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Metastatic spinal cord compression (MSCC) guidelines for physiotherapists and occupational therapists


The guidelines recommend that assessment should be carried out by a physiotherapist within 24-48 hours of admission. They state that the assessment should commence with a history of the current medical condition; the results of investigations; pre-admission mobility; function and rehabilitation history and social and drug history.

The guidelines also emphasize that the assessment should include a thorough examination of the four cardinal and diagnostic features of MSCC:

  • Pain
  • Motor Dysfunction 
  • Sensory Dysfunction
  • Bladder and bowel dysfunction

The guidelines call for the stability of the spine and the level of mobility allowed to be agreed by a multidisciplinary team, which may include an oncologist, radiologist, orthopaedic surgeon, physiotherapist and occupational therapist. They make clear recommendations for the management of the unstable MSCC patient and the stable MSCC patient. The guidelines also stress the importance of clinical vigilance and monitoring of pain, muscle power and sensation during rehabilitation.

Aileen McCartney, chair of the Association of Chartered Physiotherapists in Oncology and Palliative Care, said: ‘These are the first guidelines on MSCC patients aimed specifically at physios and occupational therapists. They should be a huge benefit to physios working with MSCC patients, and particularly those working in the acute sector who are not used to working with this group of patients.’

The guidelines were developed using research evidence, expert opinion and professional consensus. They are aimed at all physiotherapists and occupational therapists involved in the management of patients with MSCC.


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