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Research – Therapy Best Practice

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Research - Therapy Best Practice

In order to develop business rules for the funding of CB supports as part of the Participant Budget Model, we need the following information:

  • For the following disability groups: Parkinson’s Disease, multiple sclerosis, muscular dystrophy, dementia, Huntington’s Disease, arthritis, chronic fatigue, chronic pain, amputation. What is considered best practice in terms of: a) The allied health team members of a multidisciplinary team, i.e., who should be involved in managing the disability? b) The frequency of intervention (i.e., approximate dosage — how many hours per year are required for each professional?) c) Evidence-based practice for widely accepted therapy approaches? Not too much detail needed; e.g.: “For MS X therapy approach often recommended which involves intensive blocks of 20 sessions every months” Looking again regarding number that would consider best practice.

Summary

  • Information provided has been obtained through rapid review of the literature. This includes best practice guidelines, systematic reviews from Cochrane Collaboration, systematic reviews other high quality meta-analyses and reviews.
  • The personal circumstances goals of individuals disease severity impact on interventions required.Therefore cannot always be given specific hour requirements for every individual study delivering similar treatment differently resulting no consensus level standards. If Agency needs exact number for intervention time clinicians should conduct comprehensive researches into types of treatments offered in varying conditions.

Parkinson’s Disease

Clinician involved in Management

A systematic review and meta-analysis of integrated care in Parkinson’s disease provides a list of core team members to be included in interventions [1].

  • Movement disorders specialist
  • General neurologist
  • PD specialist nurse
  • Physiotherapist
  • Occupational therapist
  • Speech therapist
  • Clinical psychologist
  • Neuropsychologist
  • Community mental health team
  • Social worker
  • Dietician Models of care varied significantly, ranging from 4–8 weeks, with sessions varying between 1–7 days per week (ranging from half an hour up to two hours). No indication is given as to how many hours were allocated each profession.

Best practice treatment and frequency of intervention

Recommendations for treatment are taken from NICE UK guidelines [[2]].

First-line Treatment:

a) Offer levodopa to people at early stages where motor symptoms impact their quality of life.b) Consider dopamine agonists or MAO-B inhibitors if there’s no significant effect on daily living due to motor symptoms.

Non-pharmacological managementa. Nurse specialists can provide clinical monitoring and medicines adjustment.i. A continuing point-of-contact service including home visits when appropriate.

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Research - Therapy Best Practice

MULTIPLE SCLEROSIS

Physiotherapy and physical activity (3)

  • General physiotherapy: Duration from four weeks up to twelve months. Only two studies reported session durations including: * Twelve hours over six sessions within eight weeks, * Eighteen hours across ten weekly sessions during sixteen-week periods, or more.
  • Exercise Sessions lasted between thirty minutes through one hour per week with treatment spread out three-to twenty-four consecutive weeks;
  • Treadmill Treatment spanned forty-five-minute intervals throughout four-eight continuous weeks;
  • Cueing Interventions were conducted once every month lasting anywhere as short as five minutes but not exceeding sixty-three days collectively spanning thirteen sequential weeks at most;
  • Dance Classes offered participants lessons on tango waltz foxtrot for an entire year in either twelfth or thirteenth successive weeks under guidance provided by a trained instructor teaching these specific dances;
  • Martial Arts Training was scheduled monthly covering each participant’s progress over time ranging approximately fifteen years of duration depending upon their individual needs.

Speech & Language therapy [4]

Median length of speech therapy treatments among those receiving care is typically four weeks long. Sixty-eight percent attended single weekly meetings while another 20% received Lee Silverman Voice Therapy which required multiple visits per week totaling around nine times the number compared against standard voice training methods. Most appointments last roughly half-an-hour to just under two-hours and are usually spaced apart about twice-monthly.

Occupational therapy (5)

A Cochrane Review from July ’07 identified only Two studies meeting inclusion criteria, both delivering twelve hours across four-week periods followed up later with additional ten hour sessions spread out during fifth consecutive weeks respectively.

Nutrition (6) Monitoring occurs biannually if there have been any changes regarding medications or treatment plans focusing specifically onto swallowing recommendations; every three months when patient conditions remain stable.

For oral nutrition support regular reviews should be conducted quarterly ensuring appropriateness thereof, some centers offer one-day holistic assessments re-assessing mobility swallow speech nutritional status regularly as well.

