Multiple sclerosis clinical practice guidelines provide few complementary and alternative medicine recommendations: A systematic review

Jeremy Y Ng; Vanessa Kishimoto

doi:10.1016/j.ctim.2020.102595

Multiple sclerosis clinical practice guidelines provide few complementary and alternative medicine recommendations: A systematic review

Complement Ther Med. 2021 Jan:56:102595. doi: 10.1016/j.ctim.2020.102595. Epub 2020 Oct 18.

Authors

Jeremy Y Ng¹, Vanessa Kishimoto²

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. Electronic address: ngjy2@mcmaster.ca.
² Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. Electronic address: vanessa.kishimoto@mail.utoronto.ca.

PMID: 33197670
DOI: 10.1016/j.ctim.2020.102595

Abstract

Objective: Complementary and alternative medicine (CAM) use is prevalent among individuals with multiple sclerosis (MS), yet the quantity and quality of CAM recommendations in MS clinical practice guidelines (CPGs) has not been assessed. The objective of this study was to determine the mention of CAM in MS CPGs and assess the quality of CAM recommendations.

Design/setting: A systematic review was conducted to identify MS CPGs. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs containing CAM recommendations published by non-profit agencies on the treatment of MS for adults were assessed for quality and reporting using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.

Outcome/results: From 204 unique search results, six CPGs mentioned CAM and four made CAM recommendations. Scaled domain percentages from highest to lowest were clarity of presentation (90.3 % Overall, 83.3 % CAM), scope and purpose (87.5 % Overall, 86.8 % CAM), rigour of development (80.0 % Overall, 61.7 % CAM), applicability (55.2 % Overall, 44.3 % CAM), editorial independence (49.0 % Overall, 47.9 % CAM), and stakeholder involvement (55.6 % Overall, 39.6 % CAM). Quality varied within and across CPGs. Three of the four CPGs were recommended by both appraisers; one was recommended as "No" or "Yes with modifications".

Conclusion: CAM recommendations were only present in one third of all eligible CPGs. CPGs that scored highly can be used by patients and healthcare professionals as the basis for discussion about the use of CAM therapies for MS treatment/management. Although many people living with MS (PwMS) seek CAM therapies, few CPGs are available to provide guidance for clinicians and patients.

Keywords: AGREE II; Clinical practice guidelines; Complementary and alternative medicine; Multiple sclerosis; Systematic review.

Publication types

Systematic Review

MeSH terms

Complementary Therapies / methods*
Humans
Multiple Sclerosis / therapy*
Practice Guidelines as Topic