health services utilisation, health status and their levels of back pain intensity.

RESULTS

A total of 1620 women were deemed eligible and 1310 (80.9 %) returned completed questionnaires. Mid-age women with back pain visited various conventional, allied health and CAM practitioners for care: 75.6 % consulted a CAM practitioner; 58.4 % consulted a medical doctor; and 54.2 % consulted an allied health practitioner. Women with the most severe back pain sought conventional care from a general practitioner, and those who consulted a general practitioner first had more severe back pain than those who consulted another practitioner first. Following the general practitioner visit, the women with more severe back pain were more likely to be referred to a conventional specialist, and those with less severe back pain were more likely to be referred to a physiotherapist.

CONCLUSIONS

Our findings suggest that women with more severe back pain are likely to visit a conventional practitioner first, whereas women with less severe back pain are likely to explore a range of treatment options including CAM practitioners. The improvement of back pain over time following the various possible sequencing of consultations with different types of health practitioners is a topic with implications for ensuring safe and effective back pain care and worthy of further detailed investigation.

Back pain sufferers' attitudes toward consultations with CAM practitioners and self- prescribed CAM products: A study of a nationally representative sample of 1310 Australian women aged 60-65 years

OBJECTIVE

To analyze back pain sufferers' attitudes toward consultations with complementary and alternative medicine (CAM) practitioners and self-prescribed CAM products.

METHODS

A cross-sectional survey of a nationally representative sample of Australian women aged 60-65 years.

RESULTS

A significant number of women with back pain consulted a massage therapist (41.4%, n=578), a chiropractor (37.3%, n=488), an acupuncturist (13.3%, n=174), used self-prescribed supplements (59.2%, n=776), vitamins/minerals (45.2%, n=592) and/or herbal medicines (13.1%, n=172). Women who perceived CAM as providing greater control over their body/health were more likely to have consulted a chiropractor (OR=4.21; 95% CI; 2.16, 8.19) and/or self- prescribed supplements (OR=2.38; 95% CI: 1.05, 3.49) than those who did not perceive CAM as providing greater control over their body/health. Women who perceived CAM as natural (OR=1.56; 95% CI: 1.02, 2.37) or promoting a holistic approach to health (OR=2.73; 95% CI: 1.60, 4.64) were more likely to have self-prescribed vitamins/minerals than those who did not perceive CAM as natural and promoting a holistic approach to health. Women who expressed that knowledge about evidence of CAM as important to them were more likely to have self-prescribed herbal medicines (OR=7.15; 95% CI: 1.72, 29.64) than those who did not express an interest in knowledge about evidence of CAM.

CONCLUSION

Certain key attitudes toward CAM influence back pain sufferers' choice of CAM use, highlighting the need for back pain care providers to ensure appropriate enquiry and discussion with their patients regarding consulting CAM practitioners and/or self-prescribing CAM products for back pain.

An integrative review of complementary and alternative medicine use for back pain: a focus on prevalence, reasons for use, influential factors, self-perceived effectiveness, and communication

BACKGROUND CONTEXT

Back pain is the most prevalent of musculoskeletal conditions, and back pain sufferers have been identified as high users of complementary and alternative medicine (CAM). Despite lacking evidence, CAM treatments (e.g., acupuncture, chiropractic, and massage) and CAM products (eg, vitamins, supplements, and aromatherapy oils) for back pain care have become widely available internationally, and CAM use by back pain sufferers has become a significant health service issue. However, to date, there has been no integrative review on CAM use for back pain.

PURPOSE

This study aims to conduct an integrative review on CAM use for back pain focusing on prevalence of use, commonly used CAM, characteristics of users, factors influencing decision making, self-perceived effectiveness, and communication with health-care providers.

STUDY DESIGN/SETTING

The study is based on an integrative literature review.

METHODS

A comprehensive search of international literature from 2000 to 2014 in MEDLINE, CINHAL, AMED, DARE, EMBASE, ExceptaMedica, psycINFO, and SCOPUS databases was conducted. The search was limited to peer-reviewed articles published in English language and reporting empirical research findings on CAM use for back pain.

