If you have followed the treatment recommendations and progress has plateaued and or declined or if you do not feel confident with more specialist therapies, then REFER on as soon as possible (eg 2 sessions without improvement could trigger discussion with other team members, and 2 further sessions without improvement could trigger referral).

You should be aware that due to the nature of this condition progress can be difficult no matter how experienced you are.

If your patient’s condition/function hasn’t improved do not discharge without seeking specialist support. Please refer to your National and or local guidelines for relevant specialist centres.