  • Dysphagia management must always involve collaboration between SLPs alongside nurses dietitians alike but no information provided on level/duration intervention[7]. 3 Deep brain stimulation: a Surgery involves implantation devices sending electrical signals into specific areas within brains responsible for controlling body movements Electrodes placed deep inside these regions connected directly towards stimulator units used therapeutically. OFFICIAL Page 4 of 23

Clinician involved in management

There is variation in the make-up of MS multidisciplinary teams.

The NICE MS Clinical Guideline states that: “As a minimum, the specialist neurological rehabilitation service should have as integral members described above:

Figure 2: Self Management/Specialist Service Dependency Model for People with MS

Self-Management/Support

Patients can move fluidly between self-managed services.

Best practice treatment and frequency of intervention

Determine how often a person will need to be seen based on:

  • Their own or their family’s carers’ needs,
  • The number of visits needed (such as disease-modifying therapies).

Interventions include exercise programmes, mindfulness techniques etc.

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Multidisciplinary Rehabilitation Programmes Intensity Subdivision

  • High intensity therapy involves input from at least two disciplines, minimum thirty minutes per session totaling up to three hours daily over four days weekly; usually provided withinpatient settings or some outpatient programmes.
  • Low-intensity programs vary based on setting type & resources available but are less intensive than high-intensity ones delivered primarily through psychologists as partof Cochrane Reviews conducted between years (e.g., MS treatment). From these reviews it’s not possible yetto suggest an optimal ’dose’for therapies due to insufficient studies suggesting optimum number,duration,intensity of sessions needed for best outcomes, suchas Neuropsychological Rehabilitations which rangefrom eight-to-thirty-sixsessionsoverfour-weeksto six-monthsintervalsandtwotofive-timesweeklyfrequency.
  • Physiotherapist
  • Occupational therapists.
  • Speech-language pathologists
  • Orthotist
  • Psychologist
  • Dietician. Some people might also need a lung specialist (pulmonologist), a heart specialist (cardiologist,a sleep specialist, a specialist in the endocrine system(endocrinologist), an orthopedic surgeonand other specialists.

Best practice treatment and frequencyof intervention

Several types of therapy anda ssistive devices can improvethe qualityandsometimesthelengtho flifeinpeople who have muscular dystrophy.Examples include[13]: • Range-of-motionandexercising stretchingexercises.Musculardystrophycan restrictflexibilityamobilityojoints.Limbsoften draw inward am become fixed int hatposition.Range-o-f motion exercisescan helpto keep joints as flexibleas possible. • Exercise.Low-impaact aerobic exercise,such astalkingswimming,cana helpp mainaint strength,mobilityageneral health.Sometypes o fstrengtheningexercisealso mighthelpful. o Optimal exercisemodalitya ndintensityoe xercise forpeop lewithamuscle disease is still unclear.Large variationinfrequency,durationandi ntensit yexists within th eliterature [ 4 -6]. • Braces. Brace scanhelpkeepmusclesatendonsstretchedaflexible slowingt heprogressionoft racts.Brace s cando aidmobilitya nfunctionbyprovidingsupportfor weakened muscles . • Mobility aids.Canes,walkersandwheelchairsc anhelpm aintain mobility and independence

  • Psychosocial intervention
  • Gastrointestinal anda nnutritionalmanagement Guidelinespublishedforthediagnosisanda managem entofDuchenne’sMDessentiallystates thatpatients shouldbeassessed/reviewed every months byalliedhealthprofessionalsinvolvedintheir multidisciplinarycare[17] Thereisanospecificguidanceonhowmanyhours/visitsare requiredforeachrehabilitation intervent ionorclinician.“Provid edirect treatmentbyp hysicalandon tional therapists,andspeech-language pathologists,based on assessmentsandidividualisedtothepatient.”

Dementia

Clinician involved in management

The needs of people with dementia vary widely and tailoring care to each person’s circumstances can be complex. A multidisciplinary approach in which different health professionals work together is important. A medical specialist is required to make a dementia diagnosis. These include:

  • General physicians
  • General practitioners
  • Geriatricians
  • Neurologists
  • Psychiatrists
  • Rehabilitation physicians

A number of different allied health professionals may be required at different points in time, including but not limited to [19]: • Audiologists • Dentists • Dietitians • Occupational therapists • Orthoptists • Physiotherapists • Podiatrists • Psychologists • Social workers • Speech pathologists Nurses and aged care workers are also involved in the care of patients with dementia.

