Use of Complementary and Alternative Medicine with Osteoarthritis Patients

Purpose: This descriptive study was carried out to explore the use of Complementary and Alternative Medicine (CAM) in patients with Osteoarthritis (OA). Methods: The study was carried out with a sample of 77 patients who presented to physical therapy polyclinics at Nevşehir State Hospital between 01 November 2015 and 01 April 2016 and who were diagnosed with OA . In accumulating the data questionnaire form has been used. The data were analyzed with the Statistical Package for Social Sciences (SPSS) 20.0 package program employing numbers and percentages and the chi-square test. Güven ve ark. Use of Complementary and Alternative Medicine with Osteoarthritis Patients. Journal of Human Rhythm 2020;6(2):39-52. 40 Results: In our study it has been found out that 23.4% of OA patients used CAM. In applying CAM methods it has been determined that 66.6% used massage, 38.8% used diet and 33% used music. 83.3% of patients using CAM with the notice of a doctor whereas 16.7% without it. Marital status, birth place and income conditions in relation with the use of CAM have been statistically significant (p<0.05), gender, age, educational status and occupation in relation with the usage of CAM have been statistically insignificant (p<0.05). Conclusions: At physical therapy polyclinics working nurses when receiving in serivice training CAM methods should be added to make them well equipped. It is also suggested that the staff working in health departments should follow researches based on facts including CAM methods and its effects.


Introduction
Osteoarthritis (OA) is a joint disease which is seen part of the rising age in people, which results in aching and disability and that's why it has got a negative effect on the quality of life (1). With the rising number of the elder people in the population (society) OA has become a significant health problem. In the United States of America (USA) OA has been seen 3% among 41 people aged 30 and over (2), people aged 45 and over have been seen between 19.2%-27.8% (3).
In a study made in Turkey OA prevalence has been reported to be 14.8% (4).
The treatment of OA includes pharmacologic and non-pharmacologic methods. In getting no response to traditional medical treatment it causes the use of effective and confident treatment of OA and as a result patients tend to use Complementary and Alternative Medicine (CAM). In USA, among the patients who complain about arthritis rank the sixth place. It is estimated that among those patients having OA the percentage is quite high (5).
As a result of rising concern of CAM among individuals the need of CAM has been tried to be fulfilled by people apart from health staff (6). The resulting of this condition, nurses whose aims are to supply the health needs of human beings the role of CAM has become compulsory. In this direction the usage of CAM's in nursing intervention development, effective strategy determination and guidance of individuals concerning the usage of CAM effectively and correctly are expected (7).

Material and Methods
This is descriptive study on patients admitted to the physical therapy polyclinics of the The subjects of this study were 77 patients with OA atmitted to the physical therapy polyclinics. Each participating patient was administered a survey questionnaire, filled out through a face-to-face interview in the physical therapy polyclinics. Before performing this study approval was obtained by the Directory of Health Services of the Province of Nevşehir and by the patients. The pilot test involved the researcher distributing the questionnaire to ten people with OA at state hospital.
The patients were administered in clinical wards a survey questionnaire consisting of 23 questions; 7 of which were on demographics, 9 on the OA records, and the remaining 7 on whether, how and why they have used CAM. The questionnaire was filled in by face to face interview by the researcher.
A chi-square test was used to chart comparisons between demographic groups. All variables are included as categorical in this analysis. Univariate and multivariate logistic 42 regression analysis was applied to determine which factors are determinants of CAM use. The variables statistical significant in the chi-square test (gender, age, marital status, educational status, birthplace, income and occupation) was applied. The data were recorded and analyzed by using computer.
Before starting the research, the patients were informed about the purpose of the research and the data collection tools to be used and their approvals were obtained. Permission was obtained from the Provincial Directorate of Health in the province where the State Hospital was located and the individuals participating in the research to conduct the research.

