Journal of Gerontological Nursing

Feature Article 

Use of Complementary Health Approaches in Individuals With Parkinson's Disease

Ju Young Shin, PhD, APRN, ANP-C; Ryan T. Pohlig, PhD; Barbara Habermann, PhD, RN, FAAN

Abstract

Parkinson's disease (PD) is neurodegenerative and requires ongoing therapy. The purpose of the current study was two-fold: to (a) describe the prevalence, types, and associated factors of complementary health approaches (CHA) used in individuals with PD; and (b) explore reasons for CHA use. A self-administered, cross-sectional survey was used. The response rate was 61.9% (N = 135), and 74.1% of participants used CHA for either PD or general health. The most widely used CHA included exercise, yoga, massage, vitamins, coenzyme Q10, and coconut oil. Higher levels of education and treatment by a movement disorder specialist were significantly related to CHA use. Nurses and other health care professionals may have a role in providing safe care for individuals with PD. Further studies on effectiveness and safety of commonly used CHA are warranted. [Journal of Gerontological Nursing, 43(2), 46–54.]

Abstract

Parkinson's disease (PD) is neurodegenerative and requires ongoing therapy. The purpose of the current study was two-fold: to (a) describe the prevalence, types, and associated factors of complementary health approaches (CHA) used in individuals with PD; and (b) explore reasons for CHA use. A self-administered, cross-sectional survey was used. The response rate was 61.9% (N = 135), and 74.1% of participants used CHA for either PD or general health. The most widely used CHA included exercise, yoga, massage, vitamins, coenzyme Q10, and coconut oil. Higher levels of education and treatment by a movement disorder specialist were significantly related to CHA use. Nurses and other health care professionals may have a role in providing safe care for individuals with PD. Further studies on effectiveness and safety of commonly used CHA are warranted. [Journal of Gerontological Nursing, 43(2), 46–54.]

Parkinson's disease (PD) is prevalent among older adults, affecting at least 1 million individuals in the United States (Parkinson's Disease Foundation, 2015). PD is a progressive and degenerative neurological condition that results in the loss of dopamine-producing cells in the substantia nigra pars compact of the brain (Pavon, Whitson, & Okun, 2010). Some proposed mechanisms of PD include protein misfolding, oxidative stress, and mitochondrial dysfunction (Chao, Leung, Wang, & Chang, 2012). Individuals with PD may experience various nonmotor symptoms, including neuropsychiatric, autonomic, gastrointestinal, and sensory symptoms, as well as sleep disorders, which contribute to severe disability, impaired quality of life, and shortened life expectancy (Chaudhuri, Healy, & Schapira, 2006). Although symptoms can be initially controlled with medication, long-term use of pharmacological therapy often leads to complications (e.g., fluctuations in effectiveness and dyskinesia) that can be more disabling than the disease itself (Calabresi, Di Filippo, Ghiglieri, Tambasco, & Picconi, 2010). Due to fear of potential adverse effects of medications, complementary and alternative medicine have been used both alone and in adjunct to traditional pharmacological therapy to manage PD symptoms (Shin & Habermann, 2016).

The term complementary and alternative medicine was traditionally used by the National Center of Complementary and Alternative Medicine (2011), which is now the National Center for Complementary and Integrative Health (NCCIH). Recently, the NCCIH adopted a new term: complementary health approaches (CHA). CHA are defined as “a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional or allopathic medicine. Most of these practices are used together with conventional therapies” (NCCIH, 2016, p. 6). CHA have been widely used among U.S. adults, and include natural products (e.g., dietary supplements other than vitamins and minerals) and mind–body practices (e.g., yoga, chiropractic or osteopathic manipulation, meditation, massage therapy) (Clarke, Black, Stussman, Barnes, & Nahin, 2015). CHA use is prevalent among older adults in the United States. In a recent study, approximately one third of midlife and older adults (31%) reported their use of CHA in the past year and these CHA were perceived to provide substantial benefit (Johnson, Jou, Rhee, Rockwood, & Upchurch, 2016). In 2012, CHA use accounted for $30 billion, which was 9.2% of total out-of-pocket expenditures on health care in the United States (Nahin, Barnes, & Stussman, 2016). A total of 42.3% of CHA out-of-pocket expenditures ($12.8 billion) was spent on natural products, which is equivalent to approximately 24% of total out-of-pocket spending on prescription drugs (Nahin et al., 2016). Women and those with higher levels of education and income have reported greater CHA use (Nahin, Barnes, Stussman, & Bloom, 2009).

