From November, music and art therapists will be able to charge the National Disability Insurance Scheme (NDIS) the same as counsellors, after an independent review found they can be effective and “even life changing” for some people with disability.

The National Disability Insurance Agency commissioned the review, led by health economist Stephen Duckett, after widespread criticism of pricing changes it announced last year.

In November last year, the federal government announced it would slash the maximum therapists could bill per hour from A$193.99 to $67.56, citing insufficient evidence they were effective.

This week, the National Disability Insurance Agency (NDIA) has accepted the Duckett Review’s 19 recommendations, and the finding these therapies are effective and beneficial for people with specific conditions and disabilities.

Here’s what we know, and what will change.

What’s changing

Art and music therapies will be restored to the “therapy supports” funding category, following last year’s unexpected announcement they would be restricted to the “community participation” category.

These NDIS funding categories are different in two important ways.

The first relates to the maximum hourly rate for an individual session. Therapy supports can cost a maximum of $193.99 an hour. In contrast, “community participation” costs are capped at $67.56 an hour.

The review recommended a new hourly rate of $156.16 for individual art and music therapy sessions – the same hourly rate as counselling. However this remains significantly lower than other allied health services with similar levels of training, such as occupational therapy.

The second difference is that therapy services and community participation programs have very different requirements for providing evidence they are beneficial, and for providers’ qualifications levels and training.

The review also recommended a clearer distinction between art and music as a therapeutic support, and art and music as an activity.

And it recommended these therapies should be delivered by a qualified and registered music or art therapist.

So, what’s the difference?

As a music therapy researcher, I am often asked to explain the difference between “music therapy” and “music activity”.

People can be confused because music activities might also make us feel good. For example, music activities such as singing in a community choir can have mental health benefits for adults. Learning to play the ukulele has been shown to build stronger empathic skills in children.

Music activities like these are valuable for many people, but they are not music therapy.

Music therapy practice is informed by research into the benefits of specific methods and techniques for people with disability. These include autistic children, people with profound disabilities, and people recovering from major injury.

For example, if a client is non-speaking, the therapist might use a vocal improvisation technique, creating supportive music to encourage the person to make sounds with their voice. The back-and-forth musical dialogue at first doesn’t rely on words. But the therapist may help the client extend to more expressive vocalisations and even word production.

In Australia, music therapists must complete a two-year master’s degree before they are able to register with the Australian Music Therapy Association, and engage in continuous professional development.

The review said artists or musicians who do not have relevant qualifications to register with their professional bodies should not charge the new hourly rate for therapy.

So, what does the evidence say?

The new review acknowledged that establishing the evidence for therapy and disability is a complex task.

Around one in five Australians live with disability. Each person has unique needs and strengths, and disability occurs across the lifespan, meaning needs can also change. But when studying whether a particular kind of therapy is beneficial, researchers will focus on a particular group of people, such as adults with cerebral palsy.

This means the quantity and quality of evidence available will vary across different age groups and conditions – and there may be gaps. So care needs to be taken when interpreting the research to consider whether findings from one study might be applicable to other people with similar goals, needs, or conditions.

Qualified therapists are trained to interpret this evidence. They may be working with a client whose condition or needs differ from what’s in the existing research literature. So, they will consider whether a study showing benefits for music therapy with one group (such as non-speaking autistic children) could be relevant to another (for example, other people who have limitations in verbal expression).

The Duckett Review acknowledges this challenge of generalising evidence across different therapies. But it also warns of possible discrimination against people with rare conditions that attract limited research funding, and calls for more research.

Grace Thompson, Associate Professor in Music Therapy; Senior Academic Fellow at Melbourne Centre for the Study of Higher Education, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Have you ever wondered why most disinfectants indicate they kill 99.9% or 99.99% of germs, but never promise to wipe out all of them? Perhaps the thought has crossed your mind mid-way through cleaning your kitchen or bathroom.

Surely, in a world where science is able to do all sorts of amazing things, someone would have invented a disinfectant that is 100% effective?

The answer to this conundrum requires understanding a bit of microbiology and a bit of mathematics.

What is a disinfectant?

A disinfectant is a substance used to kill or inactivate bacteria, viruses and other microbes on inanimate objects.

There are literally millions of microbes on surfaces and objects in our domestic environment. While most microbes are not harmful (and some are even good for us) a small proportion can make us sick.

Although disinfection can include physical interventions such as heat treatment or the use of UV light, typically when we think of disinfectants we are referring to the use of chemicals to kill microbes on surfaces or objects.

Chemical disinfectants often contain active ingredients such as alcohols, chlorine compounds and hydrogen peroxide which can target vital components of different microbes to kill them.

The maths of microbial elimination

In the past few years we’ve all become familiar with the concept of exponential growth in the context of the spread of COVID cases.

This is where numbers grow at an ever-accelerating rate, which can lead to an explosion in the size of something very quickly. For example, if a colony of 100 bacteria doubles every hour, in 24 hours’ time the population of bacteria would be more than 1.5 billion.

Conversely, the killing or inactivating of microbes follows a logarithmic decay pattern, which is essentially the opposite of exponential growth. Here, while the number of microbes decreases over time, the rate of death becomes slower as the number of microbes becomes smaller.

For example, if a particular disinfectant kills 90% of bacteria every minute, after one minute, only 10% of the original bacteria will remain. After the next minute, 10% of that remaining 10% (or 1% of the original amount) will remain, and so on.

Because of this logarithmic decay pattern, it’s not possible to ever claim you can kill 100% of any microbial population. You can only ever scientifically say that you are able to reduce the microbial load by a proportion of the initial population. This is why most disinfectants sold for domestic use indicate they kill 99.9% of germs.

Other products such as hand sanitisers and disinfectant wipes, which also often purport to kill 99.9% of germs, follow the same principle.

Real-world implications

As with a lot of science, things get a bit more complicated in the real world than they are in the laboratory. There are a number of other factors to consider when assessing how well a disinfectant is likely to remove microbes from a surface.

One of these factors is the size of the initial microbial population that you’re trying to get rid of. That is, the more contaminated a surface is, the harder the disinfectant needs to work to eliminate the microbes.

If for example you were to start off with only 100 microbes on a surface or object, and you removed 99.9% of these using a disinfectant, you could have a lot of confidence that you have effectively removed all the microbes from that surface or object (called sterilisation).

In contrast, if you have a large initial microbial population of hundreds of millions or billions of microbes contaminating a surface, even reducing the microbial load by 99.9% may still mean there are potentially millions of microbes remaining on the surface.

Time is is a key factor that determines how effectively microbes are killed. So exposing a highly contaminated surface to disinfectant for a longer period is one way to ensure you kill more of the microbial population.

This is why if you look closely at the labels of many common household disinfectants, they will often suggest that to disinfect you should apply the product then wait a specified time before wiping clean. So always consult the label on the product you’re using.

Other factors such as temperature, humidity and the type of surface also influence how well a disinfectant works outside the lab.

Similarly, microbes in the real world may be either more or less sensitive to disinfection than those used for testing in the lab.

Disinfectants are one part infection control

The sensible use of disinfectants plays an important role in our daily lives in reducing our exposure to pathogens (microbes that cause illness). They can therefore reduce our chances of getting sick.

The fact disinfectants can’t be shown to be 100% effective from a scientific perspective in no way detracts from their importance in infection control. But their use should always be complemented by other infection control practices, such as hand washing, to reduce the risk of infection.

Hassan Vally, Associate Professor, Epidemiology, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.