OCCUPATIONAL THERAPY INTERNATIONAL

Occup. Ther. Int. 16(1): 57–70 (2009)

Published online in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/oti.266

A review of complementary and

alternative medicine (CAM) by
people with multiple sclerosis

SHERRI A. OLSEN, MultiCare Health Systems, 315 Martin Luther King Jr.
Way, Tacoma, WA

ABSTRACT: Multiple sclerosis (MS) is a chronic, unpredictable disease of the

central nervous system without a known cure. Because of this, people with MS often
seek complementary and alternative medicines (CAM) to manage their disease
symptoms. The goal of this review article was to describe the use of CAM by indi-
viduals diagnosed with MS. Evidence was obtained by searching Medline (1950–
2007), EBSCOhost and PubMed for studies relating CAM to MS. Results from the
literature showed that people with MS reported that they used CAM from 27 to
100%. The major reasons for choosing CAM were as follows: conventional treat-
ment was not effective, anecdotal reports of CAM’s help, and doctor referral. The
types of CAM reported by people with MS included exercise, vitamins, herbal and
mineral supplements, relaxation techniques, acupuncture, cannabis and massage.
The major symptoms treated by CAM as noted in the literature were pain, fatigue
and stress. There is a need for further research to evaluate the effectiveness of CAM
with MS patients and their application by occupational therapists. The limitation of
this literature review was the low response rate in many of the surveys reported.
Copyright © 2009 John Wiley & Sons, Ltd.

Key words: complementary alternative therapies, multiple sclerosis

Introduction

Multiple sclerosis (MS) is a chronic, unpredictable neurological disease that

affects the central nervous system and has no known cure (National Multiple
Sclerosis Society, 2006). Individuals with MS experience a variety of symptoms
that may include motor, sensory and cognitive functioning. Specifically these
symptoms may include speech and swallowing problems, tremors, spasticity,
visual and cognitive problems, fatigue, pain or bowel and bladder problems
(Shinto et al., 2008). Although most people with MS have a normal or
Occup. Ther. Int. 16(1): 57–70 (2009)
Copyright © 2009 John Wiley & Sons, Ltd DOI: 10.1002/oti
58 Olsen

near-normal life expectancy, quality of life is often affected by disease related

changes in function (Stuifbergen and Harrison, 2003). Disease modifying drugs
may be taken to reduce the frequency of exacerbations and have a beneficial
effect on the severity of the disease and reduce the progression of disability
(Goodin et al., 2002). However, these drugs do little to treat the symptoms,
improve functioning or enhance quality of life. Because of this, people with MS
may seek different methods to treat their MS symptoms (Freeman et al., 2001).
A systematic review of randomized controlled trials (RCTs) found that there
are very few controlled clinical studies assessing the efficacy of CAM therapies
for the treatment of MS symptoms (Huntley and Ernst, 2000). The RCTs were
small studies in the areas of nutrition, massage, bodywork and magnetic field
therapy. The findings indicate that these therapies may provide beneficial effects
for some symptoms of MS, but these studies are limited by small sample sizes
and lack of methodological rigor (Millar et al., 1973; Bates et al., 1978; Paty
et al., 1983; Bates et al., 1989; Nielson et al., 1996; Richards et al., 1997; Siev-
Ner et al., 1997; Hernandez-Reif et al., 1998; Gibson and Gibson, 1999; Johnson
et al., 1999).
The goal of this literature review was to describe how frequently CAM is
being used by individuals with MS, explore why CAM is chosen, define how
effective CAM is perceived by users, define what symptoms are most often
treated, and which CAM therapies are most frequently used. Evidence was
obtained by searching Ovid Medline (1950–2007) (http://ovidsp.tx.ovid.com/),
EBSCOhost (http://search.ebscohost.com) and PubMed (http://www.ncbi.nlm.
nih.gov). The search terms used were multiple sclerosis AND alternative medi-
cine, multiple sclerosis AND complementary alternative medicine (CAM),
alternative AND complementary therapy, bee venom AND multiple sclerosis.
The reference lists of articles were also reviewed for relevant publications.