Individuals with PD have used various types of CHA to improve their quality of life and motor symptoms (Wang et al., 2013). Prevalence of CHA use for PD varies, ranging from 25.7% to 76% (Wang et al., 2013). However, it is challenging to compare the reported prevalence due to heterogeneity of reported types of CHA. The most commonly used CHA for PD include acupuncture, massage, herbs, and vitamins/health supplements (Kim, Lee, Kim, Lee, & Chung, 2009; Lökk & Nilsson, 2010). Other types of CHA include non-prescribed medicines, diet therapy, Qigong, tai chi, yoga, and magnets (Rajendran, Thompson, & Reich, 2001; Tan, Lau, Jamora, & Chan, 2006). Given the array of CHA being used and combination of these therapies, it is vital that non-prescription medications, including herbs, vitamins, and other supplements, be examined to explore their effects, possible adverse effects, and interactions with prescription medications. Particular attention to potential herb–drug interactions is required in older adults or those with polypharmacy to avoid any unwanted interactions (Bhadra, Ravakhah, & Ghosh, 2015). In a previous study, more than one half of CHA users did not consult their treating health care providers before initiating CHA (Rajendran et al., 2001); however, this finding has not been replicated and suggests the need to explore the current use of CHA and various potential interactions that CHA users may experience.

Several demographic factors are associated with CHA use in individuals with PD: age, younger age at diagnosis of PD, female, degree of education, higher income, and rural location (Ferry, Johnson, & Wallis, 2002; Kim et al., 2009; Lökk & Nilsson, 2010; Pecci et al., 2010; Rajendran et al., 2001). Clinical factors associated with CHA use include comorbidity, levodopa dosage, longer duration of PD, perceived health, and severe motor symptoms (Ferry et al., 2002; Kim et al., 2009; Lökk & Nilsson, 2010; Tan et al., 2006). Other factors, including marital and employment status, religious beliefs and practice, the Hoehn and Yahr disease severity staging for describing PD symptom progression, presence of fluctuations, side of initial involvement, surgery for PD, and PD phenotype, were not related to CHA use (Pecci et al., 2010; Rajendran et al., 2001).

Although the prevalence and types of CHA use in several countries have received attention in the past decade, they not been systematically studied in the United States for more than a decade. The types of CHA have increased over the past decade, thereby warranting re-exploration with an accurate measure to capture the variety and diversity of approaches being used. Recent literature suggests CHA use is occurring in the United States (Shin & Habermann, 2016). However, a better understanding of the actual use, types, frequency, and reasons for use would provide a foundation for health care providers to have a dialogue about CHA use for PD and their possible adverse reactions and interactions with antiparkinsonian medications. The purpose of the current study was two-fold: to (a) describe the prevalence, types, and associated factors of CHA use in individuals with PD; and (b) explore reasons for CHA use.

Method

A self-administered, cross-sectional survey was used to describe CHA use and associated factors in individuals with PD. A questionnaire was constructed by the research team, based on review of the literature and conceptual framework of the biopsychosocial-spiritual concept (i.e., the patient is treated with holistic and multidimensional interactions). In addition to traditional Western medicine, the following CHA therapies were used: mind–body interventions, manual healing methods, herbal and biological treatments, energy medicine, and diet/nutrition (Ward, 2007). The survey included three sections: (a) sociodemographic, (b) disease-specific, and (c) CHA. Sociodemographic variables included age, gender, race/ethnicity, marital status, educational attainment, household annual income, and health care spending/costs per month. Disease-specific variables included duration of PD, age at onset, motor and nonmotor symptoms, PD treatments (medications and surgeries), and other non-PD health-related issues. CHA variables included previous and current use of CHA in general health and for PD treatment (25 supplements and 29 modalities/therapies) and reasons for CHA use. The survey included exercises in addition to yoga and tai chi to capture other forms of physical activities and/or exercise as self-care for PD.

Content validity, relevance, and understandability of the survey were tested by a group of five experts in PD research, practice, and holistic nursing practice. Based on their feedback, the survey items were modified. Three individuals with PD who were research advocates of the Parkinson's Disease Foundation provided feedback about the questionnaire. Details of exercise items (e.g., dancing, cycling) were added in the final survey based on their feedback. The final version of the survey had 36 questions, including multiple choice questions and one open-ended question. The reading level was set for individuals who completed sixth grade and tested by research advocates.

