GPG Malay Massage

Good Practice Guideline for

Malay Massage in Post Stroke

and Chronic Pain Management

August 2010

First edition 2010.

Copyright 2010, Ministry of Health MalaysiaAll rights reserved. No part of this book may be reproduced,

stored, or transmitted in any form or by any means, electronicor otherwise, including photocopying, recording, internetor any storage and retrieval system without prior written

permission from the publisher.

Published by:Traditional and Complementary Medicine Division

Ministry of Health Malaysia

ISBN 978-983-44754-7-5

Cover design by : Suhana Bt. JoharTraditional and Complementary Medicine Division

Ministry of Health Malaysia

ACKNOWLEDGEMENTS

1. INTRODUCTION

2. GENERAL CONSIDERATIONS 2.1. Record Keeping

2.2. Ethical Issues

2.3. Cleanliness and Sterility

3. SECTION I – PRACTICE GUIDELINE IN ASSESSMENT AND DIAGNOSIS OF PRESENTING COMPLAIN/PATIENT’S PROBLEM (EVALUATIVE PHASE)

4. SECTION II – PRACTICE GUIDELINE FOR TREATMENT PLAN (TREATMENT PLANNING PHASE)

5. SECTION III – PRACTICE GUIDELINE FOR PATIENT CARE AND MONITORING (TREATMENT PHASE)

6. SECTION IV – PRACTICE GUIDELINE IN DISCHARGE ASSESSMENT (DISCHARGE PHASE)

7. CONCLUSION

8. APPENDICES Appendix 1: Evaluative Phase

Appendix 2: Treatment Planning Phase

Appendix 3: Treatment Phase

Appendix 4: Discharge Phase

Appendix 5: Sterilization and Disinfection Methods

Appendix 6a: Clerking Form For Stroke for Use in Integrated Hospitals

Appendix 6b: Clerking Form For Chronic Pain for Use in Integrated Hospitals

Appendix 7: Case Study Example

9. REFERENCES

1

2233

3

4

6

7

7

8910111213151821

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CONTENTS

Acknowledgements

Special thanks to every individual and organizations who have in one way or

another contributed comments and advices during the preparation of this

good practice guideline on Malay massage for use in the Traditional and

Complementary Medicine (T&CM) Unit in integrated hospitals.

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Good Practice Guideline On Malay Massage

1. INTRODUCTION In Malaysia, three pioneer Traditional and Complementary Units (T&CM Units) were

started at Hospital Kepala Batas (October 2007), Hospital Sultan Ismail (January 2008) and Hospital Putrajaya (March 2008). Malay massage is one of two T&CM modalities introduced at these hospitals. Since the establishments of the three integrated hospitals, three more T&CM Units have started their operations since December 2009. The new units are at Hospital Sultanah Zahirah, Terengganu, Hospital Duchess of Kent, Sabah and Hospital Umum, Sarawak.

This Good Practice Guideline was developed from the Working Paper on Development of Good Practice Guideline for Malay Traditional Massage in Chronic Pain and Post Stroke Management for Traditional and Complementary Unit at the Integrated Hospitals, which was presented to the Standing Committee, in May 2009.

From data analyzed on the experience of the first three T&CM Units, the following improvements were identified;1. The need for a proper and systematic documentation.2. The need for a standardized approach for the assessment of patients.3. The need for a standardized treatment plan for a similar condition at all the integrated

hospitals. Thus, the purpose of this Good Practice Guideline is to guide the T&CM practitioners to;

1. Have a proper and standardized record keeping.2. Have a standardized approach to assessment and treatment of patients.3. Maintain an ethical and professional conduct at all times.

This guideline guides the practitioner through the examination, treatment and discharge of a patient. It will assist practitioners in making decisions on the suitable provisions for specific clinical circumstances. They are not standards or rules. It is the responsibility of the individual practitioner to know and understand this guideline, apply it to his/her clinical case, where and when appropriate.

