Multiple sclerosis (MS) is a severe neurological disease, characterized by chronic course of exacerbation and remission of symptoms, leading to severe disability. The absolute number of individuals with MS is increasing in the western countries and represents a substantial challenge to treatment, prevention, health promotion, and rehabilitation. The causes of MS are still unknown [
Individuals with MS face many challenges in their everyday life, like many other groups of people with chronic illness. There is no cure for MS, the medical treatment options are limited for some types of MS, and treatments often have many side effects. In addition, MS is often characterized by a wide range of accompanying symptoms [
People with MS are widely using complementary and alternative medicine (CAM) treatments [
The survey used an internet-based questionnaire and was conducted during the period from April 2011 to June 2011. Based on knowledge from a large Danish research project that took place from 2004 to 2010 within the Danish Multiple Sclerosis Society and investigated treatment collaboration between conventional and complementary practitioners [
As previous Nordic studies had shown a lack of consensus regarding the definition of CAM [
Based on power calculations and expected dropout due to members who were deceased, lived abroad, or did not have MS (registration error), 1050 people with MS were selected randomly from the member registers of the Swedish, Norwegian, and Finnish MS societies, and 3500 people with MS were selected randomly from the member register of the Danish MS society. In Iceland, the sample included the total number of all individuals who appeared in the member register of the national MS society (In Iceland, it has not been possible to distinguish between members with MS and supporting members in the register. Letters were therefore sent to all members of the Icelandic MS society (
A letter with a personal code was sent to all respondents, asking them to fill out the questionnaire online. Receiving the questionnaire in paper form was not an option. Reminders to nonrespondents were sent twice. As shown in Table
Representative characteristics of the study population.
Denmark | Norway | Sweden | Finland | Iceland | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
OR | (CI) | OR | (CI) | OR | (CI) | OR | (CI) | |||||||
Member register |
|
7123 | 4593 | 2435 | 5845 | 384* | ||||||||
Male |
2078 (29.2) | 1321 (28.8) | 579 (23.8) | 1514 (25.9) | Data missing | |||||||||
<40 years |
1404 (19.7) | 862 (18.8) | 362 (14.9) | 1224 (20.9) | Data missing | |||||||||
41–60 years |
3607 (50.6) | 2370 (51.6) | 1251 (51.4) | 3070 (52.6) | Data missing | |||||||||
>60 years |
2112 (29.7) | 1361 (29.6) | 821 (33.7)) | 1551 (26.5) | Data missing | |||||||||
| ||||||||||||||
Survey sample |
|
3361 | 1014 | 1046 | 1045 | 384* | ||||||||
Male |
976 (29.0) | 0.99 | (0.91–1.08) | 291 (28.7) | 0.99 | (0.86–1.15) | 251 (24.0) | 1.00 | (0.85–1.19) | 274 (26.2) | 1.01 | (0.87–1.16) | Data missing | |
<40 years |
671 (19.9) | 1.01 | (0.91–1.12) | 189 (18.6) | 0.99 | (0.83–1.17) | 157 (15.0) | 1.01 | (0.82–1.23) | 222 (21.3) | 1.01 | (0.86–1.18) | Data missing | |
41–60 years |
1690 (50.3) | 0.99 | (0.92–1.06) | 520 (51.3) | 0.99 | (0.88–1.11) | 536 (51.3) | 0.99 | (0.88–1.12) | 553 (52.9) | 1.01 | (0.90–1.12) | Data missing | |
>60 years |
1001 (29.8) | 1.00 | (0.92–1.09) | 305 (30.1) | 1.01 | (0.88–1.16) | 353 (33.7) | 1.00 | (0.86–1.15) | 270 (25.8) | 0.97 | (0.84–1.12) | Data missing | |
| ||||||||||||||
Respondents |
|
1865 (55.5) | 516 (50.9) | 627 (59.9) | 551 (52.7) | 236 (61.5)* | ||||||||
Male |
520 (27.9) | 0.96 | (0.85–1.08) | 150 (29.0) | 1.01 | (0.81–1.26) | 149 (23.8) | 0.99 | (0.79–1.24) | 138 (25.0) | 0.95 | (0.75–1.20) | 54 (22.8) | |
<40 years |
351 (18.8) | 0.94 | (0.81–1.08) | 76 (14.7) | 0.79 | (0.59–1.05) | 81 (12.9) | 0.86 | (0.64–1.14) | 103 (18.7) | 0.87 | (0.68–1.13) | 62 (26.2) | |
41–60 years |
1047 (56.1) | 1.11 | (1.01–1.22)+ | 304 (58.9) | 1.14 | (0.96–1.37) | 373 (59.5) | 1.16 | (0.98–1.36) | 323 (58.6) | 1.11 | (0.93–1.31) | 137 (57.8) | |
>60 years |
468 (25.1) | 0.84 | (0.74–0.95)− | 136 (26.4) | 0.87 | (0.69–1.10) | 173 (27.6) | 0.81 | (0.66–1.01) | 125 (22.7) | 0.88 | (0.69–1.11) | 38 (16.0) |
In Iceland, it was not possible to distinguish between MS Society members with MS and supporting members. Therefore, an analysis of representativeness could not be carried out. Keeping this in mind, the results of the Icelandic data are still presented in the subsequent sections.
