title: Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case-control study.
abstract: BACKGROUND
  Following the initial reports of Chronic Cerebrospinal Venous Insufficiency (CCSVI) and the purported curative potential of venoplasty, (coined the 'liberation' procedure) Canadians living with multiple sclerosis (MS) began to travel abroad to receive the unregulated procedure, often placing them at odds with their health providers. The purpose of this study was to determine the factors influencing older MS patients' decision to undergo the procedure in order to develop more specific and targeted health information.
  
  
  METHODS
  We performed secondary analysis of data collected as part of the 'Canadian Survey of Health Lifestyle and Aging with MS' from people over the age of 55 years with MS symptoms for 20 or more years. The survey consisted of self-reported information on impairments, disability, participation, demographics, personal and environmental factors. In order to compare respondents who underwent the procedure to those who did not and to develop a predictive model, we created a comparison group using a case-control algorithm, controlling for age, gender and education, and matching procedure cases to controls 1:3. We used multivariate stepwise least likelihood regression of 'a priori' variables to determine predictive factors.
  
  
  RESULTS
  The prevalence of the 'liberation' procedure in our sample was 12.8% (95/743), substantially lower than reported in previous studies of complementary/alternative treatments in MS. The predictive model contained five factors; living alone (Odds ratio 0.24, 95%CI 0.09-0.63), diagnosis of anxiety (Odds ratio 0.29, 95%CI 0.10 - 0.84), rating of neurologist's helpfulness (Odds ratio 0.56, 95%CI 0.44 -0 .71), Body Mass Index (Odds ratio 0.93, 95%CI, 0.89 - 0.98) and perceived physical impact of MS (Odds ratio 1.02, 95%CI 1.01 - 1.04).
  
  
  CONCLUSIONS
  Predictive factors differed from previous studies of complementary/alternative treatment use likely due to both the invasiveness of the procedure and the advanced age of our study cohort. Our findings suggest that health professionals should target information on the risks and benefits of unregulated procedures to those patients who feel dissatisfied with their neurologist and they should include family members in discussions since they may be providing the logistical support to travel abroad and undergo the 'liberation' procedure. Our findings may be applicable to others with chronic disabling conditions who contemplate the user-pay unregulated invasive procedures available to them.
authors.affiliation: Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada. mploughm@mun.ca.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ploughman
authors.affiliation: Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada. ojm632@mun.ca.
authors.forename: Olivia J
authors.initials: OJ
authors.lastname: Manning
authors.affiliation: Eastern Health Authority, St. John's, NL, Canada. serge.beaulieu@easternhealth.ca.
authors.forename: Serge
authors.initials: S
authors.lastname: Beaulieu
authors.affiliation: Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada. Chelsea.harris@mun.ca.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Harris
authors.affiliation: Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada. stevehogan@novaphysio.ca.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Hogan
authors.affiliation: Clinical Epidemiology, McGill University, Montreal, QC, Canada. nancy.mayo@mcgill.ca.
authors.forename: Nancy
authors.initials: N
authors.lastname: Mayo
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada. john.fisk@cdha.nshealth.ca.
authors.forename: John D
authors.initials: JD
authors.lastname: Fisk
authors.affiliation: Department of Medical Genetics and Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. dessa.sadovnick@gmail.com.
authors.forename: A Dessa
authors.initials: AD
authors.lastname: Sadovnick
authors.affiliation: Department of Neurology, St. Michaels Regional Hospital, Toronto, ON, Canada. oconnorp@smh.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: O'Connor
authors.affiliation: London Health Science Centre, London, ON, Canada. smorrow@uwo.ca.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Morrow
authors.affiliation: Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. Luanne.metz@albertahealthservices.ca.
authors.forename: Luanne M
authors.initials: LM
authors.lastname: Metz
authors.affiliation: Department of Neurology, University of Alberta, Edmonton, AB, Canada. penelopesmyth@med.ualberta.ca.
authors.forename: Penelope
authors.initials: P
authors.lastname: Smyth
authors.affiliation: Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada. allderdice.pw@gmail.com.
authors.forename: Penelope W
authors.initials: PW
authors.lastname: Allderdice
authors.affiliation: Clinical Epidemiology, McGill University, Montreal, QC, Canada. Susan.scott@clinepi.mcgill.ca.
authors.forename: Susan
authors.initials: S
authors.lastname: Scott
authors.affiliation: Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. rmarrie@exchange.hsc.mb.ca.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.affiliation: Department of Neurology, Faculty of Medicine, Memorial University, St. John's, NL, Canada. mstephane@mun.ca.
authors.forename: Mark
authors.initials: M
authors.lastname: Stefanelli
authors.affiliation: Primary Health Care Research Unit, Faculty of Medicine, Memorial University, St. John's, NL, Canada. godwinm@mun.ca.
authors.forename: Marshall
authors.initials: M
authors.lastname: Godwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply*; D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis; D016017:Odds Ratio; D015995:Prevalence; D013116:Spinal Cord / Q000098:blood supply*; D014689:Venous Insufficiency / Q000453:epidemiology*