Frequency of CAM use

Seminal research done by Pleines (1992) with MS patients in Quebec surveyed

112 individuals. The research found 64.3% of respondents had used some form
of alternative medicine. In two exploratory studies in the United States, Fawcett
et al. (1994, 1996) surveyed 16 MS patients in each study. The results of each
study found 100% use of at least one alternative health therapy. A 5-year lon-
gitudinal study done by Stenager et al. (1995) of 49 MS patients in Denmark
investigated the use of CAM therapy at the start and at the end of a 5-year
period. The use of CAM therapy at the start was reported at 55% and at the
end CAM use was reported at 27%. In a survey of 240 MS patients in California
and Massachusetts, Berkman et al. (1999) found that 58% of the patients had
used alternative treatments. Ninety per cent of the patients using a CAM treat-
ment used it as a complement to their conventional treatment. A survey of 569
MS patients in Colorado done by Schwartz et al. (1999) found 33% of those
Occup. Ther. Int. 16(1): 57–70 (2009)
Copyright © 2009 John Wiley & Sons, Ltd DOI: 10.1002/oti
 Use of complementary medicine with multiple sclerosis 59

surveyed had visited a provider of CAM in the last 6 months. The results
showed that individuals seeing a primary care doctor only reported a 34% CAM
usage; individuals seeing a single specialty doctor (i.e. neurologist) reported a
38% CAM usage; and individuals receiving comprehensive care reported a 53%
CAM usage.
In a nationwide US survey of 3,140 MS patients, Nayak et al. (2003) found
that 57.1% of MS patients had used one CAM; 70.2% of those individuals had
used three or more CAM therapies, for an average of 5.02 CAMs. In a 3-year
longitudinal study of 621 MS patients in the southwest US, Stuifbergen and
Harrison (2003) surveyed participants regarding 12 CAM therapies. Results
indicated 33% currently used 1 of 12 CAM therapies and 50% had tried a CAM
therapy in the past. Apel et al. (2006) examined the frequency of use of 254
MS patients at two neurology clinics in Germany. Their findings suggested
67.3% of individuals were currently using a CAM, for an average of 2.7 therapies.
Of those individuals using CAM, 90.6% use it as a complement to conventional
therapy and 9.4% use it as an alternate. Another study in Germany with 154
MS neurology patients found 61.7% of the patients were currently using CAM,
averaging 2.4 therapies (Apel et al., 2005). Of those individuals using CAM,
90.3% use the therapy as a complement and 9.7% as an alternative to conven-
tional treatment. In a survey of 1,667 MS patients in Oregon and Washington,
Shinto et al. (2006) reported CAM use as 87.9% have ever used, 71.1% currently
use, 16.9% have used in past and 12.1% have never used. Finally, Campbell et
al. (2006) explored CAM use in 451 veterans. Thirty-seven per cent of the
respondents reported current or past CAM use. Thirty-three per cent reported
using two or more interventions. (Refer to Table 1 for summary of frequency
data and response rates.)
There is some evidence that physicians are not aware of the full extent of
their patients’ use of CAM. For example, a survey of 150 primary care physicians
in the United States, completed by Giveon et al. (2003), found that 68% of the
physicians estimated that up to 15% of their patients use CAM. Fifty-three per
cent of the physicians estimate that up to 15% of their patients use herbs. Fifty-
per cent of the physicians surveyed estimated that 10% of their patients report
use of herbal remedies. Eisenberg et al. (1993, 1998, 2001) reported that in the
general population, 39.8 and 38.5% of patients, respectively, discussed CAM
therapies with their conventional medical doctor (M.D.).

