Attitudes and knowledge of occupational therapy professionals of complementary and alternative medicine

The purpose of this study was to identify the attitudes and levels of knowledge of occupational therapy professionals in regards to Complementary and Alternative Medicine (CAM). It has been discovered that CAM use is becoming more prevalent; however, patients are not discussing the use of these techniques with their health care professionals (AARP & NCCAM, 2007). Similar studies in parallel health care professions have discovered an overall positive attitude towards CAM’s, as well as low levels of knowledge regarding specific methods, these trends were anticipated (Baugniet, Boon, & Ostbye, 2000). One thousand surveys were sent to a sample of occupational therapists and occupational therapy assistants in the state of Ohio. Two hundred and seventy three surveys were determined useable out of the 287 surveys returned. The return rate was calculated at 29%. Ninety percent of the respondents were female, 61% were occupational therapists, 39% occupational therapy assistants. Overall, participants perceived that the use of CAM is increasing. A positive attitude towards CAM techniques was also discovered. Generally, participants reported a low level of knowledge for all CAM modalities. Participants offered specific concerns when considering CAM and occupational therapy such as; research available, professional responsibility, and consumer safety. The results of this survey reinforce the need for more education for occupational therapy professionals. Occupational therapy professionals should be aware of what patients are doing to supplement treatments offered by conventional treatments. At the very least, health care professionals should be able to direct patients to qualified professionals and accurate, scientific, information. Attitudes and Knowledge of Complementary and Alternative Medicine 3 Attitudes and Knowledge of Occupational Therapy Professionals of Complementary and Alternative Medicine Complementary and alternative medicine (CAM) is a growing trend in healthcare. Patients are taking control of their treatment in new and diverse ways. As occupational therapists, we need to be aware of what methods our clients are using to supplement conventional medical treatments. The American Occupational Therapy Association (AOTA) has provided the profession with a position paper on this topic, defining CAM within the scope of occupational therapy (Giese, 2005). In this document, AOTA advocates for research to be conducted to determine the efficacy of CAM within occupational therapy practice, and for the inclusion of CAM in educational opportunities (Giese, 2005). This study will outline the definitions of CAMs, who is using them and why. Many other professions have conducted internal parallel studies to investigate and identify attitudes and knowledge of CAM. After an extensive literature review, there were no studies found indentifying how occupational therapy professionals, exclusively, feel about CAM and the extent of their current knowledge. This study will survey practicing occupational therapists and occupational therapy assistants to fill this gap. What is CAM? The National Center for Complementary and Alternative Medicine (NCCAM) define CAM as “a group of diverse medical and health care systems, practices and products that are not presently considered to part of conventional medicine” (Barnes, Powell-Griner, McFann, & Nahin, 2002). Complementary methods are used in addition to conventional medicine, whereas alternative treatments are performed instead of conventional treatment (Barnes, Powell-Griner, McFann, & Nahin, 2002). NCCAM (2007) has also provided a classification system for CAM therapies. The five categories include: whole medical systems, mind-body interventions, Attitudes and Knowledge of Complementary and Alternative Medicine 4 biologically based therapies, manipulative and body based methods, and energy therapies. Each will be described briefly below. Whole medical systems are based on theory and practice. Examples include: homeopathy, naturopathic medicine, traditional Chinese medicine, and Ayurveda. Techniques used to enhance the mind’s ability to affect the body are referred to as mind-body interventions such as meditation, prayer, creative therapies, and mental healing. Biologically based therapies involve the use of substances found naturally. Methods such as herbs and animal products do not have scientific research proving their efficacy. Chiropractic techniques including massage and osteopathic handling are classified as manipulative and body-based methods. Energy therapies are divided into two categories; biofield modalities and energy manipulation. Biofield modalities are directed towards the energy field surrounding a patient or client. Methods of applying pressure and/or influencing these fields include Therapeutic Touch, Qi gong, and Reiki. Electromagnetic fields are manipulated in bioelectromagnetic-based therapies such as pulsed