Comparative analyses included use of specific CAM modalities as well as specific symptoms/health issues addressed by CAM users as rationale for use. As none of the five countries constitute a natural a priory reference, we have found it most correct to employ a changing reference. The country with the lowest prevalence of a specific variable was hence used as reference for presenting odds ratios (ORs), indicating the comparative relations for each variable.
The definition of CAM treatments was based on the National Center for Complementary and Alternative Medicine’s (NCCAM) definition of CAM as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine” [
Analyses of representativeness showed no major differences regarding distribution of gender and age (it was not possible to procure data on other variables than gender and age) between the national member registers and the samples. However, as shown in Table
The total prevalence of CAM use within the last 12 months varied from 46.0% in Sweden to 58.9% in Iceland. The difference was borderline significant (
Table
CAM treatment modalities used by people with MS in the Nordic countries.
CAM modality | Denmark ( |
Norway ( |
Sweden ( |
Finland ( |
Iceland ( |
|||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
(%) | OR | (CI) |
|
(%) | OR | (CI) |
|
(%) | OR | (CI) |
|
(%) | OR | (CI) |
|
(%) | OR | (CI) | |
Supplements of vitamins and minerals | 759 | (78.5) | 1.36 | (1.02–1.82)+ | 181 | (66.5) | 1.16 | (0.83–1.61) | 171 | (59.3) | 1.03 | (0.74–1.44) | 244 | (79.7) | 1.39 | (1.00–1.91)+ | 80 | (57.5) | 1 | |
Supplements of oils | 423 | (43.7) | 1.74 | (1.18–2.56)+ | 104 | (38.2) | 1.52 | (0.98–2.34) | 88 | (30.6) | 1.21 | (0.78–1.89) | 123 | (40.2) | 1.60 | (1.04–2.44)+ | 35 | (25.2) | 1 | |
Special diet | 181 | (18.7) | 1.53 | (0.90–2.60) | 40 | (14.7) | 1.20 | (0.66–2.20) | 49 | (17.0) | 1.39 | (0.77–2.50) | 57 | (18.6) | 1.52 | (0.86–2.71) | 17 | (12.2) | 1 | |
Acupuncture | 151 | (15.6) | 2.39 | (1.47–3.88)+ | 51 | (18.7) | 2.87 | (1.67–4.93)+ | 34 | (11.8) | 1.81 | (1.12–3.21)+ | 20 | (6.5) | 1 | 29 | (20.8) | 3.19 | (1.75–5.84)+ | |
Herbal medicine | 112 | (11.6) | 1.87 | (1.13–3.08)+ | 31 | (11.4) | 1.84 | (1.01–3.32)+ | 31 | (10.7) | 1.73 | (0.96–3.14) | 19 | (6.2) | 1 | 18 | (12.9) | 2.09 | (1.06–4.10)+ | |
Reflexology | 107 | (11.1) | 7.52 | (2.75–20.60)+ | 4 | (1.5) | 1 | 9 | (3.1) | 2.13 | (0.65–6.98) | 14 | (4.5) | 3.11 | (1.01–9.57)+ | 15 | (10.8) | 7.34 | (2.39–22.53)+ | |
Yoga | 106 | (10.9) | 1.40 | (0.88–2.22) | 25 | (9.2) | 1.17 | (0.65–2.10) | 42 | (14.6) | 1.86 | (1.10–3.15)+ | 24 | (7.8) | 1 | 32 | (23.0) | 2.94 | (1.67–5.17)+ | |