Best practice treatment and frequency of intervention

Best practice care has been taken from the UK NICE guidelines on dementia[20]:: - Person centred care: Involving people in decision making, Providing information, Advance care planning - Care coordination: Provide people living with dementia with a single named health or social care professional who is responsible for coordinating their care. - Interventions to promote cognition, independence and wellbeing

Research - Therapy Best Practice

a.

“Offer a range of activities to promote wellbeing that are tailored to the person’s preferences” — i.e., previous hobbies/interests cognitive stimulation for mild moderate dementia i. Cochrane Review found intervention ranged from weeks months [21]. Median session length across studies minutes median frequency three times week ranging one five total possible exposure dramatically hours two-year study Across exposures time hour hours hours in two year study The fifteen studies median exposure time thirty hours group reminiscence therapy for mild moderate dementia i. Cochrane concluded duration frequencies could differ Sessions either at or telephone) occupational therapists trained recreation therapists cognitive rehabilitation or occupational therapy for mild moderate dementia i A Cochrane Review found intervention durations ranged weeks Session ranges per week more intense classified as formal sessions per week Duration was minute day care facilities often longer NOTE: Collaboration have undertaken various reviews non-pharmacological interventions and many lack convincing evidence well described treatment protocols These include homeopathy acupuncture aromatherapy snoezelen validation therapy dance movement therapy There is promising exercise programs may improve ability perform ADL people with dementia caution interpreting these findings Included highly heterogeneous terms subtype severity participants’ type, duration frequent exercise Pharmacological acetylcholinesterase (AChE inhibitors donepezil galantamine rivastigmine monotherapies recommended options managing mild moderate disease Caregiver education skills training meta-analysis randomized clinical trials provides strong confirmation benefits caregiver education skills training reducing behavioural symptoms Collectively involved community dwelling caregivers patients Effective were wide-ranging included strategies social support linking others modifications assistive device use creating quiet uncluttered space Interventions varied dose intensity delivery mode face-to-face groups computer technologies Successful identified approximately nine to twelve tailored needs person dementia caregiver OFFICIAL Research Therapy Best Practice Page 10 of document released under Freedom Information Act by the National Disability Insurance Agency. This page contains information about best practices in therapeutic approaches including activities that promote wellbeing cognitive stimulation group reminiscence therapy occupational rehabilitation or therapies for individuals living with mild-moderate dementia pharmacological treatments such as cholinesterase inhibitors and caregiving education and skill development.

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delivered individually in the home using multiple components over 3–6 months with periodic follow-up [19].

While pharmacological intervention can be conveniently packaged and standardised, with a measured dose, non-pharmacological interventions can be more difficult to evaluate ([25]). The same intervention may be used in different studies but it may comprise quite different components (25. Non-pharmacological interventions have rarely used an standardized treatment manual; mainly due to range between people dementia (25). Although some interventions offered for discrete period time such as half hour per day many others involve at level care setting or general approach interactive style those providing care depends disease severity levels on care providers) [25] Frequency mentioned Australian Clinical Practice Guidelines Principles Care People Dementia Statements include:

  • Health system planners should ensure that person dementia access coordinator who work them their carers families from diagnosis If services involved one service is responsible coordinating across whatever intensity needed. A plan developed partnership person his her carer family takes into account changing needs of this person Formal reviews agreed professionals involved frequency reviewed care plan person dementia and/or their carer(s) family.## Huntington’s Disease### Clinician Involved ManagementThe multidisciplinary team assesses stage diseases formulates coordinates implements individual care treatments consists:• Physician • Psychologist • Speech language therapist • Social worker • Occupational Therapist • Case manager • Dentist/Oral health specialist7 Best practice Treatment InterventionsFrequency OFFICIAL Research – Therapy Best PracticesPage 10 of Page redacted of 51

