Alternative medicine includes a group of diverse healing and preventative practices that The boundaries of alternative medicine are constantly changing …
AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION ON PEDIATRICS
Considering Interventions from Complementary Alternative Medicine
What Is Complementary Alternative Medicine?
Alternative medicine includes a group of diverse healing and preventative practices that are not part of traditional or conventional medicine Alternative medicine is not widely taught nor frequently used by medical doctors or other health care providers, including physical therapists When used with conventional medicine, alternative practices are called complementary The boundaries of alternative medicine are constantly changing as different types of care gather more evidence, become more accepted by physicians and other health care providers, and are more often requested by patients Respectful, family-centered care of children requires mutual participation of physical therapist and parent when making decisions about alternative interventions Both should seek information and share with each other, with the common
goal of the best possible outcome for the child The questions and suggestions that follow are intended to facilitate decision-making about alternative and complementary interventions The National Center for Complementary and Alternative Medicine NCCAM of the National Institutes of Health NIH classifies alternative interventions into five categories: Alternative medical systems, built upon systems of theory and practice eg, homeopathic and naturopathic medicine; Mind-body interventions, which enhance the minds capacity to affect bodily functions eg, meditation or creative outlets; Biologically based therapies, which use substances found in nature eg, herbs; Manipulative and body based methods eg, chiropractic; and Energy therapies, which involve use of energy fields eg, Reiki and unconventional use of electromagnetic fields
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Section on Pediatics
FACT SHEET
AMERICAN PHYSICAL THERAPY ASSOCIATION
PEDIATRICS
What Is the Evidence for the Effectiveness of Alternative
Intervention?
Conventional medicine emphasizes evidence-based practice, which is the use of the best available knowledge and research to guide decision-making The evidence from research should be interpreted in the context of the specific child, his or her daily routines, and his or her family Anecdotes about interventions or testimonials are not considered to be adequate for decision-making, according to evidence-based practice The highest level of evidence involves controlled trials, taking the placebo effect into account Consult with the childs primary health care provider and other specialists for information on the alternative practice in question If the childs primary care physician is unsupportive or uninformed about alternative medicine, share what you know and try to be clear and objective about why you are pursuing the alternative or complementary practice Search for evidence on the practice or intervention NCCAM has a useful Web site wwwnccamnihgov, and the NCCAM
Clearinghouse can be accessed by phone 888/644-6226 The staff is available to assist you with your search of medical and scientific literature Also, search at your local or medical library; the reference librarian can help you research your topic Another useful resource is PubMed www pubmedgov, the NIH database for medical literature A bibliographic database of journals covering alternative and complementary therapies is accessible through PubMed
Section on Pediatrics APTA
1111 North Fairfax Street Alexandria, VA 22314-1488 Phone: 800/999-2782, ext 3254 Fax: 703/706-8575 E-mail: pediatrics@aptaorg
wwwpediatricaptaorg
Section on Pediatics
Considering Interventions from Complementary Alternative Medicine
Search for and read consensus documents and metanalyses on the topic, if available Consult with agencies, such as United Cerebral Palsy, for links to information about alternative medicine Search for the alternative intervention in Hooked on Evidence wwwapta
org/hookedonevidence/indexcfm; the evidence-based review of topics by the American Physical Therapy Association Be wary of interventions purported to help a variety of conditions or that claim dramatic cures
Is the Intervention Safe?
Potential problems may be difficult to identify with many alternative interventions For example, herbal medicines are not tested or regulated by the FDA, so potency can be inconsistent and the lowest effective dose for children may not be determined Talk to the childs primary health care provider to find out if the alternative practice has the potential to be dangerous Areas of concern include allergies, the childs behavioral or biological reactions to new things, musculoskeletal impairments, development of skeletal structures and functions, behavioral issues, and financial stresses in the family Remember that vitamins and herbs can be potent chemicals and may interact with current medications There may be effects of abrupt withdrawal Natural doesnt
necessarily mean safe Consider how the time and energy committed to the alternative intervention may interfere with the childs already-established daily routines and interventions Information about safety may be obtained through the sources suggested above Also, check with the Federal Trade Commission wwwftcgov to see if there are fraudulent claims or consumer alerts Try to speak with other parents who have used the intervention to discuss the pros and cons of their perspective
FACT SHEET
How Can I Evaluate the Qualifications of Alternative Practitioners?