Meditation | 91 | (9.4) | 1.60 | (0.95–2.70) | 24 | (8.8) | 1.50 | (0.80–2.82) | 33 | (11.4) | 1.95 | (1.07–3.54)+ | 18 | (5.9) | 1 | 19 | (13.7) | 2.32 | (1.18–4.56)+ | |
Alternative massage | 49 | (5.1) | 2.76 | (1.09–6.99)+ | 5 | (1.8) | 1 | 14 | (4.8) | 2.64 | (0.94–7.44) | 15 | (4.9) | 2.67 | (0.96–7.43) | 8 | (5.7) | 3.13 | (1.01–9.75)+ | |
Cranio sacral therapy | 45 | (4.6) | 2.53 | (0.99–6.44) | 5 | (1.8) | 1 | 8 | (2.8) | 1.51 | (0.49–4.68) | 0 | (0.0) | No data | No data | 17 | (12.2) | 6.65 | (2.40–18.41)+ | |
Other supplements (probiotics, superfood, protein supplement, antioxidants, alkaline supplement, colloid silver, enzymes, fiber supplement, amino acid supplement, glucosamine, and mitochondrial energy optimizer, Gelée Royale LDN) | 42 | (4.3) | 2.01 | (0.62–6.58) | 10 | (3.7) | 1.70 | (0.46–6.29) | 28 | (9.7) | 4.50 | (1.35–15.07)+ | 15 | (4.9) | 2.27 | (0.65–7.97) | 3 | (2.2) | 1 | |
Healing | 41 | (4.2) | 6.49 | (1.56–26.98)+ | 20 | (7.3) | 11.25 | (2.61–48.57)+ | 17 | (5.9) | 9.03 | (2.07–39.44)+ | 2 | (0.6) | 1 | 17 | (12.2) | 18.71 | (4.26–82.11)+ | |
Homeopathy | 28 | (2.9) | 1.67 | (0.64–4.36) | 15 | (5.5) | 3.18 | (1.14–8.86)+ | 5 | (1.7) | 1 | 10 | (3.3) | 1.88 | (0.64–5.57) | 7 | (5.0) | 2.90 | (0.90–9.30) | |
Amalgam removal | 22 | (2.3) | 1 | 11 | (4.0) | 1.78 | (0.85–3.71) | 8 | (2.8) | 1.22 | (0.54–2.77) | 8 | (2.6) | 1.15 | (0.51–2.61) | 7 | (5.0) | 2.21 | (0.93–5.28) | |
Qi gong | 18 | (1.8) | 1 | 9 | (3.3) | 1.78 | (0.79–4.00) | 30 | (10.4) | 5.60 | (3.07–10.19)+ | 0 | (0.0) | No data | No data | 0 | (0.0) | No data | No data | |
Naprapathy | 0 | (0.0) | No data | No data | 14 | (5.1) | 3.94 | (1.28–12.11)+ | 11 | (3.8) | 2.92 | (0.92–9.28) | 4 | (1.3) | 1 | 0 | (0.0) | No data | No data | |
CAM treatments with prevalence of use below 5% in all countries |
34 | (3.5) | 1.19 | (0.57–2.52) | 16 | (5.9) | 2.0 | (0.87–4.60) | 14 | (4.8) | 1.65 | (0.70–3.87) | 9 | (2.9) | 1 | 5 | (3.6) | 1.22 | (0.40–3.71) | |
|
||||||||||||||||||||
Use of one or more use of one or more energetic CAM modalities (including traditional Chinese acupuncture, reflexology, shiatsu massage, healing massage, cranial sacral therapy, healing, homeopathy, spritual psycho therapy, Qi gong, Tai Chi, and kinesiology) | 223 | (23.1) | 2.14 | (1.45–3.15)+ | 56 | (20.6) | 1.91 | (1.21–3.02)+ | 48 | (16.7) | (1.55) | (0.98–2.47) | 33 | (10.8) | 1 | 43 | (30.9) | 2.87 | (1.75–4.71) | |
Number of CAM modalities in use | 29 | 29 | 26 | 22 | 20 |
*It can be discussed whether CCSVI surgery should be classified as a CAM modality. Though it is not a “classic” CAM modality, we have chosen to include it in this table, based on the broad definition of CAM used in this study as an intervention not generally considered part of conventional medicine.