Motor Disorders

  • Chorea:
    • Mouth guards splints.
    • Physiotherapy, OT, speech intervention to assess protective measures.
  • Dystonia:
    • Active and passive rehabilitation with a physiotherapist to maintain range of movement.
  • Rigidity :
    • Physiotherapy is recommended to improve or maintain mobility and prevent development contractures joint deformities .
  • Swallowing disorder s :
    • Motor skills training w ith spee ch therapist. Psychology for moods , behavior emotional status cognition. Provision information advice dietician food textures consistency modifications bolus size placement safe swallowing procedures elimination distractions focusing attention one task at time can help avoid aspirations leads improvement swallowi ng disord ers. -Gait balance d iorders: Rehabilitative methods ( e.g ph ys io therapy occupational th erapy) may im prove walking b alance disorders p revent from main complications falls fractures loss autonomy Interventions gait balance should start as early possible be continued adapted throughout progression disease Supervised low impact exercise. -Manual dexterity Management physiotherapy occupationa l ther apy useful reduce functional impact fine motor skill deterioration. Occupational Therapy suggest adaptive aids compensate deteriorati on manual dexter it y adapt ed cutlery computer keyboard adap ted telephone etc Global motor capacities Referral t o phy siotherap ist recommend facilitate develop ment therapeutic relationship promote sustainable exercis es ensure long term funct ion independence Exercise programs personalized considering abilities exer cise capacity goal directed specific. -Cognition: Multiple rehabilitation strategies speech therapy, occupatio nal therapy cognitive and psychomotricity might improve or stabiliz e transitorily cognitiv e functions executive memory language… some point in course of diseas e Cognitive stimulation . -Language communication disorder s : Communication disorders HD variable requires comprehensive assessment languag e other factors such mood motivation behaviour OFFICIAL Research –Therapy Best Practice Page12ofPage3051

Arthritis

The main treatment for arthritis is Methotrexate.

Non-pharmacological management:*

  • Physiotherapy: Adults with Rheumatoid Arthritis (RA) should have access to specialist physiotherapy, including:
  • Improve general fitness through regular exercises;
  • Enhance joint flexibility; muscle strength, and manage other functional impairments using methods such as transcutaneous electrical nerve stimulators (TENS), wax baths over three-to-six-month periods [29].*

Hand exercise programmes: Consider tailored strengthening programs if individuals are not on an active drug regimen against rheumatic conditions OR they’ve been stable under medication regimens lasting at least six months.* The programme must be delivered professionally trained in this area.

Podiatry: All adults suffering foot problems associated directly linked with their condition need podiatric assessment and periodic reviews regarding their overall health needs.

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Monitoring

Ensure that all adults with RA have:

  • Rapid access to specialist care for flares.
  • Information about when and how to access specialist care, and ongoing drug monitoring. Consider a review appointment to take place 6 months after achieving treatment target (remission or low disease activity) to ensure that the target has been maintained.Offer all adults with RA including those who achieved their treatment targets an annual review to: - Assess disease activity & damage; measure functional ability using e.g., HAQ; check comorbidities like HTN/CHD/Osteop/depression assess symps suggesting complications like vasculitis/cervical sp/lung/eyes organize appropriate cross-referral in multi-disciplinary teams.

Chronic Fatigue Syndrome

Clinician involved in management

In most cases, a GP should be able to diagnose chronic fatigue syndrome (CFS). However, if, after careful history examination screening investigations diagnosis remains uncertain opinion specialist physician adolescent pediatrician sought. Other non-medical professionals include:

  • Physiotherapists
  • Occupational therapists
  • Psychologists
  • Social workers
  • Dieticians

Chronic Pain

This is a very broad area. Treatments depend on location of pain. Musculoskeletal pain, particularly related to joints and the back, is the most common single type of chronic pain.Information provided in the section on arthritis directly relates to the management of click here for more informationchronic pain.A substantial systematic review (by Skelly), Chou [36] investigated non-pharmacological interventionsfor chronic pain.Interventions that improved functionand/orpain forg ≥ month included:

  • Lowback pain: - Exercise - Psychological therapy - Spinal manipulation -Low-level lasertherapy - Massage -Mindfulness-based stress reduction-Yoga-Acupuncture-Multidisciplinary rehabilitation- Neckpainless:Exercise-Lowlevellaser-MindbodypracticesMassageAcupunctur-Knee osteoarthritis:-Exercise-CBT-Hiposteoarthritis:-Exercise-Manualtherapies-Fibromyalgia:-ExerciseCBTMyofascialreleasemassage Mindfulness practices Acupuncture

