Why do patients with rheumatoid arthritis use complementary therapies?
OBJECTIVE
(1) to develop an understanding as to how the use of complementary therapy (CT) affects a patient's perspective of health and well-being, (2) to offer the rheumatology professional insight and understanding as to why a patient chooses to use a CT, and (3) to raise awareness as to the forms of CT most commonly used by patients with rheumatoid arthritis.


METHODS
This qualitative study was based on phenomenological principles applied through focused inquiry to develop an understanding of the lived experience of the study participants. The inclusion criteria of an established diagnosis of rheumatoid arthritis and known use of CT were applied to a convenience sample of patients attending a rheumatology outpatient department clinic on two consecutive days. Of the 15 eligible patients identified, five were randomly selected for inclusion in the study. Narrative data were collected through analysis of transcripts taken from audiotape recordings of unstructured interviews with study participants. A manual indexing system was used to develop four significant categorisation themes to reflect the findings: (1) incentives to use CT, (2) perceived benefits of CT use, (3) the choice of CT used, and (4) perceived disadvantages and risks of CT use.


RESULTS
Incentives to use CT included dissatisfaction with conventional treatment, often in the form of side effects, and drug ineffectiveness. Social factors, such as loss of employment and social activities, were also indicated, as were psychological changes in the form of depression, hopelessness and fear. Perceived benefits were categorised as either physical or psychological with associated aspects of choice and control viewed as important elements of personal empowerment. The choice of CT used fell into three categories; physical, spiritual and herbal. The most commonly used of these were herbal remedies and supplements, closely followed by aromatherapy massage. Disadvantages and risks were identified as physical (pain and discomfort), psychological (fear and uncertainty), and/or material (cost).


CONCLUSIONS
This study suggests that regular use of CT by patients with rheumatoid arthritis offers holistic benefits. Compared to conventional treatments, CT is seen to have advantages in terms of a lower incidence of adverse reactions, greater patient choice, psychological comfort and an increased quality of the patient/therapist relationship. The use of CT by patients with rheumatoid arthritis indicates a need for evidence-based information about its use and safety in order to direct practice within a rheumatology department.
Rose
Ginny
G
Rheumatology Department, Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK. Ginny.Rose@ipswichhospital.nhs.uk
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology* / Q000628:therapy*; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care; D012649:Self Concept; D016896:Treatment Outcome