“+”signifies that the prevalence is significantly higher than the lowest prevalence. Significance has been determined by interpretation of the 95% confidence intervals (CIs) (if 1 is contained in the CI,
In all five countries, supplements of vitamins and minerals, supplements of oils, special diet, acupuncture, herbal medicine, reflexology (reflexology, also called zone therapy, involves the physical act of applying pressure to the feet. It is based on what reflexologists claim to be a system of zones and reflex areas that they say reflect an image of the body on the feet with the premise that such work effects a physical change to the body), yoga, and meditation were among the most commonly used CAM modalities, though with some variation in the order of importance. Alternative types of massage (shiatsu massage and healing massage), craniosacral therapy, healing, homeopathy, amalgam removal, qi gong, and naprapathy were used by more than 5% in one or more countries.
When comparing the use of specific CAM modalities in the five Nordic countries, some significant differences were seen (see Table
The types and prevalence of conventional treatment modalities, besides disease-modifying medicine for MS, which were reported to be used in combination with CAM treatment are presented in Table
Overview of conventional modalities combined with CAM treatment among people with MS in the Nordic countries.
Conventional modality | Denmark ( |
Norway ( |
Sweden ( |
Finland ( |
Iceland ( |
|||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
(%) | OR | (CI) |
|
(%) | OR | (CI) |
|
(%) | OR | (CI) |
|
(%) | OR | (CI) |
|
(%) | OR | (CI) | |
Physical therapy | 582 | (60.2) | 1.66 | (1.29–2.12)+ | 157 | 57.7 | 1.59 | (1.18–2.15)+ | 104 | (36.1) | 1 | 148 | (48.3) | 1.33 | (0.99–1.80) | 75 | (53.9) | 1.49 | (1.04–2.14)+ | |
Prescription |
567 | (58.6) | 1.35 | (1.06–1,71)+ | 118 | 43.4 | 1 | 173 | (60.1) | 1.38 | (1.03–1.84)+ | 226 | (73.8) | 1.70 | (1.29–2.24)+ | 81 | (58.3) | 1.30 | (0.94–1.90) | |
Non prescription medicine | 492 | (50.9) | 2.07 | (1.40–3.06)+ | 87 | 31.9 | 1.30 | (0.83–2.04) | 120 | (41.7) | 1.70 | (1.11–2.62)+ | 121 | (39.5) | 1.61 | (1.05–2.48)+ | 34 | (24.5) | 1 | |
Conventional massage | 145 | (15.0) | 1.35 | (0.89–1.05) | 30 | 11.0 | 1 | 73 | (25.3) | 2.29 | (1.45–3.62)+ | 79 | (25.8) | 2.34 | (1.49–3.67)+ | 27 | (19.4) | 1.76 | (1.00–3.07)+ | |
Therapeutic horseback riding | 138 | (14.3) | 6.59 | (2.07–20.99)+ | 7 | 2.6 | 1.19 | (0.30–4.68) | 12 | (4.2) | 1.93 | (0.53–6.95) | 14 | (4.6) | 2.11 | (0.59–7.49) | 3 | (2.2) | 1 | |
Psychology/ |
105 | (10.9) | 1.63 | (0.97–2.74) | 18 | 6.6 | 1 | 26 | (9.0) | 1.36 | (0.73–2.54) | 23 | (7.5) | 1.13 | (0.60–2.14) | 12 | (8.6) | 1.30 | (0.61–2.78) | |
Chiropractics | 73 | (7.5) | 3.84 | (1.65–8.91)+ | 33 | 12.1 | 6.18 | (2.55–14.99)+ | 13 | (4.5) | 2.30 | (0.86–6.13) | 6 | (2.0) | 1 | 11 | (7.9) | 4.06 | (1.46–11.13)+ | |