RESULTS

The review reveals a considerable variation in prevalences of CAM use for back pain internationally. Acupuncture, chiropractic, osteopathy, and massage therapy are the commonly used CAM treatments besides a range of self-prescribed CAM, and back pain sufferers use CAM alongside conventional medical treatments. Female gender, chronicity of back pain, and previous exposure to CAM are key predictors of CAM use for back pain as highlighted from the reviewed literature. Family, friends, and recommendation by doctors appear to influence decision making on CAM use for back pain. The review reveals that users of CAM for back pain tend to report CAM as beneficial, but there is little knowledge on communication between CAM users with back pain and health-care providers about such use. Existing literature is largely based on the research investigating CAM use for back pain among a range of other health conditions. Further rigorous research is needed to investigate the use of a wider range of CAM treatments, particularly self-prescribed CAM for back pain.

CONCLUSIONS

The review findings provide insights for health-care providers and policy makers on the range of CAM treatments used by back pain sufferers. Conventional medical and CAM practitioners should be aware of back pain sufferers' decision making regarding a range of CAM treatments and be prepared to communicate with patients on safe and effective CAM treatments for back pain.

What is the perceived impact of Alexander technique lessons on health status, costs and pain management in the real life setting of an English hospital? The results of a mixed methods evaluation of an Alexander technique service for those with chronic back pain

Background

Randomised controlled trial evidence indicates that Alexander Technique is clinically and cost effective for chronic back pain. The aim of this mixed methods evaluation was to explore the role and perceived impact of Alexander Technique lessons in the naturalistic setting of an acute hospital Pain Management Clinic in England.

Methods

To capture changes in health status and resource use amongst service users, 43 service users were administered three widely used questionnaires (Brief Pain Inventory, MYMOP and Client Service Resource Inventory) at three time points: baseline, six weeks and three months after baseline. We also carried out 27 telephone interviews with service users and seven face-to-face interviews with pain clinic staff and Alexander Technique teachers. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically.

Results

Those taking Alexander Technique lessons reported small improvements in health outcomes, and condition-related costs fell. However, due to the non-randomised, uncontrolled nature of the study design, changes cannot be attributed to the Alexander Technique lessons. Service users stated that their relationship to pain and pain management had changed, especially those who were more committed to practising the techniques regularly. These changes may explain the reported reduction in pain-related service use and the corresponding lower associated costs.

Conclusions

Alexander Technique lessons may be used as another approach to pain management. The findings suggests that Alexander Technique lessons can help improve self-efficacy for those who are sufficiently motivated, which in turn may have an impact on service utilisation levels.

Helping address the national research and research capacity needs of Australian chiropractic: introducing the Australian Chiropractic Research Network (ACORN) project

Chiropractic is a popular health care choice in Australia and yet major gaps in our empirical understanding of this area of practice remain. Furthermore, while some research excellence exists, a largely uncoordinated approach to research activity and development has in effect led to silos of interest and a lack of strategic ‘big-picture’ planning essential to producing a sustainable research culture and capacity for the profession. This commentary identifies the significance of a number of key features - including a national, coordinated focus, and a rich engagement with the practitioner and patient base amongst others – arguably important to the future development of research and research capacity within Australian chiropractic. The design features and phases of the Australian Chiropractic Research Network (ACORN) project are also outlined. ACORN is one contemporary initiative specifically developed to address chiropractic’s research and research capacity building needs and help grow a broad evidence-base to inform safe, effective patient care.

Health care utilisation and out-of-pocket expenditure associated with back pain: a nationally representative survey of Australian women

BACKGROUND

Back pain impacts on a significant proportion of the Australian population over the life course and has high prevalence rates among women, particularly in older age. Back pain care is characterised by multiple practitioner and self-prescribed treatment options, and the out-of-pocket costs associated with consultations and self-prescribed treatments have not been examined to date.

OBJECTIVE

To analyse the extent of health care practitioner consultations and self-prescribed treatment for back pain care among Australian women, and to assess the self-reported costs associated with such usage.

METHODS

Survey of 1,310 women (response rate 80.9%) who reported seeking help for back pain from the '1946-51 cohort' of the Australian Longitudinal Study on Women's Health. Women were asked about their use of health care practitioners and self-prescribed treatments for back pain and the costs associated with such usage.