Why CAM is chosen

There is reference throughout the literature that individuals may turn to CAM
therapies because of dissatisfaction with conventional medicine (Giveon et al.,
2003). Although, in a national qualitative study of 100 US military veteran
CAM users, Kroesen et al. (2002) suggest that although there were particular
aspects of the conventional care system that were criticized, dissatisfaction is
Occup. Ther. Int. 16(1): 57–70 (2009)
Copyright © 2009 John Wiley & Sons, Ltd DOI: 10.1002/oti
60 Olsen

TABLE 1: Complementary and alternative medicine (CAM) use frequency

Citation CAM use (%) Response Achieved Total

rate (%) sample sample

Pleines 1992 65.3 64.3 112 200

Fawcett et al. 1994, 100 100 16 16
1996
Stenager et al. 1995 Start – 55 End – 27 78 49 63
Schwartz et al. 1998 1° care dr. – 34 71 569 807
1° specialty care dr. – 38
Comprehensive care – 53
Berkman et al. 1999 58 24 240 1000
Schwartz et al. 1999 33 71 569 807
Nayak 2003 57.1 27.1 3,140 11,600
Stuifbergen and 33; 1 of 12 50; tried CAM in 77 621 811
Harrison 2003 the past
Apel et al. 2006 67.3 100 254 254
Apel et al. 2005 61.7 100 154 154
Shinto et al. 2006 87.9; ever used 71.1; currently 32 1,667 5316
use 16.9; used in past 12.1;
never used
Campbell et al. 2006 37; currently use 33; use 2 or 44 451 1032
more

not a major factor. For example, results suggested a desire for more holistic care.
Participants specifically referred to conventional medicines inadequate informa-
tion regarding diet, nutrition and exercise, as well as ignorance of spiritual
dimensions as a reason to turn to CAM. Results also suggested dissatisfaction
with conventional medicines reliance on prescription medications as an impor-
tant component in veterans’ motivation to use CAM. Instead of finding the
choice of CAM being due to dissatisfaction, Astin (1998) found the choice of
CAM alternatives being due to having more congruency with the values, beliefs
and philosophical orientations of life and health: a holistic perspective.
For individuals with MS, conventional medicine does not treat many of the
symptoms and offers no cure (Freeman et al., 2001). Fawcett et al. (1994)
reported that 63% of the individuals in the United States with MS reported
seeking CAM because conventional medicine offered no cure for MS. Anec-
dotal evidence, or hearing about another person’s success, was the reason given
for choosing CAM therapy by 68% of the respondents in the Berkman et al.
(1999) article. Other reasons for choosing CAM included; traditional treatment
did not bring symptom relief (56.4%), traditional treatment offered no cure for
MS (54.5%), condition was worsening and CAM was only hope (47.5%), a friend
persuaded me (39.6%) and my doctor recommended it (37.6%). The holistic
nature of CAM was the reason it was chosen by 63.4% of US respondents in a
Occup. Ther. Int. 16(1): 57–70 (2009)
Copyright © 2009 John Wiley & Sons, Ltd DOI: 10.1002/oti
 Use of complementary medicine with multiple sclerosis 61

TABLE 2: Reasons for choosing complementary and alternative medicine (CAM)

Citation Reason for choosing CAM Response (%)

Fawcett et al. 1994 Conventional medicine offers no cure 63

Berkman et al. 1999 Anecdotal evidence 68
Traditional treatment offers no cure 54.5
Traditional treatment offers no 56.4
symptom relief
Condition worsening 47.5
Persuaded by friend 39.6
Doctor recommended 37.6
Nayak et al. 2003 Holistic nature 63.4
Conventional healthcare not effective 51
More control 36.7
Doctor recommended 15.3
Page et al. 2003 Information from media 50
Family/friends 50

TABLE 3: Why complementary and alternative medicine (CAM) therapy is not chosen
at all

Reason given for not using CAM % (Absolute number)

Never considered CAM as an option 26.8 (361)

Unable to afford CAM 25.1 (338)
Satisfied with conventional treatment 21.7 (292)
Do not believe CAM treatments work 13.3 (179)
My physician advised me against CAM 7.9 (106)

survey done by Nayak et al. (2003). Fifty-one per cent felt that conventional
healthcare had not been effective; more control over their own healthcare was
the reason stated by 36.7% of respondents. Only 15.3% in Nayak’s study indi-
cated their physician recommended CAM treatment. CAM therapies were
chosen based on information from the media (50%), or family/friends (50%),
based on responses from individuals in a Canadian survey done by Page et al.
(2003). See Table 2 for summary of statistics for reasons CAM is chosen.