Occupational therapy | 24 | (2.5) | 7.13 | (0.96–52.95) | 14 | 5.1 | 14.82 | (1.93–113.94)+ | 1 | (0.3) | 1 | 14 | (4.6) | 13.17 | (1.72–100.84)+ | 12 | (8.6) | 24.86 | (3.20–193.14)+ | |
Others (hot water exercise, |
14 | (1.4) | 1 | 7 | 2.6 | 1.78 | (0.71–4.45) | 8 | (2.8) | 1.92 | (0.79–4.62) | 7 | (2.3) | 1.58 | (0.63–3.95) | 6 | (4.3) | 2.98 | (1.12–7.90)+ | |
No conventional treatment | 102 | (10.5) | 1.11 | (0.72–1.71) | 50 | 18.4 | 1.93 | (1.19–3.15)+ | 51 | (17.7) | 1.86 | (1.15–3.03)+ | 29 | (9.5) | 1 | 20 | (14.4) | 1.51 | (0.83–2.77) |
“+”signifies that the prevalence is significantly higher than the lowest prevalence. Significance has been determined by interpretation of the 95% confidence intervals (CIs) (if 1 is contained in the CI,
Within the last 12 months, CAM treatments were most commonly used in combination with conventional treatment in all five Nordic countries. The prevalence of exclusive CAM use (defined as no conventional treatments used besides disease-modifying medicine for MS) among CAM users varied from 9.5% in Finland to 18.4% in Norway. It was significantly higher in Norway and Sweden compared to lowest prevalence in Finland. Exclusive use of CAM was not directly connected to a high prevalence of total CAM use which was highest in Iceland and Finland. CAM treatment was most commonly combined with use of prescription medicine, physical therapy, and OTC medications.
The prevalence of the different conventional treatments use in combination with CAM was quite consistent among the five Nordic countries, though with some significant differences, for example, regarding the use of prescription medicine in combination with CAM treatment which was high in Finland and low in Norway. Combination of physical therapy and CAM was lowest in Sweden, and combination of OTC medications as well as therapeutic horseback riding and CAM was highest in Denmark.
An overview of the types and prevalence of symptoms/health issues addressed by use of CAM treatment in the five Nordic countries is provided in Table
Overview of symptoms/health issues addressed by the use of CAM among people with MS in the Nordic countries.
Symptom/health issue addressed by use of CAM |
Denmark ( |
Norway ( |
Sweden ( |
Finland ( |
Iceland ( |
|||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
(%) | OR | (CI) |
|
(%) | OR | (CI) |
|
(%) | OR | (CI) |
|
(%) | OR | (CI) |
|
(%) | OR | (CI) | |
To strengthen the body in general | 629 | (65.0) | 1.44 | (1.15–1.81)+ | 174 | (63.9) | 1.42 | (1.08–1.87)+ | 161 | (55.9) | 1.24 | (0.94–1.64) | 138 | (45.0) | 1 | 77 | (55.3) | 1.23 | (0.87–1.73) | |
To improve well-being | 510 | (52.7) | 1.35 | (1.05–1.73)+ | 106 | (38.9) | 1 | 151 | (52.4) | 1.35 | (0.99–1.81) | 207 | (67.6) | 1.73 | (1.30–2.31)+ | 100 | (71.9) | 1.84 | (1.31–2.60)+ | |
