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8 | InTouch AUTUMN 2023 on how to adjust the settings and spiritual, cultural or psychological concerns associated with CAM use. Considerations, such as those alluded to in the quote below, were not evident across all DHBs Physiotherapists acknowledged that CAM can be overwhelming, noisy, and invasive. They also recognised that adding regular CAM use into an already busy health routine might be one task too many. Being sensitive to these concerns was part of the physiotherapists’ role and they acknowledged that a process of acclimatation was required. Inequitable provision of CAM There is variable provision of CAM in New Zealand, and this creates inequities. There is geographical difference in CAM availability across New Zealand with two former DHB’s having no CAM at all. The Northern region had the largest number of CAM available within the health system (59) followed by Central with 36, Te Waipounamu with 32 and then Te Manawa Taki with 27. Within any hospital and region, the number of CAM available for use in an acute inpatient setting (short term use) versus community respiratory service setting was also evident. There was variable knowledge between physiotherapists about clinical implications for CAM provision and Fifteen people with NMD and 7 whānau (family members and caregivers) gave interviews. Two people had motor neuron disease; other interviewees had disorders such as Duchenne, Becker, Limb girdle, Spinal muscle atrophy, Facioscapulohumeral dystrophy and Frederich’s ataxia. Duration of CAM use varied from less than 1 year to 15 years. Eleven of the people with NMD used their CAM between twice and multiple times a day. Four people used a CAM only when they had an acute respiratory infection. People with NMDs, Physiotherapists (PT’s) and survey data all discussed the important place CAM has in the health of people with NMD. Short term use of CAM was discussed as being lifesaving at time of acute respiratory infection or with choking, long term CAM use was believed to have a role in preventing further infections. “So, I’ve been on [the CAM daily] since I was probably 10 or 11. I wouldn’t be alive if I didn’t have that because my lungs are that bad. That’s probably one of the most important devices I have”. (Person with NMD) Finally, CAM was believed to improve quality of life. Concerns and considerations with uptake of CAM Concerns and considerations with CAM uptake related to individual discomfort, usability of the CAM, knowledge THE “AMBULANCE AT THE BOTTOM OF THE CLIFF” Figure 1: The pooled category represents former DHB regions that did not separate Outpatient and Community CAMs. Total CAMs across sites nationally by Te Whatu Ora region