Institutional review board approval was obtained from the study sites and authors' institution. Data were collected between March and December 2015. Individuals who were diagnosed with PD; lived at home; did not have a known dementia; and were able to read, write, and converse in English were eligible for the study. Several recruitment methods were used, including flyers, advertisements on the website of the researchers' institution, Michael J. Fox Foundation for Parkinson's Research's Fox Trial Finder, and presentations in local PD support groups and other gatherings. Interested individuals contacted researchers via phone or e-mail. Once they agreed to participate in the study, the self-report questionnaire and an informed consent form were provided via mail or e-mail. Participants were asked to complete and return the survey and consent form to the research team via mail or e-mail. A gift card of a small amount was offered and provided to participants.

Data Analysis

Data from the survey were analyzed using IBM SPSS Statistics version 23. Data were reviewed for any missing data points and corrections were made. Descriptive statistics described participant characteristics and prevalence, and types of CHA use. A series of t and chi-square tests were used to describe differences in demographic and clinical characteristic health scores between CHA users (who used at least one CHA in the past 12 months) and non-users. A backward stepwise logistic regression (Wald statistic) was used to identify potential predictors of whether participants used CHA for PD or general health, with variables selected based on literature review and t and chi-square tests. Level of significance was set at p < 0.05 for descriptive tests and the logistic regression.

Results

Of 218 packets sent, 135 were returned (61.9%) (Table 1). All respondents were from the following states: Delaware (43%), Indiana (22.2%), Maryland (20%), and Pennsylvania (9.6%). New Jersey, Washington, D.C., Texas, and Virginia each had less than three respondents. The mean age of participants was 69.69 years. Participants were mostly Caucasian individuals, male, married, and not working. In addition, two African American individuals and one Asian individual participated in the study. Participants' mean years of education were 15.79. Approximately one half of participants (49.6%) reported their household's annual income as ≥$60,000.


Participants' Characteristics (N = 135)
Participants' Characteristics (N = 135)

Table 1:

Participants' Characteristics (N = 135)

A total of 62.2% of participants reported their general health as excellent (11.1%) or good (51.1%). Functional mobility was reported in 45.2% of participants. Participants had an average of 1.92 of the following eight diseases: anxiety (41.8%), hypertension (38.5%), depression (36.6%), hyperlipidemia (35.1%), cancer (17.2%), coronary artery disease (11.9%), diabetes (8.2%), and myocardial infarction (2.2%). All participants had at least one health care insurance policy.

Participants were diagnosed with PD from <1 year to 24 years prior to the survey. Participants were diagnosed with PD by a neurologist (61.1%) or a movement disorder specialist (21.4%). Thirty-six participants saw more than two health care providers for their PD. Most participants saw a neurologist (61.9%) and a movement disorder specialist (50.7%) for PD treatment.

Participants' mean number of PD symptoms was 13.03 (3.86 motor and 9.17 nonmotor symptoms). Motor symptoms reported included bradykinesia (72.4%), rigidity (64.9%), resting tremor (60.4%), and postural instability (55.2%). Nonmotor symptoms included sleep problems (67.9%), fatigue/excessive tiredness (66.4%), bladder urgency (61.2%), decreased sense of smell (59%), constipation (57.5%), memory problems (56.0%), and excessive salivation and/or drooling (50.7%).

All participants were taking at least one antiparkinsonian medicine (mean = 1.91). Most participants (87.3%) were taking various forms of levodopa. Notably, few participants took new medicines (i.e., those released in 2015), such as carbidopa and levodopa intestinal gel suspension (n = 1) and carbidopa/levodopa extended release capsules (n = 7). One hundred participants were also taking a dopamine agonist (n = 50) and/or monoamine oxidase B inhibitor (n = 50) drugs. Eleven participants had undergone surgical procedures to manage PD symptoms.