Fatigue/lack of energy | 401 | (41.5) | 1.02 | (0.80–1.31) | 139 | (51.1) | 1.26 | (0.94–1.71) | 116 | (40.2) | 1 | 135 | (44.1) | 1.09 | (0.81–1.47) | 91 | (65.4) | 1.62 | (1.15–2.28)+ | |
To prevent symptoms | 351 | (36.3) | 1.34 | (1.01–1.77)+ | 92 | (33.8) | 1.25 | (0.89–1.76) | 78 | (27.0) | 1 | 104 | (33.9) | 1.25 | (0.89–1.75) | 54 | (38.8) | 1.43 | (0.96–2.14) | |
Body pain | 210 | (21.7) | 1.14 | (0.83–1.57) | 84 | (30.8) | 1.62 | (1.12–2.36)+ | 72 | (25.0) | 1.31 | (0.90–1.93) | 58 | (18.9) | 1 | 64 | (46.0) | 2.43 | (1.61–3.65)+ | |
To improve the body’s |
192 | (19.9) | 1.50 | (1.04–2.18)+ | 50 | (18.3) | 1.39 | (0.89–2.19) | 38 | (13.1) | 1 | 43 | (14.0) | 1.06 | (0.67–1.70) | 55 | (39.5) | 2.99 | (1.89–4.75)+ | |
Problems with balance | 189 | (19.5) | 1.53 | (1.06–2.21)+ | 50 | (18.3) | 1.44 | (0.92–2.26) | 46 | (15.9) | 1.25 | (0.79–1.98) | 39 | (12.7) | 1 | 42 | (30.2) | 2.37 | (1.46–3.83)+ | |
To reduce the frequency of attacks | 188 | (19.4) | 5.93 | (3.10–11.36)+ | 33 | (12.1) | 3.71 | (1.79–7.67)+ | 22 | (7.6) | 2.34 | (1.09–5.02)+ | 10 | (3.2) | 1 | 39 | (28.0) | 8.58 | (4.17–17.69)+ | |
Spasms/tensions/cramps | 176 | (18.2) | 1.08 | (0.77–1.53) | 56 | (20.5) | 1.23 | 0.81–1.88) | 48 | (16.6) | 1 | 69 | (22.5) | 1.35 | (0.91–2.02) | 26 | (18.7) | 1.12 | (0.67–1.88) | |
Sensing disorders | 138 | (14.3) | 2.56 | (1.50–4.37)+ | 21 | (7.7) | 1.39 | (0.71–2.72) | 16 | (5.5) | 1 | 24 | (7.8) | 1.41 | (0.74–2.71) | 24 | (17.2) | 3.11 | (1.59–6.04)+ | |
Indigestion/problems with |
136 | (14.1) | 1 | 48 | (17.6) | 1.25 | (0.88–1.79) | 64 | (22.2) | 1.58 | (1.14–2.19)+ | 60 | (19.6) | 1.39 | (1.00–1.93)+ | 36 | (25.8) | 1.84 | (1.23–2.77)+ | |
Problems with bladder/urination | 119 | (12.3) | 1.29 | (0.84–1.98) | 49 | (18.0) | 1.90 | (1.16–3.09)+ | 32 | (11.1) | 1.17 | (0.69–1.98) | 29 | (9.4) | 1 | 32 | (23.0) | 2.42 | (1.41–4.17)+ | |
Headache | 115 | (11.9) | 1.45 | (0.92–2.28) | 36 | (13.2) | 1.62 | (0.94–2.76) | 24 | (8.3) | 1.02 | (0.57–1.82) | 25 | (8.1) | 1 | 34 | (24.4) | 2.99 | (1.72–5.21)+ | |
General discomfort | 113 | (11.7) | 1.12 | (0.73–1.71) | 43 | (15.8) | 1.52 | (0.93–2.49) | 30 | (10.4) | 1 | 45 | (14.7) | 1.41 | (0.87–2.30) | 44 | (31.6) | 3.04 | (1.83–5.04)+ | |
Problems with walking | 105 | (10.9) | 1.08 | (0.59–1.93) | 28 | (10.2) | 1.02 | (0.52–2.00) | 31 | (10.7) | 1.09 | (0.55–2.07) | 38 | (12.4) | 1.23 | (0.65–2.35) | 14 | (10.0) | 1 | |
Cognitive problems | 83 | (8.6) | 2.38 | (1.25–4.53)+ | 24 | (8.8) | 2.45 | (1.18–5.10)+ | 21 | (7.2) | 2.03 | (0.96–4.28) | 11 | (3.5) | 1 | 28 | (20.1) | 5.60 | (2.71–11.58)+ | |
Psychological problems | 82 | (8.5) | 2.59 | (1.33–5.06)+ | 26 | (9.5) | 2.92 | (1.38–6.18)+ | 17 | (5.9) | 1.81 | (0.81–4.01) | 10 | (3.2) | 1 | 27 | (19.4) | 5.94 | (2.80–12.62)+ | |
Dizziness | 82 | (8.5) | 3.69 | (1.69–8.09)+ | 20 | (7.3) | 3.21 | (1.34–7.72)+ | 11 | (3.8) | 1.67 | (0.64–4.37) | 7 | (2.2) | 1 | 23 | (16.5) | 7.23 | (3.03–17.26)+ | |
