Perceptions of Complementary, Alternative, and Integrative Medicine Among Neurology Researchers and Clinicians: A Large-Scale, International Cross-Sectional Survey

Background: While many patients with neurological disorders and conditions use complementary, alternative, and integrative medicine (CAIM), little is known about the use and perceptions of CAIM among neurology researchers and clinicians. With the increasing popularity of CAIM, our objective was to assess practices, perceptions, and attitudes towards CAIM among neurology researchers and clinicians. Methods: We conducted an anonymous online survey of authors who had published articles in neurology journals indexed in MEDLINE. We emailed potential participants our cross-sectional electronic survey after extracting their email addresses from one of their publications in our sample of journals. Basic descriptive statistics were drawn from quantitative data, and thematic content analysis was used to analyse qualitative data from any open-ended questions. Results: The survey was completed by 783 neurology researchers and/or clinicians (1.5% response rate, 83.9% completion rate). Overall, respondents perceived CAIM to be promising in preventing, treating, and/or managing neurological diseases. Mind-body therapies received the most positive responses, indicated by over half of respondents cumulatively agreeing that they are promising (n=368, 59.0%) and safe (n=280, 50.3%). Whole medical systems and biofield therapy were less favourable. Most neurology clinicians reported a lack of formal (n=211, 70.3%) and supplementary training (n=158, 52.5%) on CAIM. Nearly half of clinicians did not feel comfortable counselling patients about CAIM (n = 121, 44.5%), and over half did not feel comfortable recommending it (n=161, 59.3%). A lack of scientific evidence for CAIM's safety and efficacy was reported as the greatest challenge to CAIM (n=515, 92.5%). The majority of respondents believed there is value to conducting research on this topic (n=461, 82.0%) and supported increasing allocation of research funding towards CAIM (n=241, 58.9%). Conclusions: Although many participants found CAIM to be promising to the field of neurology, the vast majority did not feel open to integrating CAIM into mainstream medical practices on account of a perceived lack of scientific evidence for its safety and efficacy. Future studies can use our findings to improve educational resources on CAIM within neurology, as well as examine what effects a tailored CAIM education has on the perceptions of neurology researchers and clinicians. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study was unfunded. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: We sought and were granted ethics approval by the University Hospital Tubingen Research Ethics Board prior to beginning this project (REB Number: 325/2007 BO1). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data and materials associated with this study have been posted on the Open Science Framework.