Amputation

Clinician involved in management

The Limbs for Life is the peak body for amputees in Australia. They provide a list of professionals who assist with rehabilitation:

  • Rehabilitation Consultant (doctor): Oversees medical care coordination;
  • Occupational Therapist: Helps adjust daily activities like personal care, domestic tasks including meal preparation; assists setting up prosthetic use;
  • Physiotherapist: Designs an individualized exercise plan focusing on equilibrium improvement through wheelchair or walker assistance;
  • Prosthetist:

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Research - Therapy Best Practice (Page: [])

Section Title: Best practice treatment and frequency of intervention

Physiotherapy:

The physiotherapist progresses a patient through an assessment-based programme.

  • The physio should identify when optimum function is achieved in order to facilitate discharge into maintenance programmes based upon continuous evaluation.[Reference]
  • Consensus opinion suggests that therapists contribute towards wound management alongside other members within multidisciplinary teams as part of comprehensive care plans.[Reference] During rehabilitation, patients are encouraged to receive regular physiotherapy tailored specifically around their requirements due to varying circumstances affecting recovery processes.[Reference]
Occupational therapy:

Occupational therapist practitioners provide critical services including:[References]

  • Identifying client’s functional goals such self-care tasks like home management or work-related activities; offering modifications if necessary;
  • Analyzing tasks, providing adjustments for achieving these objectives effectively;
  • Educating clients on compensatory techniques using equipment suited toward accomplishing daily living skills efficiently with prosthetics training included where applicable;
  • Addressing psychosocial issues impacting overall well-being during this phase of care. Interventions vary according individual needs. Phases may overlap depending progress made by the person receiving support [Reference]. The administration period can range from one day up until 12 weeks per week involving between five sessions each session[40] .

Psychology

  • Counselling and psychological support is available to the person and their valued others pre-operatively and continues as part of lifelong management [41] .
  • Experienced clinical counselling and psychological support should be available to assist with issues such as adjustment and pain management from the acute phase , and throughout lifelong mangement [41] .
  • Psychosocial issues are evaluated and addressed as part of the overall treatment plan and reviewed regularly throughout the care journey [41]. No information could be sourced about how many sessions are required.

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References

Deane K.,Whurr R Clarke CE Playford ED Ben-Shlomo Y.“Non-pharmacological Therapies for Dysphagia in Parkinson’s disease”,Cochrane Database Of Systematic Reviews [ Internet ]. January, (Issue).Available form :https://doi.org//10.1002/14651858.CD002816. *Dix K Green H.DefiningThe Value Allied Health Professionals With Expertise In Multiple Sclerosis“. Published on October, Retrieved at 2019 From: < https://support.mstrust.org.uk/file/defining-the-value-AHPs.pdf > . *(NICE) NIfHaCE.Multiple sclerosis adults management.Published on October ,Retrieved At 3rd Oct 2019 From: < https://www.nice.org.uk/guidance/cg186/resources/multiples-sclerosisin-adult-management-pdf-35109816059077 >. *Khan F Turner-Stokes L Ng L Kilpatrick T Amatya B.Multidisciplinary Rehabilitation For Adults with multiple scleroseis,Cochrane DatabseOfSystemic Review[Internet].Volume( Issue ). Available from:https://doi.org//10.1002/14651858.CD006036.pub2.. *Rosti-Otajärvi EM.Hämäläinen PI.Neuropsychological rehabilitation for multiple scleosis,Cochrane Database Of Systematic Reviews [ Internet ]. Volume (Issue).Available form :https://doi.org//10.1002/14651858.CD009131.pub3.

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References

  • Hayes S., Galvin R., Kennedy C., Finlayson M., McGuigan C., Walsh CD et al.. Interventions for preventing falls in people with multiple sclerosis. Cochrane Database of Systematic Reviews [Online] . 2019 ; | 11| .Available From : https://doi.org//10.1002/14651858.CD012475.pub2.

