Patients' attitudes toward alternative medicine as a treatment for musculoskeletal conditions: One center's experience

Khalid AlSaleh; Zeyad Alkhenizan; Abdulelah Aldossari; Ali Alammari; Abdulaziz Bin Dakhil; Abdulmajeed AlZakri

doi:10.4103/jnsm.jnsm_46_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 5 | Issue : 1 | Page : 7-10

Patients' attitudes toward alternative medicine as a treatment for musculoskeletal conditions: One center's experience

Khalid AlSaleh¹, Zeyad Alkhenizan², Abdulelah Aldossari², Ali Alammari², Abdulaziz Bin Dakhil², Abdulmajeed AlZakri¹
¹ Department of Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
² Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission	22-Apr-2021
Date of Acceptance	21-Aug-2021
Date of Web Publication	07-Feb-2022

Correspondence Address:
Khalid AlSaleh
King Saud University Medical City, King Saud University, Riyadh 12372
Saudi Arabia

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnsm.jnsm_46_21

Abstract

Introduction: Despite rapid progress in providing advanced medical care, patients still seek traditional and alternative medicine (AM) therapies for their musculoskeletal complaints. Materials and Methods: A survey of adult patients attending the outpatient orthopedic clinics of a Tertiary Care Institution in Riyadh, Saudi Arabia, was performed. The survey was designed to delineate the patients' demographics, current musculoskeletal complaints, previous history of seeking an alternative treatment modality, and their opinions regarding these AM therapies. Results: One hundred and ninety-six patients agreed to fill the questionnaire. Fifty-four (27.6%) admitted to having had AM in the past. Wet cupping and traditional manual therapy were the most popular AM modalities undertaken, follow closely by herbal treatment and cautery. Age and educational level were found to be associated with the use of AM (P < 0.05). Most participants would never consider using AM, their rationale because it was perceived to be either unsafe or ineffective. Conclusion: AM use for musculoskeletal ailments is still prevalent. It is provision by the untrained and unlicensed individual is a concern. Better access to healthcare, advances in education, and a younger population may decrease its prevalence in the future.

Keywords: Alternative medicine, orthopedics, traditional medicine

How to cite this article:
AlSaleh K, Alkhenizan Z, Aldossari A, Alammari A, Dakhil AB, AlZakri A. Patients' attitudes toward alternative medicine as a treatment for musculoskeletal conditions: One center's experience. J Nat Sci Med 2022;5:7-10

How to cite this URL:
AlSaleh K, Alkhenizan Z, Aldossari A, Alammari A, Dakhil AB, AlZakri A. Patients' attitudes toward alternative medicine as a treatment for musculoskeletal conditions: One center's experience. J Nat Sci Med [serial online] 2022 [cited 2023 Mar 21];5:7-10. Available from: https://www.jnsmonline.org/text.asp?2022/5/1/7/337379

Introduction

Musculoskeletal conditions form 15% to 20% of all visits to primary care.^[1] While the quality of care can be questioned, access to modern medical facilities is widespread in most cities in the Kingdom of Saudi Arabia.^[2] Traditional and alternative medicine (AM) remains an option for many, even when medical facilities exist, and access is not an issue.^[3] AM is defined as “diagnosis, treatment, or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine.”^[4] In this study, our goal was to evaluate the prevalence of specific common AM modalities in an outpatient orthopedic setting and to investigate possible reasons for the continued perceived need for such therapies.

Materials and Methods

The outpatient orthopedic clinics of the King Khalid University Hospital deliver care to over 10,000 patients annually. All orthopedics conditions are accepted regularly and from all over the country. As such, it was chosen as the site for our cross-sectional survey. A structured, self-reported questionnaire was designed. It had three main sections: The first section included personal and demographic information (age group, gender, social status, educational level, workplace, and region of current residence with the country). The second section was concerned with the joint pain for which the patient was seeking attention from the care provider. The participant may state any joint pain that applies. The third section investigated the patients' attitudes with regards to traditional and AM. They are asked to declare if they had any past personal with specific AM modalities. The questionnaire was validated by review by an expert researcher. The patients were allowed not to reply to the questions they were not comfortable answering. The King Saud University College of Medicine Institutional Research Ethics Board approved the research project (IRB approval number Ref. No. 21/0303/IRB dated March 28, 2021). Convenience sampling was used. The questionnaire was administered to all adults (above 18 years of age) who attended the orthopedic clinics - as patients - over 1 week in early April 2021. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from the patient for being included in the study. Descriptive statistics and the Chi-square test were used to analyze the data using the SPSS version 27 (IBM Inc., Armonk, NY, USA).

Results

One hundred and ninety-six patients agreed to be involved in the study and filled the questionnaire. The demographic information is presented in the table below [Table 1]. With regards to the present complaints, the majority of patients were seeking care for either knee pain or back pain [Figure 1]. When asked if they had any personal experience with AM, 54 participants answered yes (27.6%). Of all the positive responders, 21 had used a traditional therapist (38.9%), 17 used herbal remedies (31.5%), 22 used wet cupping (40.7%), while only 7 participants admit having had used cautery (13%).

