Background Non-pharmacologic strategies contribute to the management of arthritis in the community, but little is known about the use of these therapies and how this varies by age and over time. Rehabilitation therapies, such as physiotherapy (PT), and chiropractic, have been shown to improve the management of arthritis, and there is also evidence for the benefit of acupuncture and massage therapy.
Objectives a) to compare the age-trajectories of use, by people with arthritis, of physiotherapy, chiropractic, and complementary and alternative medicine (CAM) over 18 years by birth cohort and b) to determine how these trajectories are affected by socio-economic status (SES), lifestyle factors, and reported pain.
Methods We used data from the Canadian Longitudinal National Population Health Survey (1994–2010). We examined 10,330 participants in five birth cohorts: pre-World War II (born 1935–1934), World War II (born 1935–1944), Older Baby Boomer (born 1945–1954), Younger Baby Boomer (born 1955–1964), and Generation X (born 1965–1974). Data on visits to physiotherapists, chiropractors, and CAM practitioners, arthritis, SES (education, income), and lifestyle factors (BMI, physical activity, sedentary behavior, and smoking), and pain that prevents activities were collected biannually. For each type of practitioner our outcome was whether participants reported 1+ visits in the past year. We used multilevel logistic growth models to examine cohort effects and predictors of each outcome, among arthritis patients.
Results At baseline (in 1994), 14.5% reported visiting physiotherapists, 14.2% chiropractors, and 6.0% CAM practitioners (most frequently for massage therapy or acupuncture). We found an increase in use of all types of practitioner with age in all cohorts. Comparing the age-trajectories of PT, chiropractic, and CAM use over time, we found significant cohort differences (p<0.0001) such that when compared at the same age, each succeeding younger cohort had higher odds of consulting with these practitioners than their older counterparts. Cohort differences were largest for CAM, where recent cohorts were more likely to use these services. Women had higher odds of using all types of practitioner than men in all cohorts. Pain and high SES were the main predictors of PT and chiropractic use. The predictors of CAM were similar with the addition of having a normal BMI as a significant predictor.
Conclusions The use of PT, chiropractic, and CAM is significantly higher in younger cohorts of people with arthritis. While pain was a major predictor, notably use of these practitioners was greater in those with higher SES, implying potential educational and income access barriers to this type of care. Healthcare providers for people with arthritis need to be aware that younger generations may have different patterns of use of other services such PT, chiropractic, and CAM.
Disclosure of Interest None declared