Prevalence and Types of CHA Use

A total of 74.1% of participants (n = 100) responded that they had used at least one complementary and alternative medicine for either PD or general health in the past 12 months. Mean CHA used in this sample was 5.10 (SD = 5.77). Among CHA users, 59.3% specifically used at least one CHA for PD management. The mean CHA use for PD symptoms was 2.56 (range = 0 to 32), and included natural products (mean = 1.12; range = 0 to 16) and mind–body practices (mean = 1.52; range = 0 to 16). The mean CHA use for general health was 4.10 (range = 0 to 32), and included natural products (mean = 2.61; range = 0 to 16) and mind–body practices (mean = 1.48; range = 0 to 16). Specifically, 23% of CHA users responded that they had used more than 10 natural products or mind–body practices.

As for CHA use for PD symptoms, the most widely used natural products for PD symptom management included: vitamin D; multivitamins; coenzyme Q10; non-vitamin, non-mineral, natural products; coconut oil; and vitamins B12, C, and E (Table 2). Mind–body practices for PD included yoga, massage, deep breathing exercises, prayer, tai chi, acupuncture, and meditation. Exercise was the most commonly used approach, and included spinning/cycling, swimming, rowing, and dancing. Participants also mentioned other exercises, such as boxing and Lee Silverman Voice Treatment BIG® therapy. Some exercises were provided under health care professionals' care, but others were not clear.


Complementary Health Approaches Used in Individuals with Parkinson's Disease (N = 98)

Table 2:

Complementary Health Approaches Used in Individuals with Parkinson's Disease (N = 98)

For general health, participants used vitamins D, B12, C, and E; folic acid (vitamin B9); calcium; coenzyme Q10; coconut oil; and green tea polyphenols. The following CHA were used: exercise, prayer, massage, deep breathing exercises, yoga, chiropractic care, and meditation.

Variables Associated With CHA Use

In the logistic regression model predicting CHA use, the following variables were entered: age, year of education, area of residency (dummy variables by state), sum of chronic conditions, sum of symptoms, and PD treatment by movement disorder specialist. Three significant predictors were identified (Table 3). Higher level of education was positively correlated with CHA use (p = 0.007). PD treatment by a movement disorder specialist was positively correlated with CHA use (p = 0.014). Age and sum of symptoms were not significantly correlated with CHA use, although they showed positive trends (p < 0.1). Participants in Indiana used more CHA than those in Delaware (p = 0.014). No significant differences were found in other states.


Logistic Regression Model Predicting use of Complementary Health Approaches (N = 132a)

Table 3:

Logistic Regression Model Predicting use of Complementary Health Approaches (N = 132)

Reasons and Referral Sources for CHA Use in Individuals With PD

The mean duration of CHA use was 10.10 years (SD = 11.26 years). Participants began using CHA prior to the onset of PD symptoms (43.8%), at onset of PD symptoms (13.5%), and at the time of PD diagnosis (27%); 10.1% were unsure when they began using CHA. Eighty-nine participants learned about the therapies or modalities they have used from family and/or a friend (49.4%), books or print materials (49.4%), the internet (41.6%), PD specialists (32.6%), and primary care providers (28.9%).

Participants decided to use CHA for general wellness/general disease prevention (76.1%); to delay the progression of PD (66.3%); to manage motor symptoms (59.8%); to improve or enhance energy (56.5%); as it was recommended by family, friends, or coworkers (46.7%); to manage nonmotor symptoms (46.7%); if it was recommended by a health care provider (39.1%); to manage bodily discomfort (32.6%); to improve or enhance immune function (30.4%); and because conventional medical treatments did not help (18.5%).

Most participants (62%) reported that their health care providers asked if they have used any therapies or modalities besides prescriptive medications or therapies. Most participants (92.4%) reported that they have told their health care providers their CHA use beyond prescribed medications or therapies. Forty-eight participants stopped using CHA because they did not work for them (37.5%), they were too expensive (22.9%), and they experienced adverse effects (2.1%); 14.6% were unsure why they stopped using CHA.

Discussion

The prevalence of CHA use in the past 12 months among participants was 74.1% because the study included a wide range of CHA. However, comparing the current study's findings with those of previous studies is difficult due to differences of CHA reviewed and study settings. For example, one previous U.S. study was conducted in an outpatient clinic and included 17 types of CHA (Rajendran et al., 2001). Thus, the high prevalence in the current study might partially be a result of the convenience sample in the community setting and wide range of CHA included in the survey. However, it also suggests CHA use in the United States has likely grown. Participants in the current study were also self-selected and had high levels of education and income. Those with high levels of education and income were previously reported as having greater CAM use (Rajendran et al., 2001; Wang et al., 2013).