Reasons for not using or stopping CAM

Nayak et al. (2003) also sought to find out the reasons why their subjects did
not use CAM. Table 3 shows the results of the Nayak survey of why CAM is
not chosen. There were five reasons given with a total of 1,348 respondents.
There were no correlations done as to who would be more or less likely to choose
Occup. Ther. Int. 16(1): 57–70 (2009)
Copyright © 2009 John Wiley & Sons, Ltd DOI: 10.1002/oti
62 Olsen

CAM. Page et al. (2003) found in their research that lack of knowledge about
CAM therapies (42%) and satisfaction with current care provider were reasons
for not using CAM.

CAM effectiveness

The perceived effectiveness of CAM therapies is reported inconsistently and

with different reporting methods in the literature. Pleines (1992) reported a
range of responses making mention of improvement (29.2–50%) and those
making mention of no improvement (23.1–53.3%). Although in the case of
relaxation, 80% reported improvement in well-being and/or decrease in stress.
Specific CAM therapies, percentage used and perceived efficacy for each CAM
were provided by Nayak et al. (2003). There appeared to be no relationship
between frequency (percentage using) and reported effectiveness of CAM use.
A scale of 1–5 was used to measure effectiveness with 5 being most effective.
Prayer was the most frequently used, but had a perceived efficacy of 1.12 [stan-
dard deviation (SD) 1.12]. Others include ingested herbs 26.6%, effectiveness
2.88 (SD 1.56), vitamins 44.8%, efficacy 3.34 (SD 1.39), chiropractic 25.5%,
efficacy (3.06) (SD 1.66), and acupuncture 19.9% and efficacy (2.37) (SD 1.76).
Page et al. (2003) reported 72% of their respondents perceived positive effects,
whereas 5% reported experiencing negative effects from CAM. The most often
cited beneficial therapies were massage therapy, acupuncture and cannabis.
In the 3-year longitudinal study completed in the United States by
Stuifbergen and Harrison (2003), a list of 12 CAM therapies were measured for
perceived effectiveness as well as whether the person was using the therapy at
the completion of the study. With the exception of nutritional supplements, less
than half of the people who had tried any of the listed CAM treatments con-
tinued to use them, even though the majority reported that they had found
therapeutic touch, yoga, herbal treatment, chiropractic treatment, special diets,
massage and nutritional supplements helpful (53–77%). Perceived benefits were
reported 61.5% of the time by Pucci et al. (2004) in Italy. In a 5-year follow-up
study in Denmark, completed by Stenager et al. (1995), only one patient out of
13 reported a positive effect of a CAM at the start and end of the observation
period. The authors did not provide details on the measurement used for the
patients to report positive effects. In another study, respondents perceived con-
ventional providers and therapies as being significantly more beneficial than
CAM providers and therapies (p < 0.001) (Shinto et al., 2005). Of the CAM
therapies listed by Apel et al. (2005), 65.8% of the MS patients reported improve-
ments, 32.9% reported no influence and 1.3% worsening of their condition.
Slight side effects were reported for 4.5% of the CAM therapies, including
physiotherapy, massage, traditional Chinese medicine and cannabis. In another
study by Apel et al. (2006), improvement was reported by 67.1%, no improve-
ment was reported by 32.3% and worsening of conditions was reported by 0.6%
Occup. Ther. Int. 16(1): 57–70 (2009)
Copyright © 2009 John Wiley & Sons, Ltd DOI: 10.1002/oti
 Use of complementary medicine with multiple sclerosis 63