  • Mayo Foundation For Medical Education And Research.Muscular Dystrophy [available from:]https://www.mayoclinic.org/diseases-conditionsmusculardystrophysymptoms-causes/syc-20375388. * Voet NBM, van der Kooi EL,van Engelen BGM ,Geurts ACH.Strength training and aerobic exercise trainingfor muscle disease.[Internet]. CochraneDatabaseofSystematicReviews[online].(12). Availablefrom:https://doi.org//10.1002/14651858CD003907pub5 Birnkran DJ,BushbyK.BannCM.AlmanBA.ApkonSD.BlackwellA.etal.DiagnosisandmanagementOf Duchenne muscular dystrophy part: respiratory cardiac bone health orthopaedic management.The Lancet Neurology[ Internet ]. (April) 2018; | 17| ( ):[pp.]AvailableFrom:<https://www.sciencedirect.com/science/article/pii/S1474442218300255 >

  • Birnkra Dj Bushb ykB ann CM Apko n SD Blac kwe lla Col vin MK et al.Dia gnosis an d mana gement ofDuch enne muscul ar dy stro phy pa rt : pri ma ry care emer geny man agem ent psychosocialcare, a nd tra nsit ions o f ca re ac ro ss the lif espan .The Lan cet Neurol og y [ In te rnet ].(May) ; | 17( ):[ pp]. Av ailable from: <https:// www. scienc edirec t.co m/ scie nc e/a rticle /p ii /S I4744422I B S OO Z67> Bir nkran DJ,BushbyK.BannCM.ApkonSD.BlackwellA.Brumbaugh D.etal.DiagnosisandmanagementOf Duchenne muscular dystrophy part: diagnosis and neuromuscular rehabilitation endocrine gastrointestinal nutritional management.The Lancet Neurology[ Internet ]. (March ) , | 17| ():[pp.]AvailableFrom:<https://www.sciencedirect.com/science/article/pii/S1474442218300243 >

  • Guideline Adaptation Committee.Clinical Practice Guidelines And Principles Of Care For People With Dementia.Syd ney:Guidel ineAdaptat ionCommit tee;2016.Avail ablefrom : < https:/ cdpc.sydney.edu.au/wp-content/uploads/2019/06 CDPC-Dement ia-Guidelines WEB.pdf>.

  • Brodat y H,Arasaratnam C.Meta-Analysis of Nonpharmacological Interventions for Neuropsychiatric Symptoms o fD ementia.American JournalofPsychiatry [Internet].(September) ; | 169()[: pp. ]Av ailable from: <https://doi.org//app i .ajp.2012.nnoo529>. * National InstituteforHealthCareExcellence.NationalInstituteFor HealthAndCar e Excellence ClinicalG uideliness.Dem entiaAssessment management and support fo r people living with dementiaand their carers.London:N ationalInst itutef orHe althan dCa reE xcel lenc e(UK) copyright © NICE , | ( )| .AvailableFrom:<https://www.sciencedirect.com/science/article/pii/S1474442218300243 >

  • Woods B,Aguirre E,Spector AE Orrell M.Cognitive stimulation to improve cognitive functioning inpeoplewithdementia.[ Internet ]. Cochrane Database Of Systematic Reviews[Online] . Availablefrom: < https:/ doi org/ //CD005562 pub2>.

  • Möhler R, Renom A,Ren om H,Meyer G.Personally tailored activities for improving psychosocial outcomes f o r peopl ew ith dem en t iain communitysettings[Cochr aneDatabaseofSystemat icReviews [Internet]. 2020 ;( ). Av ailable from: <https://doi.org// CD0I O5 I S. pu b2>. * Bahar FuchsA MartyraGoh AMY Sabates J Clare L Cognitivetrainingfor people with mildto moderate dementia.Cochranedatabase ofsystemicreviews.(March) ; | ()|.Avail able From :<https:// www.sc ienc edirec t.co m/s cie nc e/a rticle /p ii /S1494442218300243> Forbes D ,Forbes SC Blake CM ThiessenEJ For bes s.Exercise programs fo rp eo ple w it h d em entia[C och ran e Da ta baseo fs ystematic Re vi es[In te rn et ]. (April ) ; | .Availablefrom:< https:/ doi org/ //CDO6489 pub4>.