RESULTS

In the past year 76.4% consulted a complementary and alternative practitioner, 56% an allied health practitioner and 59.2% a GP/medical specialist. Overall, women consulted with, on average, 3.0 (SD = 2.0) different health care practitioners, and had, on average, 12.2 (SD = 9.7) discrete health care practitioner consultations for back pain. Average self-reported out-of-pocket expenditure on practitioners and self-prescribed treatments for back pain care per annum was AU$873.10.

CONCLUSIONS

Multiple provider usage for various but distinct purposes (i.e. pain/mobility versus anxiety/stress) points to the need for further research into patient motivations and experiences of back pain care in order to improve and enhance access to and continuity of care. Our results suggest that the cost of back pain care represents a significant burden, and may ultimately limit women's access to multiple providers. We extrapolate that for Australian working-age women, total out-of-pocket expenditure on back pain care per annum is in excess of AU$1.4 billion, thus indicating the prominence of back pain as a major economic, social and health burden.

Consultations with complementary and alternative medicine practitioners amongst wider care options for back pain: a study of a nationally representative sample of 1,310 Australian women aged 60-65 years

Back pain is a significant health service issue in Australia and internationally. Back pain sufferers can draw upon a range of health care providers including complementary and alternative medicine (CAM) practitioners. Women are higher users of health services than men and tend to use CAM frequently for musculoskeletal conditions. However, there remain important gaps in our understanding of women's consultation patterns with CAM practitioners for back pain. The objective of this study is to examine the prevalence of use and characteristics of women who use CAM practitioners for back pain. The method used was a survey of a nationally representative sample of women aged 60-65 years from the Australian Longitudinal Study on Women's Health. Women consulted a massage therapist (44.1 %, n = 578) and a chiropractor (37.3 %, n = 488) more than other CAM practitioners for their back pain. Consultations with a chiropractor for back pain were lower for women who consulted a General Practitioner (GP) (OR, 0.56; 95 % CI 0.41, 0.76) or a physiotherapist (OR, 0.53; 95 % CI 0.39, 0.72) than for those who did not consult a GP or a physiotherapist. CAM practitioner consultations for back pain were greater for women who visited a pharmacist (OR, 1.99; 95 % CI 1.23, 3.32) than for women who did not visit a pharmacist. There is substantial use of CAM practitioners alongside conventional practitioners amongst women for back pain, and there is a need to provide detailed examination of the communication between patients and their providers as well as across the diverse range of health professionals involved in back pain care.

Prevalence and determinants of complementary and alternative medicine use during pregnancy: results from a nationally representative sample of Australian pregnant women

BACKGROUND

Pregnant women have been identified as high users of complementary and alternative medicine (CAM). However, no research to date has provided a detailed analysis of the prevalence and determinants of CAM consumption amongst pregnant women.

AIM

To examine the prevalence and determinants of CAM use by pregnant women, utilising a national representative sample.

METHODS

The study sample was obtained via the Australian Longitudinal Study on Women's Health. This paper is based on a sub-study of 1,835 pregnant women, administered in 2010. The women answered questions about CAM use, demographics, pregnancy-related health concerns and health service utilisation.

RESULTS

Complementary and alternative medicine use was found to be high with 48.1% (n = 623) of pregnant women consulting a CAM practitioner and 52.0% (n = 842) of women using CAM products (excluding vitamins and minerals) during pregnancy. CAM practitioner visits were more likely for selected pregnancy-related health concerns, namely back pain or back ache, neck pain and labour preparation. Women were less likely to consult a CAM practitioner if they suffered with headaches/migraines. Employment was also found to be predictive of pregnant women's visits to a CAM practitioner. Significant health history and demographic predictors of CAM product use were tiredness and fatigue, embarking on preparation for labour and having a university education.

CONCLUSION

Most pregnant women are utilising CAM products and/or services as part of their maternity care and obstetricians, general practitioners and midwives need to enquire with women in their care about possible CAM use to help promote safe, effective coordinated maternity care.

Patterns and Determinants of Complementary and Alternative Medicine Practitioner Use among Adults with Diabetes in Queensland, Australia

There is evidence that complementary and alternative medicine (CAM) use is common among people with diabetes. The role of CAM in the treatment or management of diabetes is an emerging health issue given the potential side effects and benefits associated with the use of this kind of medicine. This paper examined patterns and determinants of CAM practitioner use in Queensland, Australia, using a large population-based sample of people with type 1 and type 2 diabetes. The study found that within a 12-month period, 7.7% of people with diabetes used the services of CAM practitioners alongside or as a complement to conventional health care service. Younger age, female gender, a higher education, having private health insurance, and engagement in preventive health behaviours are significant predictors of individuals who are more likely to visit a CAM practitioner. There was no significant difference in CAM practitioner use between people with type 1, type 2 insulin requiring, or type 2 noninsulin requiring diabetes. The findings highlight the need for further research on the role of CAM in the prevention and management of diabetes.

