Study assesses the use of complementary and integrative healthcare by people with spinal cord injury

In a cross-sectional self-report study led by experts from five Spinal Cord Injury Model Systems Centers, a survey of people with spinal cord injury revealed that 80 percent of participants were current or previous users of complementary and integrative healthcare approaches such as multivitamins, massage, and acupuncture. Because there is little data regarding the safety and efficacy of use among this population-;and because their risk of contraindication may be higher-;researchers urge rehabilitation clinicians to be aware of this trend and to initiate dialogues with patients about these therapies to ensure their health and safety.

The article, "Utilization of complementary and integrative healthcare by people with spinal cord injury in the Spinal Cord Injury Model Systems: A descriptive study" (doi: 10.1016/j.apmr.2021.04.023) was published in Archives of Physical Medicine and Rehabilitation on May 28, 2021.

Amanda Botticello, PhD, and Jeanne Zanca, PhD, of Kessler Foundation, co-authored the article with Jennifer Coker, PhD, MPH (lead author), Jeffrey Berliner, DO, and Susan Charlifue, PhD, of Craig Hospital; Thomas N. Bryce, MD, of Icahn School of Medicine at Mount Sinai; David Chen, MD, of Shirley Ryan AbilityLab; David Estrada, JD, and Ross Zafonte, DO, of Spaulding Rehabilitation Hospital; Kimberley R. Monden, PhD, of University of Minnesota Medical School; and Heather Taylor, PhD, of Texas Institute for Rehabilitation Research.

The use of complementary and integrative healthcare-;which includes healthcare approaches typically seen as outside of conventional medical care or traditional Western medical practices-;is on the rise. People with spinal cord injury, in particular, are using alternative therapies, often in an attempt to relieve pain. Yet there is very little scientific evidence for the efficacy of most approaches, and even less evidence for their safety, specifically for people with spinal cord injury, whose concurrent treatments and functional limitations may present additional risks as compared to the general population.

This study is the first to systematically assess complementary and integrative healthcare in people with spinal cord injury. In an analysis of an online survey completed by 411 participants with spinal cord injury, the research team characterized how often and why people try using therapies that are not prescribed by their clinicians.

Nearly 70 percent of participants reported that they were currently using a form of complementary and integrative healthcare, whereas fewer than half reported using non-traditional therapies prior to their injury. This tells us that people with spinal cord injury are eager for information about and access to alternative therapies, and we need to be able to provide rehabilitation clinicians with up to date and accurate information about what's safe and effective and what's not."

Dr. JenniferCoker, Craig's Rocky Mountain Regional Spinal Cord System

Reported complementary and integrative healthcare approaches comprised a wide range of types, with the most common being multivitamins, followed by massage, cannabis, vitamin D, cranberry extract, and vitamin C. The most common reasons for current use were general health and wellness, pain, bladder management, and to improve mobility, flexibility, and strength, though a variety of other reasons were also reported, ranging from respiratory function to mental health. Among participants who reported not trying complementary and integrative healthcare approaches, the primary reason was not knowing what options were available.

"There are still important questions to address," added Dr. Botticello at Kessler's Northern New Jersey Spinal Cord System. "Are people with spinal cord injury using complementary and integrative healthcare because it makes them healthier, meaning they experience fewer problems from secondary conditions? Or are people who experience more secondary health conditions using these approaches attempting to treat those conditions?" She continued, "There is clearly a need and opportunity to educate people with spinal cord injury and their health care providers about the potential use of complementary and integrative healthcare interventions. Expanding the toolbox of interventions available to address complications and maximize well-being would be a great benefit."