Traditional Chinese medicine use amongst women with arthritis : a health services research study

University of Technology Sydney. Faculty of Health.Background: The use of traditional Chinese medicine (TCM) has attracted increasing attention for physical and mental health studies over recent years. To date, there have been few nationally representative studies examining TCM treatments as well as consultations with TCM practitioners, for women with arthritis. Methods: The thesis study outlined here consists of four related but separate sections of research. First, a critical review was conducted focusing on TCM and other complementary and alternative medicine (CAM) use amongst patients with arthritis via a search of the key medicine and health science databases for international peer-reviewed articles published in the previous eight years (2008-2015). The study also conducted secondary and primary analyses of data from large samples (including both patients and practitioners) obtained by drawing upon three distinct large-scale established studies in Australia – the Australian Longitudinal Study on Women’s Health (ALSWH), the Sax Institute’s 45 and Up Study and the Practitioner Research and Collaborate Initiative (PRACI) study. Statistical analyses involved chi-square tests, multiple logistic regression, two proportions Z tests, Student’s t-tests, etc. to examine associations between the use of TCM (i.e. Chinese herbal medicine and acupuncture) and arthritis-related symptoms. Chi-square tests or Fishers Exact tests were employed for categorical variables, and Student’s t-tests were employed for continuous variables, to examine TCM practitioners’ perceptions and the role of TCM practitioners in Australia regarding arthritis care. Results: Findings from the critical review show a high prevalence of TCM/CAM use amongst people with arthritis in a number of countries and many people with arthritis use TCM/CAM concurrently with their conventional medicine. The results from ALSWH study identify women with arthritis are more likely to use TCM than women without arthritis, with 6.2-9.5%, and 4.0-5.7% of Australian women reported to be using acupuncture and Chinese herbal medicine, respectively, in the previous 12 months. Moreover, the analyses from the 45 and Up Study sub-study show that acupuncture use is positively associated with women experiencing a longer duration of time since initial diagnosis of osteoarthritis (OR=1.04), undertaking more exercise (OR=5.41), living in a rural area (OR=3.62), having consulted a psychologist (OR=12.21), and having consulted another CAM practitioner (OR=4.18). In addition, it is reported from the PRACI study that the majority of the TCM practitioners (82.2%) noticed that their patients with arthritis used other treatments alongside TCM and a large number of TCM practitioners who participated in the study believe TCM to be effective for treating arthritis. Conclusions: TCM use is popular amongst women with arthritis and the TCM profession represents a significant part of Australian CAM healthcare sector in treating arthritis. This thesis highlights a need for future research to examine the potential benefits of TCM for arthritis and to help inform the efficient and safe use of this treatment alongside conventional care. Moreover, all health professionals offering care for those with arthritis need to be aware of the concurrent use of both TCM and conventional medications amongst their patients