One needs to keep in mind that each patient is an individual and that each practitioner

has his or her own approach to delivery of care. Therefore, all treatment must be tailored to the patient’s specific needs.

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The good practice guideline in Malay Massage is organized into four sections. In Section I, discusses practice guidelines in assessment and diagnosis of presenting complain / patient’s problem (Evaluative Phase). Section II outlines practice guidelines for Treatment plan (Treatment Planning Phase), Section III describes practice guidelines in planning of patient Care and Monitoring (Treatment Phase), and in Section IV, practice guidelines in Discharge assessment (Discharge Phase).

2. GENERAL CONSIDERATIONS2.1. Record Keeping2.1.1. General Considerations

a. All information must be recorded in a chronological order and entered as contemporaneously as possible.

b. Records should not be backdated or altered.c. Corrections or additions should be initialled and dated.d. Charts or files should be fully documented and contain all relevant, objective

information, extraneous information should not be included.e. Records must be complete to provide the practitioner with information

required for subsequent patient care or reporting to outside parties. See Appendix 7 for example of a case study.

2.1.2. Legibility and Clarity a. All records should be neat, organized and complete to provide adequate

information requested by a subsequent healthcare provider, insurance company, and/or attorney. A dated record of what occurred on each visit and any significant changes in the clinical picture or assessment or care plan need to be noted.

b. All entries should be written in ink.c. Entries should not be erased or altered with correction fluid/tape/adhesive

labels.d. If the contents are changed, the practitioner should initial and date such

changes in the corresponding margin.e. The method in which notes are recorded is a matter of preference for each

practitioner. f. All records must be in a language that has been agreed upon, i.e. Malay or

English, typewritten or in a legible handwriting.g. The patient’s records are confidential and should be kept properly.

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2.2. Ethical Issues At all times during the provision of treatment to patients, the T&CM practitioners

should;2.2.1. Adhere to guideline for ethical conduct (refer to Code of Ethics and Code of

Practice for Traditional and Complementary Medicine Practitioners).2.2.2. Maintains clinical boundaries during the treatment through appropriate draping

and communication with the patient.2.2.3. Demonstrates responsible and caring concern for the patient.2.2.4. Responds appropriately to the patient’s emotional reaction to treatment.2.2.5. Elicit patient’s ongoing feedback on progress with clinical outcomes and provides

the patient with appropriate education on ongoing care.2.2.6. Maintain an updated documentation on the treatment provided and the patient’s

response to it.2.2.7. Maintain communication with the referring clinician or other healthcare

professional as appropriate.

2.3. Cleanliness and Sterility2.3.1. All practitioners must always maintain good personal hygiene.2.3.2. All practitioners should wash his/her hands prior to the examination of patients

and starting treatment.2.3.3. The premise and all equipments used should be cleaned regularly and after each

treatment session.2.3.4. Practitioners are required to take appropriate measures for prevention of

infection (refer to Traditional and Complementary Medicine Practice Guideline on Malay Massage, 2nd Edition 2009).

2.3.5. Opened bottles/containers of massage oils should not be left exposed for prolonged periods of time.

2.3.6. All instruments used should be disinfected and sterilized according to the recommended methods of sterilization and disinfection (Appendix 5).

3. SECTION I – PRACTICE GUIDELINE IN ASSESSMENT AND DIAGNOSIS OF PRESENTING COMPLAIN/PATIENT’S PROBLEM (EVALUATIVE PHASE)

This section is concerned with adequate practitioner’s preparation and appropriate engagement of the patient’s information into the clinical process. It provides the foundation of the practitioner’s treatment process. The steps revolve around the formulation and confirmation of the hypothesis about the patient’s problem. It begins with data gathering

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through patient examination and also involves the confirmation of the patient’s problem, the creation of a summary of clinical findings, and the decision of whether to pursue treatment. Below are the steps involved in this process of information gathering (Appendix 1);

3.1. History Taking3.1.1. Prior to taking the patient’s history, determine whether the patient has a specific

diagnosis on referral. If there is a specific diagnosis, then the history taking will include questions relating to that condition and will focus on eliciting information to confirm or refute the patient’s presenting diagnosis.