Results
We included 77 patients, of whom 79.2% were women, 51.9 % over the age of 60, 53.2 % married, 48.1% retired, 32.5% high school graduates, 51.9% living in the city and 61.0 % had a middle income in the age group ( Birth place and income conditions in relation with the use of CAM have been statistically significant (p<0.05), marital status, gender, age, educational status and occupation in relation with the usage of CAM have been statistically insignificant (p<0.05).

Discussion
The results of most of the studies on patients with OA show that most patients are women (4). In this study 79.2% of women made the number of patients. The reason why OA is more seen among women can be explained by their sex hormones (2). The result of this study which supports other studies; the nurses should determine the changeable risk factors of women with OA and should also plan and apply nursing intervention in order to eliminate the risk factors.
It has been stated that with the age the OA prevalence has been rising (3,8). In this study 43 The aim of OA treatment should be lessen the pain, protecting the joints, provide physical function independency and raising the quality of life. It order to reach the aims the OA treatment should involve nonpharmalogical, pharmalogical and when needed, surgery methods. The treatment should be applied to each patient in a special way. European League Against Rheumatism (EULAR), Osteoarthritis Research Society International (OARSI) suggest in the effective OA treatment methods both the pharmalogical and non-pharmalogical combination (9, 10). Getting no response in the conventional OA treatment makes way to new effective and confidential methods which leads patients more and more to use CAM applications. In the USA among patients using CAM rank place 6 with arthritis symptoms. Among those patients the percentage of OA patients is estimated to be high (5). In a study made on patients with OA the prevalence of CAM use has been found 40% (11). Likewise in a study made on South Australians the result of the CAM usage was 52.2% (12), in the USA 28% (13), in Spain the outcome was 65.5% (14). In this study it has been found out that 23.4% of patients with OA have used CAM.
At the end of this study it has been stated that the use of CAM has been lower compared to other studies and the reason for this has been that most patients shared their using CAM with doctors (83.3%) and becuase of this doctors might have been effective in giving up the CAM usage.
The most commonly usage of CAM among patients with OA are stated as follows; herbals, massage, vitamins, energy therapy and homeopathy (15). Zochling et al. (16) in his study stated that the OA patients in using CAM were commonly the use of vitamins. Kaboli et al. (13) in his study stated that the OA patients in using CAM was commonly the use of prayers. In the results of this study the outcomes of using CAM are respectively massage, diet, music, herbals and acupuncture. Most studies show that the usage of CAM has been among young patients more than compared to other ages (27)(28)(29)(30)(31)(32)(33). In this study the usage of CAM covered the ages 50-59 and has been more compared to other age groups.
Looking at studies show that maritual status in relation with the use of CAM has been not statistically insignificant (34)(35)(36). This study shows that among married people the CAM usage is the most.
There are studies which support the ineffective usage of CAM concerning the educational status (24, 37,38). There are also studies which show a significant correlation between the educational status and the usage of CAM and it is stated that the higher the educational status is the more the usage of CAM is (22, 23, 26,39,40). Studies different from these shows that the lower the educational status is the more is the usage of CAM [41,42]. This study shows that highschool graduates compared to other educational status groups were higher in using CAM. It may be thought that it is effective for the educated people to follow the internet and other media tools more closely.
In the studies which have been done the living place has not been effective on the usage of CAM (24, 38). Ceylan et al. (40) has stated that the living place has been effective on the usage of CAM and more widespread among people living in cities. In this study the result shows that those born in towns have used CAM more in respect with the others.
In studies which have been done comparatively on the status of income and the usage of CAM have shown that the higher is the income the more is the usage of CAM (23, 26,40). In this study the result shows that the medium income status has used more CAM compared to the other income status.

Conclusion
The result of this study confirms that OA patients used CAM. At physical therapy polyclinics working nurses when receiving in serivice training CAM methods should be added to make nurses well equipped. It is also suggested that the staff working in health departments should follow and update researches based on facts including CAM methods and its effects.