Various natural product uses were reported in the current study. These natural products may have potential neuroprotective effects, including antioxidants (e.g., vitamins C and E, green tea polyphenols, polyphenols, glutathione, coenzyme Q10, curcumin, resveratrol, alpha-lipoic acid), vitamin D, and creatine (Chao et al., 2012). Coenzyme Q10 is still used by individuals with PD, but there was no evidence of its clinical benefits in a clinical trial (Parkinson Study Group QE3 Investigators, 2014). In the current study, coconut oil was used for PD; this CHA was not reported in the literature. The use of coconut oil has been documented for various diseases, such as cardiovascular disease, hypercholesterolemia, diabetes, chronic fatigue, Alzheimer's disease, Crohn's disease, irritable bowel syndrome, and thyroid conditions, rather than PD (Natural Medicine, 2016).

The most used mind–body practices for PD in the current study included exercise, yoga, massage, deep breathing exercises, prayer, tai chi, and acupuncture. Use of massage, yoga, and acupuncture were also found in a previous review (Wang et al., 2013). Various types of exercise/physical activities were also popular among participants in the current study, and included boxing, bicycling, walking, and dancing. However, it was not clear whether participants used those exercises based on their health care providers' recommendation or their own decision.

Aerobic and strength training can improve physical abilities of individuals with PD (Tambosco, Percebois-Macadré, Rapin, Nicomette-Bardel, & Boyer, 2014). For instance, dance therapy is considered safe, enjoyable, and effective for improving gait and balance in the PD population (Bega, Gonzalez-Latapi, Zadikoff, & Simuni, 2014). Despite the popularity of acupuncture use in individuals with PD, no sufficient evidence exists about its effectiveness in PD treatment based on the results of a meta-analysis and review (Kim & Jeon, 2014; Lee, Shin, Kong, & Ernst, 2008). Massage therapy in PD has different types of methods and has shown promising effects (Craig, Svircev, Haber, & Juncos, 2006; Suoh, Donoyama, & Ohkoshi, 2016). Neuromuscular therapy was shown to improve the Unified Parkinson's Disease Rating Scale (UPDRS) motor score in comparison to a music relaxation and control group (Craig et al., 2006). Continuous Anma massage sessions were shown to alleviate various physical PD symptoms (Donoyama, Suoh, & Ohkoshi, 2014). Yoga showed an improvement in UPDRS scores and more positive symptom changes (Sharma, Robbins, Wagner, & Colgrove, 2015). Despite positive effects of yoga in PD, the evidence of its effectiveness in PD is insufficient due to small sample sizes and levels of evidence (Hall, Verheyden, & Ashburn, 2011; Moriello, Denio, Abraham, DeFrancesco, & Townsley, 2013). Although use of magnets has been reported (Rajendran et al., 2001), use of them were not reported in the current study. According to the NCCIH (2013), magnets have been used inside shoe insoles, bracelets and other jewelry, mattress pads, and bandages. However, their effectiveness on PD has not been reported in the literature.

Variables associated with CHA use in previous studies are inconsistent due to different samples and settings. The current study found that individuals in Indiana used CHA more often than those in Delaware. It is hypothesized this finding might be a sample artifact, as participants in Indiana were mostly recruited in Rock Steady Boxing classes and church support groups. State location variables were primarily included to remove potential confounding. Higher education was also related to CHA use, which is consistent with previous studies in PD populations and the general U.S. adult population (Lökk & Nilsson, 2010; Nahin et al., 2009; Rajendran et al., 2001). CHA use might be related to individuals' personal beliefs or choices about management of their health/PD symptoms (Lökk & Nilsson, 2010).

Participants who saw a movement disorder specialist used more CHA than those who did not visit a movement disorder specialist, suggesting they were more proactive to find ways to manage their PD symptoms or had better means to seek care for their health. Despite the known concerns about lack of communication among health care providers and CHA users (Wang et al., 2013), most participants (92.4%) in the current study communicated with their health care providers about their CHA use, compared to only 40% in a previous U.S. study (Rajendran et al., 2001). However, not all health care providers, including nurses, inquired about whether their patients used CHA besides prescriptive medications or therapies, suggesting health care providers may need additional education regarding the wide use of CHA in PD and that this should be a standard part of their medical history intake. In addition, nurses and other health care providers must discuss fall prevention given the frequency of physical activities/exercise use and potential for frequent falls in individuals with PD.