3.1.2. If it is a walk-in patient, without a specific diagnosis, begin by eliciting general information that will clarify the patient’s presenting problem and suggest a diagnosis.

3.2. Physical Examination3.2.1. The practitioner then proceeds to patient examination, in which the practitioner

analyzes the patient’s presenting problems/impairments and further confirms the clinical diagnosis.

3.2.2. Practitioners are required to document all findings in the clerking form (Appendix 6a and 6b).

3.3. To Treat or Not To Treat?3.3.1. Not all patients who are referred are suitable for massage therapy. Therefore,

determine whether the patient would benefit from treatment or not.3.3.2. Once the practitioner has confirmed that treatment is appropriate, and before he/

she begins treatment planning, the practitioner has to determine the presence or absence of contraindications. The patient should be referred to the appropriate healthcare professional should the need arise.

4. SECTION II – PRACTICE GUIDELINE FOR TREATMENT PLAN (TREATMENT PLANNING PHASE)

This section will discuss the steps involved in planning the patient’s treatment (Appendix 2).4.1. It begins with the summary of clinical findings from the evaluative phase.

The practitioner has to distinguish between the patient’s area of function and dysfunction, or those areas that will respond to direct application of massage technique and those that will not.

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4.2. Once these areas have been identified, the practitioner should select treatment techniques that are appropriate for the patient. In the Consensus Meeting on Improvement Strategy in Traditional and Complementary Medicine Services in Integrated Hospital (March 2009), for treatment of post stroke patients, the concept is whole body massage, and half body massage for chronic pain patients.

4.3. The choice of treatment technique depends on the identification of functional outcomes of care for the patient. These outcomes should be consistent with the functional limitations that the patient has.

4.4. The patient should be explained regarding the treatment technique that has been decided upon. If there is significant harm from the proposed treatment, this risk should be disclosed, understood and accepted by the patient.

4.5. Obtain patient’s consent prior to the provision of treatment. Patients must be competent to give consent of care. In care of minors (less than 18 years old) and mentally impaired adults, practitioners requires the consent of a guardian.

4.6. The number of follow up or frequency of visits planned is catered to the individual patient. Below is a guide for the number of sessions in management of chronic pain and post stroke patients;

Chronic pain

3 sessions

3 sessions in a week

Can either be:

3 days in a row

OR

Alternate days

Done at third session

5 sessions

Number of sessions

Breakdown of sessions

Assessment for effectiveness

Maximum session given in the unit for cases

Post stroke

7 sessions

First week: 3 sessions

Second week: 2 sessions

Third week: 2 sessions

Done at the 7th session

10 sessions

Table 1: Regime Treatment of Malay Massage for Chronic pain and post stroke cases (Presented at WHO Workshop on Development of Harmonized Policy and Standards of

Integrative Medicine).

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5. SECTION III – PRACTICE GUIDELINE FOR PATIENT CARE AND MONITORING (TREATMENT PHASE)

This phase involves an ongoing cycle of treatment; re-examination and treatment progression that begins after the practitioner completes the plan of care (Appendix 3).5.1. In the first stage of treatment, the practitioner evaluates the appropriateness of

the plan of care and gauges the patient’s treatment tolerance. Be cautious not to introduce too many treatment techniques at once, lest it be difficult to identify which technique to which the patient has a positive or adverse response to.

5.2. At any time during the intervention, the practitioner can perform patient examination to assess any clinical change. The reexamination is focused on the identification and measurement of changes in the patient’s impairment and functional level form the baseline. It is also to identify whether the patient has a positive or adverse response to treatment given.

5.3. The practitioner should reassess the patient’s impairments and functional level as recommended (see Section II, Table I) and at other suitable intervals deemed appropriate.