Problems with coordination/shaking | 67 | (6.9) | 1.88 | (0.95–3.70) | 10 | (3.6) | 1 | 16 | (5.5) | 1.51 | (0.67–3.39) | 16 | (5.2) | 1.33 | (0.59–3.02) | 21 | (15.1) | 4.11 | (1.88–8.96)+ | |
Visual disorders | 49 | (5.1) | 1.32 | (0.68–2.58) | 11 | (4.0) | 1.06 | (0.45–2.48) | 11 | (3.8) | 1 | 13 | (4.2) | 1.11 | (0.49–2.52) | 22 | (15.8) | 4.14 | (1.95–8.78)+ | |
Paralysis | 26 | (2.7) | 1.64 | (0.62–4.31) | 7 | (2.5) | 1.57 | (0.49–5.02) | 7 | (2.4) | 1.48 | (0.46–4.7) | 5 | (1.6) | 1 | 10 | (7.1) | 4.40 | (1.47–13.12)+ | |
Problems with speech, chewing, and swallowing | 22 | (2.3) | 1 | 8 | (2.9) | 1.29 | (0.57–2.94) | 10 | (3.4) | 1.53 | (0.72–3.27) | 8 | (2.6) | 1.15 | (0.51–2.61) | 16 | (11.5) | 5.07 | (2.59–9.89)+ | |
Symptoms/health issues addressed by less than 2% in |
50 | (5.2) | 1.17 | (0.61–2.23) | 12 | (4.4) | 1 | 22 | (7.63) | 1.73 | (0.84–3.56) | 19 | (6.20) | 1.41 | (0.67–2.95) | 9 | (6.4) | 1.46 | (0.60–3.56) | |
Addressing of one or more nonspecific/preventive symptoms/health issues (including strengthening the body in general, improving well-being, preventing symptoms, improving the body’s muscle strength, and reducing the frequency of attacks and general discomfort) | 797 | 82.2 | 1.04 | (0.85–1.26) | 222 | 81.6 | 1.03 | (0.80–1.32) | 228 | 79.2 | 1 | 256 | 83.7 | 1.06 | (0.83–1.34) | 118 | 84.9 | 1.07 | (0.79–1.45) |
“+”signifies that the prevalence is significantly higher than the lowest prevalence. Significance has been determined by interpretation of the 95% confidence intervals (CIs) (if 1 is contained in the CI,
The present study shows a widespread use of CAM treatments among people with MS. These findings support the findings of similar studies [
Regarding the types of CAM treatment used, this study supports previous findings where supplements of vitamins and minerals, supplements of oils, herbal medicine, special diets, acupuncture, and yoga were reported as popular CAM modalities among people with MS [
This study shows that CAM treatments are most often used in combination with conventional treatments and supports hereby the findings of similar studies [
The motives for using CAM treatment among people with MS in the Nordic countries found in this study include both those of a specific and of a general nature, and the study results hereby support previous findings [
Regarding differences in CAM use in the Nordic national populations, a study from 2005, comparing use of CAM in Denmark, Norway and Sweden, showed that the prevalence of CAM use varied from 34% in Norway to 45% in Denmark and 49% in Stockholm (Sweden) [
According to our knowledge, this is the first cross-national study to compare the use of CAM treatments among people with MS in the Nordic countries and one of the first studies to compare the use of CAM treatments among populations in the Nordic countries.
