Prevalence of visits to five types of complementary and alternative medicine practitioners by the general population: A systematic review

Abstract

Objective

To systematically review surveys of 12-month prevalence of visits to complementary and alternative medicine (CAM) practitioners for five therapies: acupuncture, homeopathy, osteopathy, chiropractic, and medical herbalism.

Methods

Studies were identified via database searches to 2011. Study quality was assessed using a six-item tool.

Results

Forty-one surveys across 12 countries were included. Twenty-five (61%) met four of six quality criteria. Prevalence of visits by adults were (median, range): acupuncturists 1.4% (0.2–7.5%, N = 27 surveys), homeopaths 1.5% (0.2–2.9%, N = 20 surveys), osteopaths 1.9% (0.2–4.4%, N = 9 surveys), chiropractors 7.5% (0.3–16.7, N = 33 surveys), medical herbalists 0.9% (0.3–4.7%, N = 14 surveys). Estimates were slightly lower for children and higher for older adults. There was little change over the past 15–20 years.

Conclusions

This review summarises 12-month prevalence of visits to CAM practitioners in Europe, North America, Australia, East Asia, Saudi Arabia and Israel. A small but significant percentage of these general populations visit CAM practitioners each year.

Introduction

We recently published results of a broad-scale systematic review assessing prevalence of use of complementary and alternative medicine (CAM) within general populations across 15 countries [1]. Estimates of 12-month prevalence of use of any CAM ranged from 9.8% to 76% (based on 32 studies), while estimates of 12-month prevalence of visits to CAM practitioners ranged from range 1.8%–48.7% (based on 33 studies). Though these ranges were wide, estimates of 12-month prevalence of any CAM use (excluding prayer) from surveys using consistent measurement methods showed remarkable stability within some countries, such as Australia (49%, 52% and 52% in 1993, 2000 and 2004 respectively) and USA (36% and 38% in 2002 and 2007).

The focus of the study reported here is to systematically review the subset of these general population studies that reported 12-month prevalence of visits to practitioners for any one of five types of complementary and alternative medicine (CAM): acupuncture, homeopathy, osteopathy, chiropractic, and medical herbalism. Each of these therapies has established training and governance practices in the countries surveyed, and each claims to utilise a specific diagnostic approach which is independent of Western medical practice [2].

Brief definitions of the five therapies are as follows [2]. Acupuncturists insert small needles into various points in the body. Traditional Chinese acupuncturists use the idea of ‘qi’ (vital energy) traveling around the body along ‘meridians’, while Western acupuncturists prefer to think of needle insertion as affecting nerve impulses and the central nervous system. Homeopaths use the principle of treating ‘like with like’. Homeopathic remedies are highly diluted and serially succussed substances that if given to a healthy person would produce the symptoms that the remedies are being given to treat. Osteopaths use a system of diagnosis and treatment, usually by manipulation, which mainly focuses on musculo-skeletal problems, though some branches aim to treat a wider spectrum of disorders. Chiropractors treat musculo-skeletal complaints through adjusting muscles, tendons and joints and using manipulation and massage techniques. Medical herbalists use remedies derived from plants and plant extracts to treat disorders and maintain good health.

This review focusses on visits to practitioners rather than self-treatment using over-the-counter products (for example for homeopathic remedies and herbal preparations). This decision was made on the basis that practitioner visits represent significant examples of health behavior, and estimates for this behavior are likely to be better-defined and less prone to recall bias than estimates for self-treatment.