5.4. Ideally, during each treatment session, the practitioner incorporates patient’s examination and progression or modification of either the treatment techniques or client education.

Table 2: Duration of Malay massage therapy for chronic pain and post stroke cases.

New case

Follow up case

Chronic pain

30 – 45 minutes

30 minutes

Post stroke

30 – 60 minutes

30 – 60 minutes

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6. SECTION IV – PRACTICE GUIDELINE IN DISCHARGE ASSESSMENT (DISCHARGE PHASE)

The discharge phase involves the transition of the patient from the care of the practitioner to the care of another clinician or to self-care. The steps involved are (Appendix 4);6.1. The practitioner elicits the patient’s perceived discharge needs.6.2. The patient is then informed of post-discharge treatment requirements.6.3. An appropriate initial discharge plan based on clinical findings is prepared.6.4. Discharge goals and arrangements are discussed with the patient, and the

practitioner documents the final discharge plan.6.5. The patient is prepared for pre-discharge education and preparation.6.6. The practitioner completes and documents pre-discharge examination and

determines whether the patient has achieved the identified functional outcomes. The patient may be referred to another practitioner or healthcare provider for follow up care as appropriate.

6.7. Advice should be given on self-care, maintenance of health and prevention of recurrence of the patient’s problem(s).

7. CONCLUSION This guideline with the clinical decision making process proposed is a guide for T&CM

Practitioners of Malay Massage, through the evaluative, treatment planning, treatment and discharge phases of a patient care. It provides guidelines for enhancing the appropriateness and adequacy of examinations performed, the plans of care outlined, and the interventions planned and provided by the practitioners. This guideline also encourages the T&CM practitioners to adhere to the code of ethics and code of practice, and maintains a high level of medical professionalism.

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APPENDICES

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APPENDIX 1 : EVALUATIVE PHASE

Patient with presenting

problem

Case history & physical

examination

Within scope

of treatment

No

No

Refer to

appropriate

healthcare

professional

Yes

Yes

Contraindications

Treatment planning

phase

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APPENDIX 2 : TREATMENT PLANNING PHASE

Treatment planning

phase

Areas of

impairment/problem

Establish diagnosis

For active

treatment

Preparation for

treatment

Treatment sessions

Other appropriate

technique

Reassess for

treatment

Areas of normal

function

compensating for

deficit

Plan of care

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APPENDIX 3 : TREATMENT PHASE

Session procedure

completed

Compensation mechanism

done

Treat accordingly

and possibility of

referrals to other

health care

professional

Revise plan of care

Refine application

technique

Reassess – to refer

Monitoring of

symptoms/

complications

Continue treatment programme,

reassessment and after care advise

Functional

changes/

outcome met

Continue treatment plan

Yes

Yes

No

No

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APPENDIX 4 : DISCHARGE PHASE

Assess progression

and re-examination

Functional

outcome met/

improved physical

function

Initiate discharge

assessment &

education

Document findings

and plans on

discharge

Discharge

Continue

treatment plan

No

Yes

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APPENDIX 5: STRERILIZATION AND DISINFECTION METHODS

Methods of sterilization

Steam sterilization is the most widely used method for apparatus and instruments made of metal. It is nontoxic, inexpensive, sporicidal and rapid if used in accordance with the manufacturer’s instructions (e.g. time, temperature, pressure, wraps, load size and load placement). Steam sterilization is only fully effective when free from air, ideally at 100% saturated steam. Pressure itself has no influence on sterilization, but serves as a means of obtaining the high temperatures required.

Recommended sterilizing temperatures and times for steam under pressure, and for dry heat, are shown in the table below.

* Steam under pressure (e.g. autoclave, pressure cooker)

Required pressure: => 15 pounds per square inch (101 kilopascals)

Temperature

115°C

121°C

126°C

134°C

Time

30 minutes

15 minutes

10 minutes

3 minutes

* Dry heat (e.g. electric oven)

Temperature

160°C

170°C

180°C

Time

120 minutes

60 minutes

30 minutes

(Source: WHO - GPA/TCO/HCS/95/16 p.15.)