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| Reference | Title | |-| |National Collaborating Centre for Mental Health (NCCMH), Dementia: A NICE SCIE guideline on supporting people with dementia and their carers, British Psychological Society., 2007.|Dementia, 2014. |Veenhuizen et al., Coordinated multidisciplinary care for ambulatory Huntington’s disease patients; evaluation over a period of implementation., Orphanet J Rare Dis,[Online], June–July 2011.; Vol.: Volume, No.Number.[pp.-]Available at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253686/; |Bachoud-Lévi et al. , International guidelines for treatment in HD., Frontiers Neurology [Internet]. July – August 2019 ;Vol:* Volume ,No. Number *. Available from:[https://doi.org/10.3389/fneur.2019.00710][online]; [National Institute for Health Care Excellence] (), Rheumatoid arthritis management guide., National Institute for Health & Care Excellence (NIHCE)., 2018 Peter W F et al . Clinical practice guideline for physical therapist management among individuals living with rheumatic diseases., Physical Therapy [internet]. May -June 2021; vol:*number, no *number. available form:https://doi.org/10.1093/ptj/pzab127. Dixon KE and others Psychological interventions to manage pain associated with RA in adults: a meta-analysis of randomized controlled trials., Health Psychology [Online], March–April Year, Vol.:Volume, No.Number[pp.-]Available at:https://www.frontiersin.org/article/10.3389/fneur.2019.00710[online] Working Group Royal Australasian College Physicians () Chronic fatigue syndrome clinical guidelines–2002 Med J Aust.[Internet].May – June- July 6th , Year ;Vol: Volume ,No. Number *. Available from:[S17-s55 pp.] https://doi.org//10.1177/030802260907200102 [National Institute for Health Care Excellence] (), Myalgic encephalomyelitis (or myasthenia gravis)/chronic fatigue syndrome diagnosis & management guide., National Institute for Health & Care Excellence, NICE., May -June 2020; vol:*number, no number. available form:https://www.nice.org.uk/guidance/gid-ng10091/documents/draft-guideline. Hughes JL ().Chronic Fatigue Syndrome and Occupational Disruption in Primary Care: Is There a Role of Occupational Therapy? British Journal Occup Ther [Online], January–February Year, Vol.:Volume, No.Number[pp.-]Available at:https://doi.org/10.1177/030802260907200102[online] Price JR et al () Cognitive behaviour therapy to manage chronic fatigue syndromes among adults Cochrane Database Syst Rev[Internet].March – April 2008 ;Vol: Volume ,No. Number . Available from:[https://doi.org//14651858.CD001027.pub2][online]; Larun L Brurberg KG Odgaard-Jensen J Price Jr() Exercise therapy as an intervention against Chronic Fatigue Syndromes Cochrane Database Syst Rev[Internet] October- November, Year ,vol :volume,no . number [pp.]available on: <https://doi.org//14651858.CD003200 pub8>.html Skelly AC Chou R Dettori JA Turner JA Friedly JL Rundell SD etal Agency for Healthcare Research and Quality Comparative Effectiveness Reviews., Noninvasive nonpharmacological treatment of chronic pain: a systematic review update [internet], Rockville (MD):Agency for Health Care Res & Qual US; May–June Year, vol.number no Number. available form:https://www.ncbi.nlm.nih.gov/books/NBK556229/. Limbs For Life () Your recovery guide 2021.[Available at:]https://www.limbsforlife.com.au/steps-to-recovery/your-rehabilitation-team; Broomhead P Dawes D Hale C Lambert A Quinlivan D Shepherd R (). Evidence-based clinical guidelines in physiotherapy management among adults with lower limb prostheses British Association Chartered Physiotherapists Amputation Rehabilitation.; June – July year, Vol:Volume ,No. Number . Available from:[https://docuri.com/download/csp-guideline-bacpar_59c1cb4df581710b2860eb11.pdf][online]; Gulick K(). The occupational therapy role as part of rehabilitation process after upper-limb amputations American Occupational Therapy Association[Online].January - February Year,Vol :volume, No: number[pp.-]available on: https://doi.org//10.3389/fneur.2019.00710[online]

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References:

  • Othman R, Mani R, Krishnamurthy I, Jayakaran P Non-pharmacological management of phantom limb pain in lower limb amputation : a systematic review Physical Therapy Reviews [Internet]. March/April; 2017. Available from:doi link.
  • Innovation AfC ACI Care following Amputations: Minimum Standards for Care Australia; April/May 2017.