Policy implications of complementary and alternative medicine use in Australia: data from the National Health Survey

OBJECTIVES

The objective of this study was to investigate the drivers of complementary and alternative medicine (CAM) use in the general population in Australia and to identify key policy implications.

DATA AND METHODS

The National Health Survey 2007/2008, a representative survey of the Australian population, provides information on CAM use (practitioners and products) in the last 12 months. All adult respondents (N=15,779) aged 18 years or older are included in this study. Logistic regression is employed to determine the effect of socio-economic, condition-specific, health behavior variables, and private health insurance status on CAM use.

RESULTS

In addition to socio-economic variables known to affect CAM use, individuals who have a chronic condition, particularly a mental health condition, are more likely to use CAM. There does not appear to be a correlation between CAM use and more frequent General Practitioner use; however, ancillary private health insurance is correlated with a greater likelihood of CAM use, as expected.

CONCLUSIONS

The Australian government does not currently intervene in the CAM market in a systematic way. CAM is clearly considered to be a legitimate and important component of health care for many Australians, despite the limited availability of clinical evidence for its efficacy and safety. Policy interventions may include the regulation of CAM products, practitioners, and information as well as providing subsidies for cost-effective modalities.

Use of complementary and alternative medicine by mid-age women with back pain: a national cross-sectional survey

BACKGROUND

The use of complementary and alternative medicine (CAM) has increased significantly in Australia over the past decade. Back pain represents a common context for CAM use, with increasing utilisation of a wide range of therapies provided within and outside conventional medical facilities. We examine the relationship between back pain and use of CAM and conventional medicine in a national cohort of mid-aged Australian women.

METHODS

Data is taken from a cross-sectional survey (n = 10492) of the mid-aged cohort of the Australian Longitudinal Study on Women's Health, surveyed in 2007. The main outcome measures were: incidence of back pain the previous 12 months, and frequency of use of conventional or CAM treatments in the previous 12 months.

RESULTS

Back pain was experienced by 77% (n = 8063) of the cohort in the previous twelve month period. The majority of women with back pain only consulted with a conventional care provider (51.3%), 44.2% of women with back pain consulted with both a conventional care provider and a CAM practitioner. Women with more frequent back pain were more likely to consult a CAM practitioner, as well as seek conventional care. The most commonly utilised CAM practitioners were massage therapy (26.5% of those with back pain) and chiropractic (16.1% of those with back pain). Only 1.7% of women with back pain consulted with a CAM practitioner exclusively.

CONCLUSIONS

Mid-aged women with back pain utilise a range of conventional and CAM treatments. Consultation with CAM practitioners or self-prescribed CAM was predominantly in addition to, rather than a replacement for, conventional care. It is important that health professionals are aware of potential multiple practitioner usage in the context of back pain and are prepared to discuss such behaviours and practices with their patients.

Epidemiology: spinal manipulation utilization

The objectives of this article are to (1) describe spinal manipulation use by time, place, and person, and (2) identify predictors of the use of spinal manipulation. We conducted a systematic review of the English-language literature published from January 1, 1980 through June 30, 2011. Of 822 citations identified, 213 were deemed potentially relevant; 75 were included after further consideration. Twenty-one additional articles were identified from reference lists. The literature is heavily weighted toward North America, Europe, and Australia and thus largely precludes inferences about spinal manipulation use in other parts of the world. In the regions covered by the literature, chiropractors, osteopaths, and physical therapists are most likely to deliver spinal manipulation, often in conjunction with other conservative therapies. Back and neck pain are the most frequent indications for receiving spinal manipulation; non-musculoskeletal conditions comprise a very small percentage of indications. Although spinal manipulation is more commonly used in adults than children, evidence suggests that spinal manipulation may be more likely used for non-musculoskeletal ailments in children than in adults. Patient satisfaction with spinal manipulation is very high.