Supplementary Material for: A Systematic Literature Review of Complementary and Alternative Medicine Prevalence in EU

<b><i>Background: </i></b>Studies suggest that complementary and alternative medicine (CAM) is widely used in the European Union (EU). We systematically reviewed data, reporting research quality and the prevalence of CAM use by citizens in Europe; what it is used for, and why. <b><i>Methods: </i></b>We searched for general population surveys of CAM use by using Ovid MEDLINE (1948 to September 2010), Cochrane Library (1989 to September 2010), CINAHL (1989 to September 2010), EMBASE (1980 to September 2010), PsychINFO including PsychARTICLES (1989 to September 2010), Web of Science (1989 to September 2010), AMED (1985 to September 2010), and CISCOM (1989 to September 2010). Additional studies were identified through experts and grey literature. Cross-sectional, population-based or cohort studies reporting CAM use in any EU language were included. Data were extracted and reviewed by 2 authors using a pre-designed extraction protocol with quality assessment instrument. <b><i>Results: </i></b>87 studies were included. Inter-rater reliability was good (kappa = 0.8). Study methodology and quality of reporting were poor. The prevalence of CAM use varied widely within and across EU countries (0.3–86%). Prevalence data demonstrated substantial heterogeneity unrelated to report quality; therefore, we were unable to pool data for meta-analysis; our report is narrative and based on descriptive statistics. Herbal medicine was most commonly reported. CAM users were mainly women. The most common reason for use was dissatisfaction with conventional care; CAM was widely used for musculoskeletal problems. <b><i>Conclusion: </i></b>CAM prevalence across the EU is problematic to estimate because studies are generally poor and heterogeneous. A consistent definition of CAM, a core set of CAMs with country-specific variations and a standardised reporting strategy to enhance the accuracy of data pooling would improve reporting quality.

**背景：** 研究显示补充与替代医学 (Complementary and Alternative Medicine, CAM) 在欧盟 (European Union, EU) 中应用广泛。本研究对相关数据开展系统综述，报告欧洲民众使用补充与替代医学的研究质量、流行率、使用用途及使用原因。
**方法：** 本研究通过Ovid MEDLINE（1948年至2010年9月）、Cochrane Library（1989年至2010年9月）、CINAHL（1989年至2010年9月）、EMBASE（1980年至2010年9月）、包含PsychARTICLES的PsychINFO（1989年至2010年9月）、Web of Science（1989年至2010年9月）、AMED（1985年至2010年9月）及CISCOM（1989年至2010年9月），检索补充与替代医学使用情况的一般人群调查文献。此外通过专家咨询与灰色文献获取额外研究。纳入所有以欧盟任意语言发表的、报告补充与替代医学使用情况的横断面研究、基于人群的研究或队列研究。由2名研究者采用预先设计的数据提取方案与质量评估工具，提取并审阅相关数据。
**结果：** 本研究共纳入87项研究。评定者间信度良好（kappa=0.8）。研究方法学与报告质量欠佳。欧盟各国境内及各国间的补充与替代医学使用流行率差异悬殊（0.3%~86%）。流行率数据存在显著异质性，且与报告质量无关，因此无法合并数据开展荟萃分析，本报告为叙述性综述，基于描述性统计结果撰写。草药医学是最常被报告的补充与替代医学类型。补充与替代医学使用者以女性为主。最常见的使用原因为对常规医疗服务不满；补充与替代医学被广泛用于肌肉骨骼系统疾病的干预。
**结论：** 由于现有研究普遍质量不佳且异质性较强，难以准确估算欧盟范围内的补充与替代医学流行率。若能采用统一的补充与替代医学定义、一套包含国别差异的核心补充与替代医学分类标准，以及标准化的报告策略以提升数据合并的准确性，将有助于改善研究报告的整体质量。