Recommended methods of sterilization

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Instruments made of rubber or plastic which are unable to stand the high temperature of an autoclave can be sterilized chemically, at appropriate concentrations and ensuring adequate immersion times (e.g. 6% stabilized hydrogen peroxide for six hours).

It should be noted that boiling needles in water is not sufficient for sterilization, nor is soaking in alcohol, since these methods do not destroy resistant bacterial spores or certain viruses.

Methods of DisinfectionA high level of disinfection is achieved when instruments are boiled for 20 minutes. This is the simplest and most reliable method of inactivating most pathogenic microbes, including HIV, when sterilization equipment is not available. Boiling should be used only when sterilization by steam or dry heat is not available. Hepatitis B virus is inactivated by boiling for several minutes; HIV, which is very sensitive to heat, is also inactivated by boiling for several minutes. However, in order to be sure, boiling should be continued for 20 minutes.

Chemical disinfection is used for heat-sensitive equipment that may be damaged by high temperatures. Most disinfectants are effective against a limited range of microorganisms only and vary in the rate at which they destroy microorganisms. Items must be dismantled and fully immersed in the disinfectant. Care must be taken to rinse disinfected items with clean water so that they do not become recontaminated. Chemical disinfectants are unstable and chemical breakdown can occur. They may also be corrosive and irritating to skin. Protective clothing may be required. Chemical disinfection is not as reliable as boiling or sterilization. The agents include:• chlorine-basedagents,e.g.,bleach• aqueoussolutionof2%glutaraldehyde• 70%ethylorisopropylalcohol.

(Source: WHO - GPA/TCO/HSC/95/16 p.16 and WHO AIDS Series 2, 2nd edition, p.3, 1989.)

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Lokasi (site):

Ciri-ciri kelumpuhan (Character)

Ketidakupayaan (Disability) yang lain:

Faktor yang menjadikan keadaan lebih buruk (Aggrevating Factor) :

Faktor yang menambahbaikan keadaan(Relieving Factor) :

Kemajuan (Progression) :

Huraian : Isikan nama bahagian yang mengalami kelumpuhan . Samada bahagian Kiri atau Kanan. Anggota yang sakit e.g Kaki, Bahu dll

Huraian:Isikan ciri yang dialami;e.g tidak boleh mengerak anggota bahagian,kejang, keras

Huraian: Isikan samada pesakit mengalami simptom yang lain e.g tidak boleh bertutur , tidak boleh menelan air atau/dan makanan dll

Isikan perbandingan keadaan pesakit dari tempoh kelumpuhan hingga hari ini.

Jenis kelumpuhan :

Seluruh badan Separuh badan Kiri Kanan

PENILAIAN PESAKIT

CATATAN

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PENILAIAN PESAKIT

Lokasi (site):

Ciri-ciri kesakitan (character):

Menjalar (Radiate):

Masa bermula (Onset):

Perkembangan (Progression):

Tempoh (Duration):

Faktor yang menyebabkan keadaan kesakitan lebih teruk (Aggravating Factor):

Faktor yang mengurangkan kesakitan(Relieving Factor):

Simptom yang berkaitan (Associated symptoms):

Huraian : Isikan nama bahagian yang sakit. Samada bahagian Kiri atau Kanan. Anggota yang sakit e.g Kaki, Bahu dll

Huraian:Isikan ciri kesakitan yang dialami;e.g cucuk,tarik,dll

Huraian: Isikan pergerakkan kesakitan yang dialami. Sebagai contoh bermula kesakitan bermula di kaki kiri dan ianya dapat dirasakan/menjalar hingga ke paha kiri

Huraian:Isikan masa mulanya kesakitan itu bermula e.g 3 bulan yang lepas , 6 bulan yang lepas

Huraian:Isikan perbandingan keadaan kesakitan pesakit dari tempoh ia bermula hingga hari ini.e.g kesakitan bertambah teruk dari boleh berjalan dulu tetapi sekarang menggunakan bantuan untuk berjalan.