of the patients. Minor side effects were reported for 3.7 of the CAM therapies,
including; exercise, vitamins, relaxation, massage, traditional Chinese medi-
cine, hippotherapy, magnetic field therapy, cannabis and enzyme therapy.
In a randomized pilot study of naturopathic medicine in individuals with
MS, Shinto et al. (2008) investigated the quality of life impact of naturopathic
intervention using a three-arm, parallel-group, randomized clinical trial. Forty-
five subjects were randomized to either (1) naturopathic treatments plus usual
care; (2) usual care alone or (3) MS focused educational visits with a nurse plus
usual care. The intervention period was 6 months. On the primary outcome
measure of quality of life there was no significant difference between groups.
There were also no significant differences between groups for the secondary
outcome measures of fatigue, depression, disability and cognitive impairment.

Symptoms treated

Numbness, weakness and vision were the primary symptoms reported as being
treated by the patients in the study by Fawcett et al. (1996). In the Berkman
et al. (1999) study, benefits mentioned included less fatigue, more energy/strength,
overall good health, stress relief, pain relief, improved memory, less numbness,
better bowel and bladder control, less spasticity and depression relief. Slowing
of progression or facilitation of a remission as the reason for CAM use was
mentioned only 12.1% of the time. Page et al. (2003) reported that 68% of their
patients use CAM to improve their health and 61% use CAM to manage symp-
toms; specific symptoms were not provided. Nayak et al. (2003) found that CAM
was primarily used for symptom relief (73.9%), slowing of progression (52.2%),
relapse prevention (33.6%) and induced remission (26.7%). The most frequently
listed symptoms that were treated include, all MS symptoms (86.6%), pain
(59.5%), fatigue 57.8%) and stress (37.9%). Pucci et al. (2004) reported 66% of
the 61 CAM interventions used by the patients in their study were for the
treatment of symptoms; the other 34 were disease modifying.

CAM treatments used

Being aware of the various reporting methods used in the literature is important
when analyzing and comparing data. For example, Fawcett et al. (1994, 1996)
and Apel et al. (2006) provided participants an open-ended questionnaire about
therapies received for MS; whereas in the Berkman et al. (1999); Page et al.
(2003); and Stueifbergen and Harrison (2003) studies, participants were pre-
sented with a fixed list of options to choose from. Another example of differ-
ences in reporting methods among studies is the timeframe when the CAM was
used by the participant. For example, Astin (1998), Eisenberg et al. (1998) and
Barnes et al. (2004)used the past 12 months as the timeframe; whereas others
Occup. Ther. Int. 16(1): 57–70 (2009)
Copyright © 2009 John Wiley & Sons, Ltd DOI: 10.1002/oti
64 Olsen