In conventional medicine, medical doctors and other health care providers have licensing boards that standardize practice and qualifications Professional organizations also set practice and ethical standards This is not necessarily true of alternative practitioners Inquire about the education and official credentials the practitioner has Some states license alternative practitioners, such as acupuncturists or massage therapists
There may not be licensure for other practitioners Ask whether there is a brochure or Web site to tell you more about the practice Find out if theres a professional organization for the type of practitioner that youre considering and contact it to obtain information about standards of care Search for professional organizations on the Internet or by using directories in the library The Directory of Information Resources Online dirlinenlmnihgov lists locations and information about a variety of health organizations Ask the childs primary care practitioner if he or she knows of a reputable practitioner of the intervention you are investigating Seek recommendations from other parents or someone that you trust Determine if the practitioners claims about the intervention are realistic and if the practitioner is open to discuss limitations and advantages Evaluate the practitioners knowledge about your childs medical or developmental condition
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AMERICAN PHYSICAL THERAPY
ASSOCIATION
PEDIATRICS
How Will I Know if the Intervention Is Helping?
Change may occur at many different levels, including: change in participation in daily routines at school, at home, or in the community and change in body structures and functions, such as flexibility of joints and selective attention Physical therapists and parents need to collaborate to develop objective ways to measure change over time Determine the characteristics or behaviors of the child that are targeted by the intervention and the expected timing for change
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Section on Pediatics
Considering Interventions from Complementary Alternative Medicine
Physical therapists and parents should observe the effects of the intervention and discuss them The effects of the intervention and its withdrawal may be systematically observed by providing the intervention for a specified time, safely withdrawing the intervention, then repeating the sequence
Resources
Adams RC, Snyder P Treatments for cerebral palsy: making
choices of intervention from an expanding menu of options Infants and Young Children 1998;104:1-22 Davis CM Complementary Therapies in Rehabilitation Slack Inc; 2004 Dowshen S, Hassink S Alternative Medicine and Your Child, 1/25/03 wwwkidshealth org/parent/general/sick/alternative_medicinehtml Galantino ML, Parker J, Masciangelo J, Westcott C Complementary and Alternative Medicine in the Pediatric Population Presented at Using Evidence in Clinical Decision Making: Conventional and Complementary Approaches in Pediatric Occupational and Physical Therapy March 29, 2003 Drexel University Harris SR How should treatments be critiqued for scientific merit? Physical Therapy 1996;762:175-181 Nickel RE Controversial therapies for young children with developmental disabilities Infants and Young Children 1996;84:29-40 Palisano R Keynote Address Using Evidence in Clinical Decision Making: Conventional and Complementary Approaches in Pediatric Occupational and Physical Therapy March 29, 2003 Drexel
University Sandler AD, Cooley WC, Hirsch D Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability Pediatrics 2001;1073:598-601
FACT SHEET
For More Information
If you have additional questions, would like to order additional copies of this fact sheet, or would like to join the Section on Pediatrics, please contact the Executive Office of the Section on Pediatrics of the American Physical Therapy Association at: APTA Section on Pediatrics 1111 North Fairfax Street Alexandria, VA 22314 800/999-2782, ext 3254 Fax: 703/706-8575 pediatrics@aptaorg Or visit the Sections Web site at wwwpediatricaptaorg
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AMERICAN PHYSICAL THERAPY ASSOCIATION
PEDIATRICS
Copyright 2004 by the Practice Committee of the Section on Pediatrics, APTA, with special thanks to expert contributors Joanne Valvano, PT, PhD; Mary Jane Rapport, PT, PhD; and Kathy David, PT, MS, PCS
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