Clinical Chiropractic 2009 (Mar); 12 (1): 23–27 ~ FULL TEXT
Elizabeth A. Carson, Gabrielle Swait, Ian P. Johnson, and Christina Cunliffe
McTimoney College of Chiropractic,
Kimber Road, Abingdon,
Oxon OX14 1BZ, United Kingdom
Objective: Many of the musculoskeletal symptoms associated with multiple sclerosis (MS) can be managed with physical therapy. Chiropractors are well placed to deliver this, but the extent of their involvement in the team management of multiple sclerosis in the UK is unknown. The present study investigates the level of awareness and use of chiropractic by people with MS in the UK.
Methods: A retrospective cross sectional postal survey design was employed, utilising a structured, self-administered questionnaire and convenience sampling of individuals aged over 18 years with a definitive diagnosis of MS who were members of UK MS Therapy Centres.
Results: Ninety-one per cent of respondents had used complementary therapy modalities of some kind, with physiotherapy being the most popular (52%), followed by massage (44%), then chiropractic (42%). Of those that had used chiropractic, 68% used it to manage their MS symptoms and most would recommend it to others with MS. Just under half had consulted their General Practitioner for approval prior to receiving the treatment, with 79% obtaining support. Of those who did not use chiropractic, 78% cited lack of knowledge about chiropractic as the main reason. All of the MS therapy centres contacted during this study offered physiotherapy and massage, but none offered chiropractic.
Conclusions: There is moderate uptake of chiropractic by people with MS in the UK together with a willingness to recommend it. Further awareness of the potential benefits of chiropractic amongst stakeholders may help its integration into the team management of MS.
From the Full-Text Article:
Multiple sclerosis (MS) is an inflammatory demyelinating condition of the central nervous system (CNS), producing a large variety of symptoms, and progressive functional impairment, which varies widely with each individual. Commonly reported symptoms include: mobility challenges, fatigue, pain, visual disturbances or blindness, impaired cognition, and problems with bowel and bladder function. This long-term, chronic neurological disorder is sometimes benign, frequently remitting, but often progressive with gradually increasing disability. The damage caused by MS can occur anywhere in the CNS and, as a result, symptoms can be extremely diverse, with a gradual loss of function a common result.  Symptoms can come and go quite unpredictably, and no two people experience them in exactly the same way. Most of the symptoms of MS can be effectively managed, and complications avoided, with regular care by a neurologist and allied health professionals. [1–2]
Between three and seven people per 100,000 globally are diagnosed with MS each year and, in the UK, prevalence is approximately 100–120 per 100,000. In all, 85,000 people in the UK are currently estimated to have MS. 
Usually diagnosed between the age of 20 and 40, MS tends to affect people at a crucial stage in their lives when they are establishing their careers, setting up home and having a family. Awareness of the treatment options available to manage a chronic neurological illness lasting upwards of 30 years is clearly important both for those with MS and those involved in their healthcare.
Sensible symptom management is recognised as a key factor for optimising quality of life for most people with MS.  Positive outcomes for physiotherapy and neurorehabilitative interventions for a number of specific MS impairments have been reported. [7–11] It would seem that chiropractic may potentially fit well into this overall model of care, particularly for management of musculoskeletal symptoms.  As many as 85% of those with MS are reported to use Complementary and Alternative Medicine (CAM) at some stage over the course of their disease5, with half the GP practices in England now providing access to CAM in some form.  In 2003, chiropractic was the second most frequently used CAM modality cited by those with MS in the USA.  There is, however, no comparable information for those with MS in the UK. Such information is vital for the rational delivery of healthcare services and for decisions relating to the dissemination of healthcare information so that informed choices can be made. The purpose of this study was therefore to scope the level of awareness and utilisation of chiropractic amongst people with MS in the UK.