Table: Demographic information of the study sample of 196 patients

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Figure 1: Location of joint pain in the study sample

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When asked about the rationale behind their choice of AM, 20 participants (10.1%) replied it was due to previous personal experience. Most of the responders-however - answered that it was due to recommendations by people they trust (30 participants, 15.2%). The mainstream media and social media were the reasons for only 18 participants (9%). When asked their opinion of AM, most replied it was never an option (77 participants, 39.3%) or only an option if modern medicine fails (37 participants, 18.9%). Twelve participants (6.1%) reported they would seek AM before consulting a physician, and 16 (8.2%) reported that their view is that AM is superior to modern medicine.

For the patients who answered that AM was never an option, they were asked was the rationale behind this view. Eighty-nine participants reported they thought it was not safe (44.9%). Fifty-one participants reported that they are opposed to it by principle (25.8%), while 16 participants reported they thought it was not effective (8.1%).

When analyzing the participants who underwent AM by their demographic data, age above 60 was found to be associated with using traditional or alternative treatment (P = 0.02). On that note-and probably related to the issue of age-, being married or a widower was significantly associated with the use of AM (P = 0.005). In addition to that, having only basic education was associated with using traditional or AM (P = 0.005). Gender, region of residence, and workplace were not found to be associated with seeking alternative therapy (P > 0.05 for all three).

Discussion

The importance of AM within any society cannot be ignored. In 2008, the council of ministers of the Kingdom of Saudi Arabia passed a resolution to establish the “center for complementary and AM” as a regulatory body under the supervision of the Ministry of Health. And yet, the provision of AM exists to this day in the hands of traditional healers. The overall prevalence of AM utilization in this study is only 27%. The reported prevalence of AM in other studies within the Kingdom of Saudi Arabia varies from 24%–85%.^{[3],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18]} The overall prevalence can hardly be compared to this study, as no two studies compared the same AM modalities in the same background or geographic area. Only one study was done nationwide.^[19] Most studies focused on particular regions only.^{[8],[9],[10],[11],[14],[19]} Moreover, the highest incidence found in the paper by Elolemy et al. dropped from 85% to 47% when prayers and spiritual therapy were excluded from the study.^[10] Prayer and reciting the Quran is a well-established religious activity practiced by almost all the native population of Saudi Arabia, and as such, including it as a form of AM skewed the incidence in most studies toward a higher number. For that reason, the authors of this study did not include it.

The role of the traditional manual therapist has not been studied well. In fact, very little exists in the literature about it.^[19] The traditional manual therapist claims to heal bone and joint ailments, and the methods he employs are ancient and not well studied. In this study, 10% of all participants - and 39% of those admitted to using AM-admitted to having been treated by a traditional therapist. This area of traditional medicine is an excellent area for further study as little exists to explain the continued interest while manual therapy is currently available provided by either a licensed physical therapist or a licensed chiropractor.

The use of herbal remedies has been well studied. The prevalence reported in the literature varies from 23% to 42%.^{[8],[10],[15],[16],[20]} In our study, the prevalence was 8.6% (31.5% in those admitted to using AM). The safety of using herbal treatment is questionable, and the literature includes many reasons to be alarmed.^[21],[22]

Cupping is another ancient treatment that is currently gaining popularity worldwide.^[23] A randomized controlled trial has been done locally, claiming it is an effective treatment for common complaints, such as back pain.^[24] Cupping has been accepted into use by the national regulating bodies with services currently provided by licensed private clinics.^[25] In this study, the prevalence of wet cupping (Hijama) was 11% (40.7% in those admitted to using AM). This is comparable to other similar studies.^{[8],[10],[15],[20]}

Cautery is-unfortunately - still a prevalent form of AM in the region. Its prevalence seems to be somewhat dropping; however, Watts et al., in 1989 reported it to be 22% in his series.^[26] The prevalence in the most recent series is down to 5.6%.^[16] Other studies have reported values in between.^[8],[10] In our study, the prevalence was just 3.5% (13% in those admitted to using AM).

In our study, most participants either never considered AM an option or viewed it as an option if modern medicine fails. Other studies have addressed this extensively and have come to similar conclusions.^{[5],[6],[7],[8],[10]} When asked why they would not consider it an option, most believed it was not safe or ineffective. This shows that the public's awareness plays a vital role in the decision-making about such practices.

A consistent finding when reviewing the national literature about the subject is the association of middle age and less education with increased prevalence of AM use.^{[6],[7],[8],[15],[20]} This was indeed the case in our study too. Some international studies have found the opposite to be the case.^[27] Gender was not found to be associated with the use of AM in our study, and most other recent studies agree with that finding.^{[15],[16],[17],[19]}

Conclusion

AM is prevalent, and its popularity does not seem to wane. This study has shown that specific AM modalities are still popular with patients suffering from musculoskeletal conditions, even when the safety and effectiveness of some of these modalities are questionable. This is the first study to report on the prevalence of AM in an orthopedic setting. Although the sample size is small, it confirmed the finding of other studies and gave insight into the behavior of the target population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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