fields, alternating-current or direct-current fields, and magnetic fields. Additional definitions of specific treatments are also delivered via the NCCAM (2007). Widely recognized and easily defined treatments such as acupuncture, chiropractic, imagery, hypnosis, vitamins, natural herbal products, prayer, yoga, and relaxation are included as CAMs. Additional lesser known techniques such as Ayurveda, Qi gong, and others, will be further explained here. Ayurveda is an ancient Indian medical system that incorporates diet and herbal remedies and also places focus on mind, body, and spirit interaction to prevent and/or cure disease. Energy therapies that manipulate electromagnetic fields affect the force that surrounds every electric device. The currents of the Earth’s core are said to create these fields that are also responsible for thunderstorm activity in the atmosphere. Homeopathic medicine is built on the Attitudes and Knowledge of Complementary and Alternative Medicine 5 belief that “like cures like,” a smaller dose of what causes the symptom is given to cure the current problem. This concept is similar to vaccination treatment. Another CAM alternative medical system is that of naturopathic medicine. Naturopathy emphasizes the healing power that the body establishes, maintains and restores health. Common interventions include exercise, medicinal plants, dietary supplements, lifestyle counseling, and homeopathy. A form of conventional medicine that has been included in NCCAM’s definitions of CAM alternative medical systems is osteopathic medicine. The focus of this system is the musculoskeletal system and the interaction of other body systems in relation to disease. Manipulation may be used to restore function and alleviate pain. Yet another uncommon treatment is Qi gong. Immune and body functions are thought to be improved by the manipulation of blood flow through the interventions of breathing exercises, meditation, and movement. Reiki is a spiritual and energy driven modality. A practitioner heals a patient’s spirit, which in turn improves physical function. Finally, Therapeutic Touch is a professional technique of “laying-on of hands”. The therapist affects the energy field that surrounds a patient with his or her hands, detecting and correcting imbalances. These definitions are not inclusive of all alternative methods, but only intended to provide orientation to specific CAMs. Incidence and prevalence Much research has been performed in the last two decades defining the typical patients and characteristics of CAM use in an ever-changing society. Prevalence and use of CAMs ranges from 35 – 67% depending on the sample (Barnes et al., 2002; Kessler, Davis, Foster, Van Rompay, Walters, & Wilkey, et al., 2001). This demonstrates the idea that multiple factors play a role in CAM use. Persons in different geographical regions, cultural backgrounds, and religious beliefs may have a large impact. In a national study performed by the Center for Disease Control Attitudes and Knowledge of Complementary and Alternative Medicine 6 (CDC), it was found that when prayer and multivitamins were added to the definition of CAMs the number of users increased from 36% to 62% (Barnes, Powell-Griner, McFann, & Nahin, 2002). Specific populations have been studied as well. In older adults surveyed by the American Association of Retired People (AARP) and NCCAM (2007), 63% of the respondents had used at least one CAM technique. This number has increased from 35% of older adults who had participated in an earlier 2000 survey (Foster, Phillips, Hamel, & Eisenberg, 2000). These conflicting results reflect multiple individual differences and remind practitioners, of traditional and non-traditional medicine, that patients may be adding to their treatment. In fact, in 1998 it was found that monies spent for visits to alternative care practitioners of the previous year had exceeded the projected amount spent for traditional care physicians by an estimated $243 million (Eisenberg et al., 1998). This shows that patients are moving towards alternative methods instead of, or in addition to, conventional treatments. Specific trends and socio-demographic characteristics have been identified by multiple studies. The typical CAM user tends to be female, aged younger than 65, highly educated, a higher income than the national average, and hospitalized within the past year (Barnes, PowellGriner, McFann, & Nahin, 2002; Tindle, Davis, Phillips & Eisenberg, 2005; Eisenberg et al., 1998). Another typical characteristic of CAM users show that its use is less common with African Americans, except when including prayer (Conboy et al., 2005). In a 2000 study performed by Foster et al., the authors focused on CAM use in specific age groups. In participants 18-35 years of age, 43% had used CAM. Half of participants aged 36-55 had reported using used CAM. Thirty eight percent of baby boomers, aged 56-64 had used CAM, while 65-74 year old participants showed only 33% usage. The oldest age groups, 75-84 years old