The aim of this survey was to act as a preliminary investigation of whether people with MS utilise chiropractic, and what factors may influence this. The method was chosen so as to be as easy to implement as possible for the participating MS therapy centres; therefore, sample selection was pragmatic, rather than strictly controlled. In this sample of respondents with MS who were recruited via 8 UK MS therapy centres, 42% had chosen to receive chiropractic care. This level of utilisation of chiropractic in the UK would seem to be approximately one-third higher than the utilisation of chiropractic care reported by people with MS in the USA (25.5%) who were on the MS Foundation mailing list.  Direct comparison is, however, difficult due to possible differences in recruitment methods and response rates. The higher UK utilisation indicated here could reflect selection bias, with MS respondents who had used chiropractic or CAM perhaps being more likely to respond to the survey; nevertheless, this survey does indicate that chiropractic was well utilised by MS patients who responded.
Financial limitations, and possibly cultural views relating to expectations of free treatment provision via the National Health Service, may be reasons that prevent MS sufferers from utilising chiropractic. This is supported by our finding that of the 58% (n = 134) of respondents who had not used chiropractic, 17% cited lack of availability within the NHS as the reason, and indicated that they would utilise chiropractic if it were available.
Of the 42% (n = 97) of respondents in the present study who utilised chiropractic care, the majority stated that they did so to manage their MS symptoms. It likely that most utilise chiropractic care to manage pain, as this is one of the commonest symptoms,  although the nature of this survey is such that it may be difficult for MS patients to differentiate primary MS symptoms from secondary, or coexisting chronic spinal problems. There would, however, be prior reason to suppose that chiropractic care may be beneficial in managing musculoskeletal pain in this patient group.  Other aspects of chiropractic care that are of potential benefit to all patients with musculoskeletal pain are its psychosocial effects,  which have been reported to be important predictors of chronicity for back pain in general practice and occupational therapy environments. However, in the context of UK chiropractic, it has been found that general health and duration of the back pain episode are more important than psychosocial factors in predicting treatment outcomes.  This may reflect differences in how chiropractors address or manage psychosocial aspects of back pain, or it may reflect a difference in the type of patients who generally seek chiropractic care. There is some limited evidence that multidisciplinary approaches to management of MS result in psychosocial benefits.  While it is unclear how psychosocial factors may influence response to chiropractic care among MS sufferers, the chiropractic clinician could have a positive role in managing these.
In the present sample, most respondents with MS who utilised chiropractic had heard about it through a friend or relative; however, a substantial proportion (37%) had obtained information from the MS Society website or from an MS support group. This seems to indicate a good level of awareness and positive perception of chiropractic as a treatment for MS sufferers among specialist organisations. Only 13% had heard about chiropractic through their GP. Previous studies investigating the referral of patients by GPs for chiropractic or CAM have indicated relatively low rates. [17–18] This may contribute towards a lack of awareness of the potential role of chiropractic care in MS and be compounded by the lack of information available about current utilisation of chiropractic by MS patients. Of those people with MS who sought GP approval for chiropractic care, most (79%) received support, but the questionnaire did not ask for what specific symptoms such care was sought and approved. The results of the present study, therefore, do not indicate whether the GPs had considered chiropractic care in the context of the overall management of MS, or whether they had simply considered it in relation to an isolated musculoskeletal symptom, such as low back pain.
Overall, while there are some methodological limitations to generalising the results here to all MS patients in the UK, this survey achieved data on a large number of participants. Results indicate that chiropractic was well-utilised among respondents with MS, yet most people learned about the benefits of chiropractic through friends, family and MS support groups, rather than through their GP or advertisements. This disparity suggests a need for better communication regarding utilisation and the potential role of chiropractic in this population. Practical and financial considerations, as well as lack of knowledge about chiropractic, were the main factors that deterred utilisation of chiropractic among this sample of MS patients. This has implications for healthcare provision for this group. Further investigation is warranted into whether, and for which symptoms, chiropractic might be a useful addition to the multidisciplinary therapeutic approaches that are currently provided for MS patients.