There were more referrals from health care providers in the current study than in previous studies (Pecci et al., 2010; Rajendran et al., 2001). Other referral sources of CHA were similar to those of previous studies, and included family and/or friends, web sources, and print materials (Rajendran et al., 2001; Tan et al., 2006). Use of the internet as a referral source has increased since 1999 (Rajendran et al., 2001). Due to the popularity of the internet, there is a need to screen the quality of products. Reliable websites, such as the NCCIH ( https://nccih.nih.gov) and Natural Medicines ( https://naturalmedicines.therapeuticresearch.com), may be a good source of safety information for individuals with PD, their family members, and health care providers in various settings. Lack of effectiveness or dissatisfaction were the main reasons to discontinue CHA, followed by cost issues. Costs and health care insurance coverage of each CHA listed in the current survey were not explored. However, additional out-of-pocket costs for PD care might be a financial burden for individuals who have fixed income.

Implications

The findings of the current study showed various CHA uses in individuals with PD, most of whom were older adults. Most CHA users sought specialized care for their PD and engaged actively in self-care. Because insufficient scientific evidence on natural products and mind–body practices exists, further research is warranted to examine their effectiveness and safety, and expand health care insurance coverage on any CHA methods commonly used for PD.

Most older adults with PD live in their homes until the end of life (Goy, Carter, & Ganzini, 2008). Thus, nurses may encounter older adults with PD in various settings regarding their PD or non-PD–related health issues. Nurses who work with older adults with PD in various settings have a role in providing safe care by assessing possible interactions among prescriptive medications and natural products, especially in those who have functional limitations and/or chronic diseases. In addition, many mind–body practices may not be monitored by health care providers, including nurses. Thus, it is important to assess possible risks for falls or other safety issues at all encounters with older adults with PD.

Limitations

The current findings are limited due to the study design and sample. One limitation is that a mailed survey was used. It is also possible that other CHA used by individuals with PD in the United States were not reported in the current study. Another limitation is that the sample was small and homogeneous, and most participants were self-selected and highly educated individuals. Although efforts to recruit a geographically diverse sample were made through registering the study with a national foundation, most participants were from the mid-Atlantic region, therefore the results are not generalizable to other U.S. regions.

Conclusion

Findings from the current study show prevalent CHA use in individuals with PD. Exercise was the most widely used approach along with vitamins and natural products (with antioxidants and possible neuroprotective components). Participants also reported higher rates of communication with their health care providers. Thus, nurses and other health care professionals may play an important role in providing safe care for individuals with PD. Further studies on the effectiveness and safety of commonly used CHA are warranted.

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Participants' Characteristics (N = 135)

Mean (SD)
CharacteristicTotalCHA Users (n = 100)CHA Non-Users (n = 35)p Value
Age69.69 (8.31)70.06 (8.34)68.63 (8.23)0.382
Years of education15.79 (2.96)16.16 (3.02)14.32 (3.3)0.03*
Total number of difficulties in ADL1.5 (1.73)1.43 (1.74)1.69 (1.71)0.454
Sum of conditions (8 conditions)1.92 (1.37)1.84 (1.354)2.15 (1.417)0.261
Emergency visit in the past 12 months0.5 (0.93)0.46 (0.88)0.6 (1.03)0.445
Years of being diagnosed with PD6.37 (4.94)6.35 (5.19)6.41 (4.19)0.95
Age at onset63.07 (9.54)63.43 (9.91)62.06 (8.45)0.472
Sum of motor symptoms3.86 (1.982)3.73 (1.889)4.23 (2.211)0.199
Sum of non-motor symptoms9.17 (4.77)9.02 (4.562)9.6 (5.353)0.538
Sum of total symptoms13.03 (5.87)12.75 (5.574)13.83 (6.658)0.351
Sum of medications1.91 (0.95)1.9 (0.985)1.94 (0.873)0.816
Male80 (59.3)59 (59)21 (60)0.917
Caucasian132 (97.8)97 (97)35 (100)0.568
Married118 (87.4)88 (88)30 (85.7)0.914
Employment
  Not working (retired/disabled)117 (86.7)88 (88)29 (82.9)0.563
  Working18 (13.3)12 (12)6 (17.1)
Household income
  <$20,0008 (5.9)7 (7.1)1 (3)0.715
  $20,000 to $40,00010 (7.4)8 (8.2)2 (6.1)
  >$40,000 to $60,00022 (16.3)18 (18.4)4 (12.1)
  >$60,000 to $100,00025 (18.5)17 (17.3)8 (24.2)
  >$100,00042 (31.1)32 (32.7)10 (30.3)
  Do not wish to respond24 (17.8)16 (16.3)8 (24.2)
Global health
  Excellent15 (11.1)13 (13)2 (5.7)0.051
  Good69 (51.1)54 (54)15 (42.9)
  Fair47 (34.8)32 (32)15 (42.9)
  Poor4 (3)1 (1)3 (8.6)
Monthly spending for health care
  <$5012 (9)12 (12.2)00.221
  $51 to $10018 (13.5)11 (11)7 (20)
  $101 to $30039 (29.3)26 (26)13 (37.1)
  $301 to $50022 (16.5)18 (18)4 (11.4)
  $501 to $1,00024 (18)18 (18)6 (17.1)
  >$1,00010 (7.5)8 (8)2 (5.7)
  Unsure8 (6)5 (5)3 (8.6)
Treated by neurologist83 (61.5)58 (58.6)25 (71.4)0.073
Treated by movement disorder specialist68 (50.4)56 (56.6)12 (34.8)0.03*

