Volume 112, Issue 1

Approximately 30% of older adults fall at least once per year, with falls being the leading cause of fatal and nonfatal injuries for individuals in this age group. Because of projected increases in the older adult population, the annual cost of fatal and nonfatal fall-related injuries is estimated to reach $32.4 billion in 2020. Falls in older adults are likely due to an interaction of multiple risk factors, including vitamin D deficiency, diminished strength and coordination, depression, multiple medications, and home hazards. Ultimately, the evidence supports a multifaceted approach to screening for fall-related risk factors and targeting treatment to address specific risks for each patient. While keeping in mind that the patient is the product of the dynamic interaction of body, mind, and spirit, the osteopathic physician is well suited to provide comprehensive, patient-centered care.

Context: Many patients with multiple sclerosis use complementary and alternative medicine (CAM) to supplement their traditional treatment. Objective: To identify both the prevalence and frequency of use of therapies other than disease-modifying agents (DMAs), including CAM, among patients with multiple sclerosis. Design: The authors administered a 13-question survey regarding patients' current use of non-DMA therapies—including dietary supplements, exercise, and “true” CAM (eg, acupuncture, chiropractic, massage)—and mainstream treatments, including physical therapy and osteopathic manipulative treatment. Patients rated their level of disability on a scale of 1 to 10 (with 10 being most severe). Setting: A hospital outpatient clinic in Philadelphia, Pennsylvania. Patients: Inclusion criteria were physician-confirmed multiple sclerosis (either relapsing-remitting or progressive), regardless of sex, duration of disease, age at onset, disability level, or type of disease. Patients were excluded if they were younger than 18 years. Main Outcome Measure: Patient-reported use of non-DMA therapies and perception of disability. Results: A total of 111 patients with multiple sclerosis completed the survey properly. All respondents used non-DMA therapies. Twenty-three patients (20.7%) used these therapies without concomitantly taking a DMA. A plurality (34.8%) of those patients reported a disability score of 7 or 8. Sixty-two of the 88 participants (70.5 %) who used DMAs reported disability scores of 5 or less. Sixty-five patients (58.6.%) reported exercising on a weekly basis. Among those patients, 47 (72.3%) reported a disability score of 5 or less. Sixty-four patients (57.7%) used such CAM therapies as acupuncture and massage, or such other non-DMA treatments as osteopathic manipulative treatment and psychotherapy. Among those patients, 37 (64.9%) reported a disability score of 5 or less. Conclusion: Many patients with multiple sclerosis are seeking more than traditional medical treatment. Physicians and other health care professionals must be aware of the extensive use of alternative modalities among these patients, and these professionals must provide guidance and monitoring in use of these therapies to improve outcomes.