Although characterized by extensive accordance, the study shows some differences between the MS populations in the Nordic countries. In their study on CAM use in Denmark, Norway, and Sweden from 2005, Hanssen et al. (2008) conclude that reasons for variations in the use of CAM therapies in such culturally uniform areas, where there is also equally little financial support for CAM treatments, remain unknown [
The study is based on a large sample of respondents, allowing for statistical tests to be performed on various levels. A further strength of the study is that surveys have been performed simultaneously in all five Nordic countries, based on a very thorough process of translation, using the same methods. The possibility of valid comparison among the countries has thereby been strengthened. The development of the questionnaire, including a pilot test of 400 Danish respondents, three sessions of cognitive interviews, and the coding of numerous skip-sections as well as extensive use of branching, has made it possible to collect data of rather high complexity among respondents with physical as well as cognitive limitations. Although we cannot be sure that all the respondents have understood the questions in the exact same way, the above-mentioned preparations have contributed considerably to the quality of the data.
At the same time, the internet-based questionnaire entails a limitation as it requires internet access. One may also suspect the internet-based questionnaire to discriminate in favor of younger respondents. As shown in Table
The present study indicates that CAM treatments are of significant importance among MS populations. The use of CAM was primarily reported for reasons related to the general state of health among the respondents, indicating that the usage is part of an overall coping strategy rather than a temporary or fortuitous attempt to alleviate a specific symptom. Therefore, the study can contribute to a better understanding of the widespread use of different CAM treatment modalities among people with MS, and among people with chronic illnesses in general. The study may also help to qualify communication between patients and representatives of conventional health care systems regarding motives, goals, and rationales linked to the CAM usage. Such communication is very relevant with regard to possible negative impact/risks connected to CAM treatments, for example, CCSVI surgery, amalgam removal, and supplements of vitamins and minerals.
In recent years, patient organizations as well as health care systems have brought into focus the possible relevance of addressing different groups of patients/members in different ways, acknowledging the lack of homogeneity in attitudes, opinions, and motives. In that respect, it would be relevant to investigate whether the tendencies indicated by this study in connection to the national groups of Nordic MS CAM users are generally applicable in each country or whether different subgroups of CAM users exist and differ from each other—and from CAM nonusers—in terms of CAM modalities used and motives for use. Further studies may elucidate these matters.
The results of the present study indicate that the use of CAM treatment among individuals with MS was widespread in all five Nordic countries. Interestingly, the five countries had quite similar patterns in relation to prevalence of CAM use, the types of CAM modalities used, the types of conventional treatments that CAM treatment was used in combination with, and the types of symptoms/health issues that were most often addressed by use of CAM treatment. Some differences were found between the countries as well, especially regarding the prevalence of use of some specific CAM modalities, the prevalence of exclusive CAM use, and the prevalence of use of one or more energetic CAM treatments. Generally, Iceland and Finland represented the largest differences. The analyses showed that Iceland was characterized by a high prevalence of overall CAM use, including high-level use of energetic CAM modalities, and that the CAM treatments were very often used for nonspecific/preventive purposes. Finland was also characterized by a high prevalence of total CAM use, but mainly due to a high-level use of supplements. The use of energetic CAM modalities was low in Finland compared to the other four countries, and CAM treatments were very often used in combination with prescription medicine. Patterns of use were quite homogenous between Denmark, Norway, and Sweden, with Sweden having a slightly lower prevalence of total CAM use, including the use of supplements as well as energetic CAM modalities. Norway and Sweden had higher prevalence of exclusive CAM use than the other three countries.
The results of the present study support the findings of previous, similar studies with regard to the prevalence of CAM use and the motives for CAM use among people with MS. No previous studies have compared use of CAM treatments among the five Nordic countries, and the study contributes new knowledge in this area concerning the use of CAM as well as concerning the use of CAM in combination with conventional treatments. The study is based on a large sample of respondents and may contribute to a better understanding of the role that CAM treatments play in the disease coping among people with MS as well as among people with chronic illnesses in general.
The authors are full of gratitude to the respondents, the Danish MS Society, the Norwegian MS Society, The Swedish Association of Persons with Neurological Disabilities, the Finnish MS Society, the Icelandic MS Society, Mette Kristensen, and members of the project group (Gurli Vagner, Annica Bernehjält, Marju Toivonen, Berglind Olafsdottir, Ulla Wæber, Torben Damsgaard, and Karen Allesøe).