Complementary Health Approaches Used in Individuals with Parkinson's Disease (N = 98)

VariableUsed for Parkinson's DiseaseUsed for General Health
n (%)
Natural products
  Vitamin D15 (15.3)55 (56.1)
  Multivitamins14 (14.3)63 (64.3)
  Coenzyme Q1012 (12.2)16 (16.3)
  Non-vitamin, non-mineral, natural products (e.g., herbs)11 (11.2)14 (14.3)
  Coconut oil11 (11.2)16 (16.3)
  Diet-based therapy (special diet)10 (10.2)13 (13.3)
  Vitamin B1210 (10.2)34 (34.7)
  Vitamins C and E10 (10.2)32 (32.7)
  Green tea polyphenols9 (9.2)15 (15.3)
  Curcumin8 (8.2)7 (7.1)
  Calcium6 (6.1)33 (33.7)
  Folate (folic acid, vitamin B9)5 (5.1)16 (16.3)
  Ginger (zingiber officinalis)4 (4.1)10 (10.2)
Mind–body practices
  Exercise (spinning/cycling, swimming, rowing, dancing)61 (62.2)47 (48)
  Yoga20 (20.4)13 (13.3)
  Massage19 (19.4)19 (19.4)
  Deep breathing exercises18 (18.4)18 (18.4)
  Prayer14 (14.3)26 (26.5)
  Tai chi12 (12.2)5 (5.1)
  Acupuncture11 (11.2)9 (9.2)
  Meditation11 (11.2)12 (12.2)

Logistic Regression Model Predicting use of Complementary Health Approaches (N = 132a)

VariablebSEExp (B)p Value
Age0.0510.0281.0530.065
Education0.0230.0751.2250.007
Treatment by movement disorder specialist1.4360.5144.2060.014
Residency in Indiana1.6430.6715.1680.014
Sum of symptoms−0.0700.0400.9330.079
Authors

Dr. Shin is Assistant Professor of Nursing, College of Health Sciences, Dr. Habermann is Nannie Longfellow Professor of Nursing and Associate Dean for Translational Research, School of Nursing, and Dr. Pohlig is Senior Biostatistician, Biostatistics Core Facility, College of Health Sciences, University of Delaware, Newark, Delaware.

The authors have disclosed no potential conflicts of interest, financial or otherwise. This study was supported by the University of Delaware General University Research Award (UDGUR Award ID 14A00557) to Dr. Shin 2014–2016.

The authors thank the Parkinson's disease (PD) experts who reviewed the survey contents; participants; local PD support groups; the National PD Foundation; the Michael J. Fox Foundation; Rock Steady Boxing; and the Parkinson's & Movement Disorders Center of Maryland.

Address correspondence to Ju Young Shin, PhD, APRN, ANP-C, Assistant Professor of Nursing, College of Health Sciences, School of Nursing, University of Delaware, 24 North College Avenue, Newark, DE 19716; e-mail: jushin@udel.edu.

Received: March 10, 2016
Accepted: September 16, 2016
Posted Online: November 15, 2016

10.3928/00989134-20161109-04

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