Complementary and alternative medicine: Canadian physiatrists' attitudes and behavior.

OBJECTIVE: To document the prevalence and patterns of knowledge about, referrals to, training in, and practice of complementary and alternative medical therapies and their perceived effectiveness by a sample of Canadian physiatrists.

DESIGN: Cross-sectional survey by written questionnaire.

SETTING: Physiatrists in the province of Ontario, Canada.

SUBJECTS: All 116 physiatrist/rehabilitation specialists listed in the Ontario Medical Association directory. Data were obtained from 98 respondents.

MAIN OUTCOME MEASURES: Statistical analysis of responses in these areas: attitudes, knowledge, and recommendations about alternative therapies, and clinical approach including referral pattern, training, and practice of alternative medicine.

RESULTS: Of the respondents, 72% reported referring patients for alternative medicine therapies, and 20% had training in and 20% practiced some form of alternative medicine. The therapies rated highest in usefulness were acupuncture (85%), biofeedback (81%), and chiropractic (80%). Sixty-three percent believed that alternative medicine had ideas and methods that would be of benefit to physiatrists. Only 9% believed it to be a threat to public health. A greater proportion of physiatrists who refer were women, were younger, had graduated more recently, and scored higher in their ratings of more useful alternative medicine therapies. Previous training in alternative medicine was correlated with a higher practice rate but not with referral rate. Practice profile and academic affiliation were not associated with greater or less use of alternative medicine.

CONCLUSION: In Ontario, physiatrists report greater knowledge of and more use of alternative medicine therapies than do general practitioners. The most commonly used therapies are acupuncture, biofeedback, and manipulation (chiropractic, osteopathy). It is recommended that these approaches be taught in physiatry residency training and be the focus of future research. Incorporating such therapies into practice will help to meet the public demand for such approaches in the decade to come.