Huraian:Disini menjelaskan tempoh masa kesakitan apabila pesakit diserang kesakitannya.e.g 10 minit, 20 minit dll

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APPENDIX 7 : Case Study Example

Name : Mr M

Address : 3, Jalan Kenanga, Seksyen 5, 40000 Shah Alam, Selangor

I/C No. : 800205-14-5689

Age : 30 years

Referral : none

The patient is a 30 years old man who works as an accountant at a local company.

He presented with 4 months history of neck pain which has steadily increased in severity.

The neck pain occurs at rest, at end of range of motion and during functional activity. The

patient does not recall any injury or events preceding the onset of the neck pain. He also

reports difficulty in driving due to tightness of neck muscles, and transient headaches

(temporal region). He has no other medical illness.

Despite the fact that Mr. M has suffered for 3 months, he has not yet sought any

treatment for his neck pain. He does however, took various types of available over

the counter pain relief medications. He reports that the medications provides him with

temporary relief and enables him to continue working and has a good functional activity.

But, for the last 1 month, the medications are providing with very minimal pain control.

Since then, he finds that even getting up from bed is agonizing.

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PENILAIAN PESAKIT

Lokasi (site):Posterior neck, right side, and right upper back

Ciri-ciri kesakitan (character):Sharp, pricking

Menjalar (Radiate):Radiating to right shoulder and upper arm

Masa bermula (Onset):4 months ago

Perkembangan (Progression): Increasing in severity, previously able to turn head to right side more easily. Now unable to turn head to the right at all.

Tempoh (Duration): Everytime

Faktor yang menyebabkan keadaan kesakitan lebih teruk (Aggravating Factor):Driving, upon getting up form lying down, lifting up right arm

Faktor yang mengurangkan kesakitan (Relieving Factor):Medications (painkiller)

Simptom yang berkaitan (Associated symptoms):None

Huraian : Isikan nama bahagian yang sakit. Samada bahagian Kiri atau Kanan. Anggota yang sakit e.g Kaki, Bahu dll

Huraian:Isikan ciri kesakitan yang dialami;e.g cucuk,tarik,dll

Huraian: Isikan pergerakkan kesakitan yang dialami. Sebagai contoh bermula kesakitan bermula di kaki kiri dan ianya dapat dirasakan/menjalar hingga ke paha kiri

Huraian:Isikan masa mulanya kesakitan itu bermula e.g 3 bulan yang lepas , 6 bulan yang lepas

Huraian:Isikan perbandingan keadaan kesakitan pesakit dari tempoh ia bermula hingga hari ini.e.g kesakitan bertambah teruk dari boleh berjalan dulu tetapi sekarang menggunakan bantuan untuk berjalan.

Huraian:Disini menjelaskan tempoh masa kesakitan apabila pesakit diserang kesakitannya.e.g 10 minit, 20 minit dll

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REFERENCES

1. Andrade and Clifford, Outcome-based Massage, Part I: Client Examination and Treatment

Planning.

2. Lynn Freeman, Mosby’s Complementary and Alternative Medicine, A Research-based Approach

(2nd Edition), Chapter 13: Massage Therapy.

3. Code of Ethics and Code of Practice for Traditional and Complementary Medicine Practitioners

(2nd Edition 2007).

4. Traditional and Complementary Medicine Practice Guideline on Malay Massage (2nd Edition

2009).

5. Consensus Meeting on Improvement Strategy in Traditional and Complementary Medicine (T&CM)

Services in Integrated Hospital with T&CM Practitioners, March 2009.

6. WHO Workshop on Development of Harmonized Policy and Standards of Integrative Medicine.

7. Presentation of Working Paper, Development of Good Practice Guideline for Malay Traditional

Massage in Chronic Pain and Post Stroke Management for Traditional and Complementary Medicine

Unit at Integrated Hospitals, May 2009.

