Multiple Sclerosis (MS) is known to be the most common cause of non-traumatic disability in young people. Iran has the highest MS prevalence in Asia and among the Middle Eastern countries. Various studies have shown a rapid increase in the prevalence of MS in Iran, especially in women. According to the definition of the World Health Organization, complementary or alternative medicine includes a number of preventive, diagnostic and therapeutic measures that are not part of standard medicine, such as herbal medicine, acupuncture, massage therapy, etc. Past studies have reported a wide range of numbers as the rate of complementary medicine usage and self-reports among patients with MS. This requires the use of a uniform standard to enable data comparison, especially at the international level. In this regard, Norway’s National Research Center in Complementary and Alternative Medicine (NAFKAM) designed an international standard questionnaire called the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q). This questionnaire was published in 2009 and has been translated into many languages [1].
So far, no study has been conducted in Iran to evaluate the self-reported use of complementary and integrated medicine in routine visits to modern medicine clinics. Due to the lack of data on the use of complementary and integrated medicine in MS patients and the importance of having knowledge about it, this study aims to survey the self-reported rate of complementary and integrated medicine among patients with MS in Iran in 2020.

This is a cross-sectional study. Study population consists of the MS patients in the Fars MS disease Registry (FMSR) in Fars, Shiraz, which is under the supervision of Shiraz University of Medical Sciences, between March and May 2020. Due to the lack of previous studies and to provide the most appropriate sample size, the prevalence of self-reported complementary and integrated medicine use was considered to be about 50%. Then, using Cochrane formula and taking into account the first type error of 5% and measurement accuracy of 10%, the minimum sample size was calculated to be 384. To reach this sample size with 70% response, if all phone numbers were correct, it was necessary to select 577 samples. 577 MS patients were selected by simple random sampling method from the FMSR.
Data related to the use of complementary and integrated medicine, self-reported use of complementary and integrated medicine at the last visit, reasons for not declaring the use of complementary and integrated medicine, demographic and background information and patients’ health status were collected. Data were collected using a standardized questionnaire on the use of complementary and integrated medicine in patients with MS based on the I-CAM-Q. It had five sections concerned with 1- visits to complementary and integrated medicine care provider, 2- complementary and integrated treatments received from physicians, 3- use of herbal medicine and dietary supplements, and homeopathic drugs, 4- self-help practices such as Yoga and meditation, and 5- Declaration or non-declaration of the use of complementary and integrated medicine at the last visit of doctor and the reasons for its non-declaration. Each section had 4 sub-sections. The first question was about the use of that complementary and integrated medicine in the last 12 months; the second question was about the number of times that complementary and integrated medicine has been used in the last 3 months; the third question was about the main reason for use, and the last question was about the patient’s satisfaction with the use.
Descriptive statistics were used to describe the data. The prevalence of self-reported use of complementary and integrated medicine and its 95% confidence interval were estimated by gender and other subgroups of patients. Chi-square test (to measure the relationship between qualitative variables) and one-way ANOVA (to measure the relationship between quantitative variables) were used to analyze the data considering a significance level of 0.05.

A total of 97% of participants had used at least one of the complementary and integrated medicine items, where herbal medicines (n=407, 97%) and dietary supplements (n=369, 88.1%) had the most use, followed by self-help practices (n=366, 87.56%), visits to complementary and integrated medicine care provider (n=144, 34.4%), receiving complementary and integrated treatments received from physicians (n=25, 6%). Chi-square test results showed a significant relationship between participants’ self-reported complementary and integrated medicine use and gender where women were more likely than men to use complementary and integrated medicine (p=0.0001). Moreover, a significant relationship between participants’ self-reported use and education where those with a university education level were more likely than others to use complementary and integrated medicine (p=0.0001).

Age, education and disease duration play an important role in self-report of complementary and integrated medicine in MS patients. Other related factors should also be considered and studied. Physicians should try to better communicate with their MS patients to know about the use of complementary and integrated medicine by them as well as the benefits and side effects of these treatments.

This study was approved by the Ethics committee of Shiraz University of Medical Sciences (Code: IR.SUMS.REC.1399.149).

This study was extracted from PhD. dissertation of the first author at the School of Medicine, Shiraz University of Medical Sciences, Shiraz. Also, Shiraz University of Medical Sciences supported financially of this study (Grant ID: 95-01-64-1396). 

All authors equally contributed to preparing this article.

The authors declared no conflict of interest.
 

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