use current and/or lifetime as the timeframe for CAM use (Nayak, et al. 2003;
Stuifbergen and Harrison 2003; Shinto et al. 2006).
Vitamins and diets (40%), acupuncture (35.4%), Shaklee natural nutritional
products (29.9%), and chiropractic and relaxation (23%) were the favoured
CAM used by the patients in the research done by Pleines (1992). Although a
per cent is not given, Pleines does report that in the majority of cases, there
was no medical supervision of the CAM. When the data from the Fawcett
et al. (1994, 1996) studies was combined, the most frequently used CAM thera-
pies were physical therapy (44%), nutrition counselling, massage and psychologi-
cal therapy counselling (38%). Thirty-one per cent of the combined sample used
homeopathy, acupuncture or dental therapy. The study by Schwartz et al. (1999)
examined the use of CAM providers rather than the use of CAM products
without guidance from a provider. The therapies received in the last 6 months
include massage (14%), chiropractic (12%), nutritional (9%), holistic (6%), herbal,
healing touch, and acupuncture (3%), faith healing (1%) and bee sting (0.2%).
Berkman et al. (1999) reported on the past or current use from a comprehensive
list of specific CAM treatments. No time frame was attached to the past use.
The CAM therapies used were reported as massage (33.6%), chiropractic (29.3%),
vitamin C (29.3%), acupuncture (27.9%), meditation (22.9%), vitamin E (22.9%),
visualization (22.1%), yoga (16.4%), homeopathy (12.1%), vitamin B complex
(12.1%), marijuana (10.7%), and calcium/magnesium and other B vitamins
(8.6%). The other 29 CAM treatments listed were used by ≤5% of the respon-
dents who had ever used a CAM.
The respondents of the Somerset et al. (2001) study reported on the use of
‘self-treatments’ in the previous 12 months. Use was reported as evening prim-
rose oil (47%), multivitamins (37%), special diets (18%) and cannabis (8%).
Hanyu et al. (2002) analyzed data from the 1999 National Health Interview
Survey, which collected data on CAM use in the past 12 months. The three
most commonly used therapies were spiritual healing/prayer (13.7%), herbal
medicine (9.6%) and chiropractic therapies (7.6%). In Stuifbergen and Harri-
son’s (2003) 3-year longitudinal study, nutritional supplements, massage, special
diets, chiropractic treatment and herbal treatment were the most frequently
used CAMs. The current use (at the end of the 3-year study) for each of these
therapies was reported as; nutritional supplements (60.5%), massage (20.8%),
special diets (45.4%), chiropractic treatment (22.9%) and herbal treatment
(49.1%). There was no significant correlation between continued use after 3
years and perceived effectiveness. Table 4 shows the results of the research by
Apel et al. (2006). There is a breakdown between complementary and alterna-
tive use, and the subjective therapeutic effects of the top six currently used
CAM therapies reported by the patients in the study. These results also show
no significant correlation between specific CAM use and perceived
effectiveness.

Occup. Ther. Int. 16(1): 57–70 (2009)

Copyright © 2009 John Wiley & Sons, Ltd DOI: 10.1002/oti
 TABLE 4: Types of complementary and alternative medicine (CAM) use and perceived effectiveness

Therapy Absolute Alternative Complementary Improvement Constant/no

number (%) use (%) use (%) (%) effect (%)

Exercise therapy 126 (27.0) 9 (7.1%) 117 (92.3) 97 (76.4) 29 (22.8)

Vitamins 68 (14.6) 10 (14.7) 58 (85.3) 27 (40.9) 39 (59.1)

Copyright © 2009 John Wiley & Sons, Ltd

Mineral and other 58 (12.4) 2 (3.4) 56 (96.6) 30 (52.6) 27 (47.4)
supplements
Phytotherapy 43 (9.2) 3 (7.0) 40 (93.0) 26 (63.4) 15 (33.6)
(herbal therapy)
Relaxation 42 (9.0) 4 (9.5) 38 (90.5) 38 (86.4) 6 (13.6)
techniques
Massage 23 (4.9) 3 (13.0) 20 (87.0) 19 (82.6) 4 (17.4)

DOI: 10.1002/oti
Occup. Ther. Int. 16(1): 57–70 (2009)
Use of complementary medicine with multiple sclerosis
65
66 Olsen