8. http://nccam.nih.gov/health/massage

9. http://www.redmoonmassagetherapy.com

10. http://www.integrative-healthcare.org

11. http://www.emedicine.medscape.com

12. http://massagetherapy.suite101.com

13. Daniel C. Cherkin, Karen J. Sherman, Richard A. Deyo, Paul G. Shekelle. A Review of the Evidence

for the Effectiveness, Safety, and Cost of Acupuncture, Massage Therapy, and Spinal Manipulation

for Back Pain. Annals of Internal Medicine, June 2003. Volume 138, Number 11.

14. Jennie C.I. Tsao. Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review.

eCAM, February 2007.

15. E. Ernst. The Safety of Massage Therapy. Rheumatology, May 2003.

16. Anita R. Gross, Jan L. Hoving, Ted A. Haines, Charles H. Goldsmith, T. Kay, Peter Aker, Gert

Bronfort, and the Cervical Overview Group. A Cochrane Review of Manipulation and Mobilization

for Mechanical Neck Disorders. Spine, 2004. Volume 29, Number 14.

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17. Harald Walach, Corina Güthlin, and Miriam König. Efficacy of Massage Therapy in Chronic Pain:

A Pragmatic Randomized Trial. The Journal Of Alternative And Complementary Medicine, 2003.

Volume 9, Number 6.

18. Catherine A. Warms, Judith A. Turner, Helen M. Marshall, and Diana D. Cardena. Treatments for

Chronic Pain Associated With Spinal Cord Injuries: Many Are Tried, Few Are Helpful. The Clinical

Journal of Pain, 2002.

19. EG Widerstro¨m-Noga, and DC Turk. Types and effectiveness of treatments used by people with

chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics.

Spinal Cord, 2003.

20. Barrie R. Cassileth, and Andrew J. Vickers. Massage Therapy for Symptom Control: Outcome

Study at a Major Cancer Center. Journal of Pain and Symptom Management, 2004. Volume 28,

number 3.

21. Tiffany Field, Maria Hernandez-Reif, Susan Seligman, Josh Krasnegor, William Sunshine, Rafael

Rivas-Chacon, Saul Schanberg and Cynthia Kuhn. Juvenile Rheumatoid Arthritis: Benefits from

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Editorial Board

Dr. Ramli Abd. Ghani

Director

Traditional and Complementary Division

Ministry of Health

Dr. Shamsaini Shamsuddin

Senior Principal Assistant Director


Ministry of Health

Dr. Zalilah Abdullah

Principal Assistant Director


Ministry of Health

Dr. Nur Hidayati Abdul Halim

Senior Assistant Director


Ministry of Health

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Traditional and Complementary Medicine

Practitioners

Syed Mahdi Syed Fouzi Barakhbah

Fauziah Mat Jani

Robaieyah Ramlie

Kamarul Abdul Rahman

Che Nab Shaari

Rohani Ibrahim

Zakariya Saad

Haniyah Ismail

Azlina Abdul Razak

Mimi Samsuddin

Razmah Mohd Amin

Mahani Mohd Aris

Norizan Radinmas

Siti Zawiyah Sarip

Shamsuri Ibrahim

Mary Kasim

Ab Rahim T. Ahmad

Siti Hajar Baba

Sharifah Yunnah

Sharifah Mariamah Abdullah

Zailani Omar

Rozana Ramli

Committee Members

Ministry of Health

Dr. Khadijah Abu Bakar

Deputy Director, Hospital Sultan Ismail,

Johor

Wan Najbah Nik Nab

Head of Traditional and Complementary

Medicine Unit, Hospital Putrajaya

Liew Ai Chi’i

Head of Traditional and Complementary

Medicine Unit, Hospital Kepala Batas,

Pulau Pinang

Documents

GPG Malay Massage