title: Complementary and alternative medicine in multiple sclerosis: survey of licensed naturopaths.
abstract: OBJECTIVE
  This paper describes the treatments and treatment outcome measures used by licensed naturopathic physicians in the United States who treat people with multiple sclerosis (MS).
  
  
  METHODS
  A cross-sectional mail survey was used.
  
  
  METHODS
  The participants were licensed naturopaths who were members of the American Association of Naturopathic Physicians.
  
  
  METHODS
  Outcome measures included practitioner demographics; patient demographics by practitioner report; recommended therapies; perceived effectiveness of treatments for MS; methods for measuring treatment effectiveness.
  
  
  RESULTS
  Forty three percent (43%) of the respondents (166/385) had treated at least one patient with MS while 56.9% (291/385) had never treated MS. 63.3% had treated 1-10 patients with MS, 19.9% had treated 11-20 patients with MS, and 16.8% had treated > or =20 patients with MS. Among the naturopaths, 68.1% communicated with an M.D. about their patient(s)' care and the majority of patients with MS were diagnosed by an M.D. (mean % = 96.3). The mean number of therapies recommended for M.S. was 3.91 (standard deviation [SD] =2.01, range 1-10). The most frequently recommended therapies included, diet (52.4%), essential fatty acid supplementation (44.6%), vitamin/mineral supplementation (33.7%), homeopathy (30.7%), botanicals (22.3%), and antioxidants (18.1%). Respondents perceived their treatments as "very effective" for the following stages of MS: early stage (57.2%); middle stage (25.3%); and late stage (3.0%). Respondents perceived their treatments as "very effective" for the following disease-related outcomes: improved quality of life (59.0%); decrease relapse rates (48.2%); decreased symptom severity (45.8%); prevention of disease progression (41.6%). The methods used "most often" for measuring treatment effectiveness included, patient report (88.0%); physical examination (27.1%); medical records/laboratory testing (13.3%). The mean estimated percentage of patients not taking conventional disease-modifying medication was 51.2% (SD = 42.7%).
  
  
  CONCLUSIONS
  Naturopaths use both a broad range and multiple complementary and alternative medicine CAM therapies for treating MS and report treatment effectiveness on the following outcomes: quality of life; symptom severity; relapse rates; and disease progression. Further research on single CAM therapies and holistic CAM systems is warranted in MS.
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA. shintol@ohsu.edu
authors.forename: Lynne
authors.initials: L
authors.lastname: Shinto
authors.forename: Carlo
authors.initials: C
authors.lastname: Calabrese
authors.forename: Cynthia
authors.initials: C
authors.lastname: Morris
authors.forename: Shannon
authors.initials: S
authors.lastname: Sinsheimer
authors.forename: Dennis
authors.initials: D
authors.lastname: Bourdette
mesh_terms: D000529:Complementary Therapies; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006306:Health Surveys; D006801:Humans; D008004:Licensure; D009103:Multiple Sclerosis / Q000628:therapy*; D009324:Naturopathy; D009922:Oregon; D010043:Outcome and Process Assessment, Health Care; D016896:Treatment Outcome