Discussion

The use of CAM by the general public has increased steadily since the 1950s
and the evidence suggests this trend will continue in the foreseeable future
(Kessler et al., 2001). The findings of this research indicate the use of CAM by
individuals with MS tends to be slightly higher than in the general public. CAM
usage among the chronically ill tends to be higher than in the general popula-
tion (Berkman et al., 1999; Page et al., 2003). It becomes more of a risk to MS
patients, because as the prevalence of CAM usage continues to increase, it is
occurring with a lack of strong evidence to support the effectiveness of the
treatments. Even with the absence of controlled research, there remains limited
relationship between the frequency of use and reported perceived effectiveness
of CAM use. In a review of randomized controlled trials, Huntley (2006) found
the research lacked strong methodology, including small sample sizes and there
being only one or two trials done for each of the treatment approaches. This
increases the risk of type II error and makes it difficult to generalize the findings
to the larger MS population.
A potential weakness of this literature review is selection bias because of the
relatively low response rates of most of the studies, which threatens the internal
(rigor of the study) and external (generalizability) validity of the findings. Most
of the studies recruited subjects from MS chapters. This decreases the ability to
generalize to the larger population of people with MS. Many of the studies also
have small sample sizes. Limitations of the review also resulted because of rec-
ognized problems comparing the results of utilization surveys. In particular,
there are differing definitions used in the surveys for CAM. Specifically, some
surveys list the CAM therapies for the individual to choose from, while others
have open-ended questions, allowing the individual to fill in the CAM(s) he
uses. There are also differences in the time periods of use referred to in the
surveys (e.g. current vs. used in last 6 months vs. lifetime use vs. past use). These
differences contribute to considerable variation in the prevalence of use
reported.
Other patterns emerging from the literature review include the use of CAM
therapies as a complement to conventional medicine (National Center for
Health Statistics, 2008). Individuals do not tend to give up their conventional
healthcare providers in lieu of CAM treatment (Berkman et al., 1999; Apel
et al., 2006). The trend is to use CAM as an adjunct to the treatment being
received from a conventional M.D. Another pattern that emerged was the use
of CAM to treat or manage MS symptoms. Although a small percentage of
patients do seek CAM for disease modifying purposes, significantly more patients
use CAM to treat or manage the daily symptoms (Nayak et al., 2003; Page
et al., 2003; Barnes et al., 2004; Pucci et al., 2004). In the surveys reviewed,
the most frequently used CAM therapies include; massage, acupuncture, chiro-
practic, vitamins/herbs and nutrition.

Occup. Ther. Int. 16(1): 57–70 (2009)

Copyright © 2009 John Wiley & Sons, Ltd DOI: 10.1002/oti
 Use of complementary medicine with multiple sclerosis 67

Implications for occupational therapy (OT) practitioners

Knowledge about the prevalence of use and CAM treatments being used is
valuable to OT practitioners, not only for interactions with their MS clients,
but also for all clients. The topic of CAM is pertinent to the Occupational
Therapy Practice Framework (American Occupational Therapy Association,
2002). Communication about CAM use is initiated as part of the occupational
profile (American Occupational Therapy Association, 2002). Use of a client-
centred approach is used to gather information about what is important and
meaningful to the client. This will include priorities about health and wellness,
prevention and quality of life. While it is impractical to expect OT practitioners
to be knowledgeable about all forms of CAM, the principles of evidence-based
medicine can be applied to CAM as in any other area of practice. The knowl-
edge gained from this literature review and further research can help OT prac-
titioners in their consulting role, collaborating with and assisting MS clients to
make educated decisions about various types of healthcare. The knowledge can
also help OT practitioners who may use CAM as part of their treatment
program. This may include, but is not limited to, yoga or relaxation. In addition,
the information from the occupational profile provides the OT practitioner with
information about their client’s interests, values, needs and perspectives.
Knowing how the client perceives his or her illness will assist the OT practitio-
ner to empower the client with the skills needed to feel comfortable discussing
their healthcare priorities, including prior, current or future CAM use, with
their M.D.

Acknowledgement

The author wishes to thank Martha Hartgraves, PhD, OTR/L, CLT, OT Gradu-
ate Program Director at Rocky Mountain University of Health Professions,
Provo, Utah, for her assistance with this project while she was a doctoral student
at the university.

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70 Olsen

Stuifbergen AK, Harrison TC (2003). Complementary and alternative therapy use in persons
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Address correspondence to Sherri A. Olsen, 18006 - 64th St. E., Lake Tapps, WA 98391, USA
(E-mail: olsenls1515@msn.com).

Occup. Ther. Int. 16(1): 57–70 (2009)

Copyright © 2009 John Wiley & Sons, Ltd DOI: 10.1002/oti